Cold neuroasculitis: treatment, diagnosis, symptoms, causes, prognosis

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First	Note: increased chilliness of the feet( brushes), weak swelling; decrease in cutaneous temperature on the affected parts of the body; marked pallor; sweating of hands and feet, rapid muscle fatigue; paresthesia( numbness, tingling); increased response( hyperesthesia) to pain; tenderness of the tissues of the hands and feet during compression; spasms, stitching pains on cooling, subsiding after the cessation of cold exposure; burning and itching caused by warming of the limb; development of edema at the end of the working day; the occurrence of an allergy to cold by hive type with the development of blisters, red spots, swelling and itching.
Second	Progression of manifestations of stage 1 is observed and the development of such symptoms as: "marbling" of skin with pronounced pattern of subcutaneous vessels; appearance of reddish, cyanotic spots on the skin with a visible border between them; instagram viewer aching pain, stitching, bursting with varying intensity; persistent swelling of the feet, shins and knees, which does not disappear after warming; cramps in the limbs, pain when walking in the muscles of the lower leg; as the disease develops, hypoesthesia manifests itself in the reduction of pain, skin, temperature sensitivity, which manifests itself first on the surface of the big toes, then spreads to the entire foot; signs of circulatory and vascular obstruction: muscle weakness, weakening, then - disappearance of pulsations on the arteries( usually - feet), loss of hair follicles on the legs, intermittent claudication; manifestations of deficiency of blood supply of tissues: brittle nails with frequent rejection, hyperkeratosis - excessive growth and thickening of the stratum corneum, excoriation - peeling, abrasions, cracks;trophic ulceration; acrocyanosis( cyanosis) of brushes and feet; development of polyneuropathy of the upper limbs with involvement of the peripheral nerves of the hands, complicated by the mobility of the fingers in the morning, pain and swelling of the joints. Affected parts of the body become extremely sensitive to cold and quickly frosted even at moderately low and plus air temperatures, in water the process occurs many times more intensively.
Third	sharp edema does not subside; pains are intense and persistent; pulsation on the arteries of the feet is absent; skin temperature is reduced by 2 to 4 degrees compared to the norm; the resistance of the skin to injuries falls, and therefore it becomes easily rubbed( due to maceration - swelling of tissues impregnated with interstitial fluid). In addition, observe: lesions of larger arteries and veins with the development of deep hard-to-repair ulcers; appearance on a damp( with palpation) skin of blisters with watery contents; increased pain in the joints and muscles, increasing with the movements of the fingers; reduction of reflex tendon reactions; violation of fine motor skills of brushes, fingers( there are difficulties even when trying to take small objects in the fingers); extreme decrease in skin sensitivity, as a result of which a person is not able to correctly assess the severity of the lesion of the foot; If the alternation of hypothermia of the hands and feet with warming repeats repeatedly, black spots appear on the tips of the fingers and feet, the foci of necrosis, around which the development of moist gangrene begins without treatment. These phenomena are accompanied by increasing intoxication( poisoning with secretions of dead tissues), chills with high fever, headache, nausea and vomiting. Similar clinical signs are also characteristic for lesions of hands and fingers. The sick person becomes disabled.
Stage	External signs, internal disturbances, subjective sensations

Cold neurovasculitis is an unpleasant and even dangerous condition. He can even strip you of your fingers. But it can be cured if everything is done on time and correctly.

Features of the ailment

Cold neuroasculitis is a chronic functional( reversible) inflammation of the vessels of the extremities, caused by a disorder of reflex neurogenic reactions to irritation in the form of cold, which develops as a result of regular action of temperatures in the range from minus 2 to plus 12 C with high humidity( or a single frostbite).

Pathology is indicated in medicine by numerous definitions: "trench, trench or marsh foot", "miner's foot", "sailor's or waterer's leg", "Fen's disease", "cold acrocyanosis", "gangrene from dampness". These terms represent the same disease, which is observed by physicians under different circumstances, but with the invariable combined effect of dampness and cold( moderate temperatures).

occurs in adults of 25 years( more often - from 35 to 60 years) working in industries characterized by prolonged or frequent exposure to a damp cold environment: fishery workers, sailors, hunters, miners, loggers, waterers, milkmaids,passengers of sea ships after accidents.

The causes of such an ailment as a cold neurovasculitis are described below.

Causes of

Development mechanisms of

The basis of cold neurovascular disease is the lack of blood supply to the peripheral vessels of the limbs due to the constant reflex spasm of small arterioles, capillaries, and as a result - a chronic lack of oxygen and important nutrients in the tissues. The disease is typical for both lower and upper extremities. But due to the peculiarities of the movement of blood in the legs - stagnant phenomena, widening of veins, weak development of blood flow along the side( bypass) branches of blood vessels - in the feet more often than in the hands there is vascular spasm, swelling and clot formation.

Water, falling on unprotected skin of hands or impregnating shoes and socks, increasing the thermal conductivity of the skin, increases the rate of heat transfer by tens of times. In the cold( and at a positive temperature - also), this causes additional cooling of the skin, the development of local hypothermia( supercooling), when the temperature in the tissues falls below the required for metabolic processes, followed by spasmodic small vessels and a decrease in the functions of the nerve receptors.

