fibers reach internal carotid artery, they braid it and on the eye socket artery they reachthe eye socket, where they innervate the muscle, which expands the pupil,
(m. dilatator pupillae),
the muscle, which expands the ocular slot
(m. tarsalis superior)
and the ciliarymuscles, which ensure certain position of anterior eyeball.
Symptoms and the syndromes of the vegetative the disturbances
The defect of hypothalamus can lead to different neuroendocrine syndromes (diseaseItsenko-Cushing, diabetes melltitus and other), whose detailed account is given in theappropriate divisions of the course of endocrinology. The diffuse defect of the peripheral vegetative nervous system (predominantlysympathetic neurons) causes the peripheral vegetative insufficiency - syndrome, which ismanifested by the disturbance of innervations of internal organs, vessels and secretaryglands. More frequent and severe manifestation of peripheral vegetative insufficiency –orthostatic hypotension: head spins, shroud before eyes or development of syncope whenchanging from horizontal position to vertical or when prolonged standing. In expressedorthostatic hypotension, patient can be riveted to the bed. Orthostatic hypotension can beprovoked by abundant food, alcohol use, by physical load. For diagnostics, the orthostatictest is conducted: BP investigation is measured at lying position, it’s which it preliminarilywas located not less than 15 min, but then in vertical position for several minutes. Test isconsidered positive, if 3 min after getting up, systolic BP decreases 20 mmHg and moreand diastolic more than 10 mmHg and according to the relation to BP in horizontal position.Other manifestations of peripheral vegetative insufficiency can be observed as constanttachycardia (“fixed pulse”), sleep apneas (cessation of respiration in the sleep period),dyskinesia of gastrointestinal tract, pelvic disorders, disturbance of perspiration (increasedsweating or hypohydrosis and hyperthermia), cyanosis or hyperemia of the skin, peripheraledemas, dry eyes and mouth cavity.In damage of ciliospinal center where sympathetic fibers exit from, it appears as thedisturbance of the eye sympathetic innervation in the form of Claude-Bernard-Hornersyndrome: the contraction of ocular slot (ptosis), the contraction of pupil (myosis), theretraction of eyeball (enophthalmos), and also the disturbance of perspiration (anhydrosis)and reddening, the dryness of the skin. Horner's syndrome in the form of ptosis, myosisand enophthalmos is developed also with the defect of the brain stem (dorsolateraldivisions of medulla oblongata with Wallenberg-Zakharchenko syndrome) on the side of damage as a result of the involvement of central sympathetic fibers, which go to ciliospinalcenter from hypothalamus.
Reasons of vegetative disturbances and their treatments
Vegetative disturbances are observed with different psychic, neurological or somaticdiseases.Primary vegetative insufficiency appears in vegetative polyneuropathy, Parkinson's diseaseand other degenerative diseases of nervous system. Secondary vegetative insufficiency ispossible with polyneuropathies of different genesis (diabetic, alcoholic, and other), multiplesclerosis, tumors of head and spinal cord. Primary vegetative insufficiency (vegetativepolyneuropathy) is established only after the exclusion of the intake of medical drugs(hypotensive, etc), which can cause orthostatic hypotension, and also diseases of theblood, heart, endocrine system and electrolyte disturbances, which can be manifested bysimilar symptoms.
Basic syndromes of defect of the peripheral of vegetative nervous systemSyndromes of defectLocalization of defect
Peripheral vegetative insufficiency: orthostatichypotension, constant tachycardia, sleep apneas,disturbance of perspiration, hyperthermia,cyanosis or hyperemia of skin, peripheraledemas, dry eyes and mouth cavityPredominantly sympathetic neurons