Vasoneural conflict is a condition in which a vessel passing near the nerve directly affects the area of the nerve fiber. That is, in fact, this is a violation of the normal interaction of the vessel and nerve. The term "neurovascular conflict" is also widely used in clinical practice. Read more about the symptoms, diagnosis and treatment of this condition later in the article.
What nerves can be affected
In everyday life, you can often hear about a vasoneural conflict of the trigeminal or facial nerve. The latter condition is also called hemifacial spasm, which literally means "spasm of half the face." But this pathology can spread to other nerves, among which:
- auditory, or vestibulo-cochlear nerve;
- glossopharyngeal nerve ;
- oculomotor nerve.
Causes of the disease
The exact causes of the development of pathology have not yet been elucidated. According 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 older people suffer more. In young people, the disease develops less frequently. And most often there is a lesion of the trigeminal nerve.
Conventionally, all the 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, an abnormal vessel compresses the nerve and causes unpleasant symptoms.
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
The 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 manifests itself paroxysmally;
- the pain is asymmetric, that is, it affects the face on only one side;
- 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 be crooked, this is due to muscle contraction;
- during pain, the patient freezes and tries not to move, so as not to provoke an even more severe attack.
Trigeminal nerve damage
Most often, a neurovascular conflict of the trigeminal nerve occurs. 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 such vessels:
- basilar artery;
- vertebral artery;
- upper and lower cerebellar arteries.
Most often, a conflict with the inferior cerebellar artery is observed.
Attacks of pain with 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 primarily aimed at reducing the severity of pain.
Pain sensations have the following characteristics:
- pain is felt only in one half of the face;
- the presence of the 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 severe;
- without treatment, the disease has a progressive course, and the frequency of seizures increases with time;
- attacks begin abruptly for no apparent reason and pass abruptly;
- the duration of the attack - from a few seconds to minutes;
- between pain attacks complaints are completely absent.
Facial nerve damage
Symptoms of a vasoneural conflict of the facial nerve are fundamentally different from trigeminal lesions. This is due to the fact that the facial nerve performs a motor function, in contrast to the sensitive trigeminal. Therefore, violations will be primarily motor.
The main clinical manifestation is involuntary movements of the facial muscles of the face. 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 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 rise up.
In severe cases, seizures appear even in a dream. They become more frequent after overwork, stress, anxiety.
Neurovascular conflict of the facial nerve can develop due to the following vessels:
- upper and lower cerebellar arteries;
- vertebral artery;
- main artery;
- multiple exposure of several vessels at once.
Hemispasm should be distinguished from other conditions that are similar in their manifestations:
- tic - spasm of the muscles of the face of a psychological nature;
- facial myokimia - contractions of individual bundles of muscle fibers;
- paresis of the facial nerve - a violation of its function due to trauma, inflammation;
- tardive dyskinesia - a condition that occurs after taking antipsychotics.
Auditory nerve damage
The vasoneural conflict of the auditory nerve has very specific symptoms that are different from all other nerves. The auditory nerve is also called the vestibulo-snail. One part of it is responsible for the actual hearing, and the second for balance. With the development of neurovascular conflict, both of these parts are damaged.
Most often, patients express such complaints:
- noise in the ear on one side;
- hearing loss on the same side;
- dizziness.
With damage to the auditory nerve, 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 commonplace attack of hypertension (high blood pressure). Both there and there are dizziness, tinnitus. The only feature is the one-sidedness of the lesion in the conflict of the vessel and nerve.
Diagnosis of the disease
Which doctor should I contact in case of a vasoneural conflict? Much depends on the location of the lesion. In case of a conflict of the trigeminal or facial nerve, consult a neurologist. If the auditory nerve is affected, a collaboration between a neurologist and an otorhinolaryngologist is necessary. It is these specialists who can diagnose and prescribe appropriate treatment. But if the doctor and patient made a decision about the operation, the patient is referred to a neurosurgeon.
MRI diagnostics
The standard diagnostic method in modern medicine is the magnetic resonance imaging (MRI) of a vasoneural conflict.
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 that are in all body tissues. These pulses are read by the device, and a high-precision image of the internal organs becomes visible on the computer.
In the case of 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 compression of the nerve, early MRI diagnosis makes it possible to prescribe an effective treatment in time.
Drug 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. For this purpose, doctors prescribe all kinds of pills.
It is important to remember that medications only reduce the severity of symptoms, but do not eliminate the cause. To remove the cause of the conflict, an operation is needed.
How to treat a vasoneural conflict? To reduce the severity of symptoms, such 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 injection. Popularly, 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 widespread in neurological practice.
The mechanism of action of Botox is a 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.
Surgery
Although symptomatic treatment plays a large role, only surgical intervention will help to finally get rid of a 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 with a diameter of 3 cm is drilled in the skull.
- Using a special technique under the control of a microscope, a neurosurgeon finds an artery that interferes with the trigeminal nerve. Most often, it is compressed by the superior cerebellar artery.
- After detecting the vessel, the neurosurgeon separates it from the nerve and establishes a gasket between the two structures. The gasket may be synthetic or made from the patient’s own tissues.
- After resolving the conflict, the surgeon performs plastic surgery of the bones of the skull, sutures the skin.
- The operation ends by applying a bandage to the head.
A few days after surgery, the patient is in the intensive care unit for observation.