Accelerating factors

These conditions include:

• vascular disease, including thrombosis, phlebitis;
• diabetes mellitus, Raynaud's disease, cold urticaria;
• increased blood clotting;
• skin diseases, including fungal and purulent infections;
• rubber, tight, airtight shoes;
• physical overstrain of the limbs in heavy work;
• forced immobility, long standing;
• regular immersion of hands or feet in cool water without subsequent drying and warming;
• no cotton, woolen socks or a rare change;
• excessive sweating of the feet;
• hygiene non-compliance.

Symptoms of

In the development of cold neurovasculitis, three stages are distinguished, which correspond to certain external symptoms and internal subjective sensations of the patient.

Diagnosis

An expert can make an accurate diagnosis based on external manifestations, patient complaints, data on long-term work experience in a cold and humid microclimate.

Instrumental methods

Among the instrumental methods for diagnosing a cold neurovasculitis are:

• UZDG( dopplerography), showing the state of the vessels of the hands and feet, the nature of the blood flow;
• thermography, which determines the reduction of cutaneous and tissue temperature;
• rheovasography( RVG) of peripheral vessels. Informative and safe method, which allows to determine the drop in pulse blood filling of vessels, to assess their patency;
• capillaroscopy, which will detect spasm, spastic-atonic state - weakening of the tone of the capillaries against the background of a spasm.

Assays

The diagnosis of a cold neurovasculitis is confirmed by various assays. Orlov's test is as follows.

If a cold neurovascular muscle is suspected, the wrist or foot of the patient is immersed in cool water( 15C) for 1 minute, then watching how quickly the original skin temperature is restored by thermography, contact thermometry. If the limb warms up from the fingertips, it means that the blood circulation is normal.

Infringement of a blood flow in peripheral vessels at carrying out of Orlov test will be evidenced by:

• prolonged preservation of areas with a lowered temperature( hypothermia);
• temperature recovery in the limb, which occurs "downward" - that is, from parts warmer and closer to the center of the body to the fingertips.

Differential diagnostic measures

Differential diagnosis is performed by consulting with a rheumatologist, neurologist, vascular surgeon, so as not to confuse a cold neurovasculitis with other diseases having similar manifestations. Cold neurovasculitis should be distinguished from:

• disease and Reynaud syndrome;
• peripheral vascular disease;
• syringomyelia;
• systemic lesions of connective tissue( lupus erythematosus, dermatopolymyositis, scleroderma).

Treatment of

Treatment of cold neovasculitis provides complex therapy, which solves problems such as:

• elimination of pain syndrome;
• reduction of spasm of peripheral vessels;
• elimination of circulatory disorders in the affected limbs;
• improvement of collateral circulation in bypass vessels;
• normalization of microcirculation;
• suppression of peripheral nerve inflammation.

To this end, prescribe medications, physiotherapy methods, conduct surgical interventions( in advanced severe conditions).

Therapeutic method

To restore the peripheral circulation,

• uses ultraviolet irradiation of the affected parts alternately with UHF( 8-10 procedures)
• diathermy with short waves;
• ultrasound and Bernard currents for pain relief;
• phonophoresis with Hydrocortisone - in case of severe inflammation.

To eliminate the effects of accumulation of toxins in tissues, removal of vascular spasm and improvement of blood circulation in the capillaries of the affected parts of the body,

• therapeutic massage is used;
• wiping feet or brushes with formic alcohol;
• baths for limbs with turpentine only in the absence of ulcers( 15 minutes course 10 - 12 days).

To prepare the solution take: 0.5 liters of turpentine, 1.5 - 2 grams of aspirin, ground baby soap 30 grams, 0.5 liters of boiled water. Insist 24 hours. For the tub: in 10 liters of water( 40 ° C) add not a full tablespoon of infusion. After 2 - 3 days, the amount of turpentine infusion is increased, but not more than 30 ml per 10 liters of water.

After the baths, bandages are applied to the lesions with camphor alcohol, with grazes, cracks - bandages impregnated with Sintomycin or Streptocide acid emulsion, Solcoseril ointments, Actovegin. With pains - ointment Ketonal.

With the use of medicines

The selection of the main drugs for the treatment of cold neovasculitis is carried out in order to improve blood supply, metabolism, tissue trophism, relieve spasm, pain, inflammation of nerve fibers, prevent blood clots, improve blood flow.

In the inpatient setting appoint:

• Reopoliglyukin, intravenously through a 300 ml dropper course 4 to 6 days;
• Anticoagulants: heparin subcutaneously in the stomach area of ​​5000 ED after 6 hours( the first 4 - 5 days), later transferring the patient to medications of indirect action: Phenylin, Pelentan, Neodikumarin, Warfarin;
• Trental 2% intravenously drip 5 ml in 200 ml of physiological solution, then - inside after 8 hours at 100 mg;
• Acetylsalicylic acid 3 grams per day up to 12 days( excluding patients with gastrointestinal and ulcer diseases);
• Nicotinic acid at 0,05 grams( twice a day), Nikospan 1 tablet every 12 hours. Solution Papaverina 2% subcutaneously 10 - 12 days or 2 - 3 times a day in tablets of 50 mg;
• Halidor 0.1 grams three times a day, long( 8 - 12 weeks) with an interval of 2 - 3 months;
• for pain relief use Ketonal IM for 1 to 2 ampoules per day, Diclofenac( 1 ampoule once, no longer than 3 days), Reopirin 5 ml once daily, Voltaren twice daily for 1 tablet, Xefokam( 1 tablet twice daily);
• antiallergic, sedative and anti-inflammatory: intramuscularly Diphenhydramine( up to 2 times a day for 1 ampoule), Pipolphen( 2 ml per night), Suprastin, Tavegil;
• intramuscular injection of Milgramam, B group vitamins, ascorbic acid.
• antibacterial agents in case of complications of neurovascular disease: thrombophlebitis, lymphangitis.

Also:

• For severe pains and severe inflammatory phenomena( neuritis), the pulse-therapy method is used - the appointment of "shock doses" of hormonal drugs in a short course( Methylprednisolone, Prednisone, Dexamethasone).
• Intensive pains are stopped by carrying out novocain blockades, the therapeutic effect of which is caused by vasodilation, rapid and profound anesthesia and anti-inflammatory effect( paranephalic, aimed blockade of ganglia, animal nerves).
• Many patients are greatly helped by prolonged intra-arterial infusions of drug complexes for vascular repair and tissue nutrition.
• Also recommended sedatives, including tranquilizers( Phenazepam), drugs that activate metabolic processes in the muscle tissue of the vessels( ATP, MAP).

Surgical intervention

In cases of complicated course of cold neurovasculitis, in the absence of a positive reaction to drugs, surgical treatment is indicated. Apply sympathectomy from one or two sides, in which the ganglia( nerve nodes) of the lumbar region are removed, which in most patients gives an excellent therapeutic effect.

Prevention

The complex prevention of cold neovasculitis includes timely detection of the first symptoms and active treatment of such diseases and pathological conditions as:

• obliterating vascular diseases( endarteritis, thromboses);
• varicose veins;
• chronic thrombophlebitis;
• angiospasm( spasm of blood vessels);
• chronic peripheral nerve disease;
• chronic inflammation of the reproductive organs with exacerbations;
• ingrown toenails;
• skin diseases that reduce the tone and resistance of the skin and underlying tissues to cold.

An important part of prophylaxis of professional cold neurovasculitis at workplaces is:

• providing breaks for regular heating, drying clothes and shoes in separate rooms with a temperature of 21 - 26 C for people working in cold, damp shops or on the street;
• application of devices for accelerated local heating of hands and feet.
• establishment of regulated breaks for the use of hot soft drinks( tea, coffee, cocoa), compulsory hot meals at lunch breaks;
• taking a hot shower after working until completely warmed;
• application of warmed overalls, thermal underwear, mittens and socks made from natural materials and heaters( cotton, cloth, wool, feather).
• use of rational footwear( boots, shoes made of genuine leather with a sole of frost-resistant rubber).

It is also mandatory to take personal preventive measures, which include:

• when developing a disease - contacting a surgeon and setting up a dispensary account;
• switch to a place of work in a dry, warm room;
• limitation of extended stay standing;
• smoking cessation;
• rejection of tight or too large shoes, which contributes to the appearance of scuffs, calluses, cracks, ulcers;
• purchase of shoes at a larger size, because even the right shoes at the end of the working day becomes cramped due to swelling of the feet;
• prevention of sweating and vascular training, for which daily use of contrasting showers or foot baths and hands, followed by drying and mildly rubbing them to redness;
• use of binder and drying agent: weak solutions of boric, salicylic acid, tannin;
• dusting of feet and gaps between the fingers of powder from talc, boric, salicylic acid;
• when it is not possible to change rubber shoes, rational in damp conditions, should:
  • use a multi-layered footing, wearing cotton and woolen socks, warm footcloths( with frequent shifts);
  • put insole shoes, drying them daily.

Complications of

In the early development of a cold neurovasculitis with timely treatment and prevention, the consequences can be manifested in the increased sensitivity of the affected hands( feet) to cold and moisture, rapid freezing and increased risk of frostbite in conditions that do not pose a hazard to healthy people.

If all the manifestations of the disease have reached stage II, in addition to complications of the first stage of neurovascular disease in 60 to 70% of patients, it is possible to develop: obliterating endarteritis of vessels, thromboses, phlebitis, trophic ulcers, neuritis, polyarthritis and other joint diseases, as well as exacerbation and progression of already existingthe patient has pathologies.

Prognosis for cold neurovasculitis

Cold neovasculitis is considered as a functional disease, which means a high degree of reversibility of all pathological manifestations. Therefore, with timely measures taken for prevention and treatment, the outlook is encouraging.

The severe stage of the disease is characterized by severe impairment of vascular circulation, loss of large volumes of necrotic tissue, amputation of the fingers. However, in many cases, surgeons manage to save the affected parts of the body with intensively conducted treatment.