Is there a pathogenetic relationship between cervical osteochondrosis, coronary heart disease, and hypertension?
When considering this issue , the following should be considered : 1) the presence of only radiological changes characteristic of cervical osteochondrosis, without other neurological syndromes, is not significant in the diagnosis of concomitant diseases of the cardiovascular system; 2) there is no strict parallelism between the severity of radiological changes and the clinical manifestations of cervical osteochondrosis; 3) the presence of radiological changes and neurological manifestations of cervical osteochondrosis in patients with cardiovascular diseases, in particular with atypical pain syndrome, indicates only the likelihood of a pathogenetic relationship between these diseases.
The presence of a pathogenetic relationship between cervical osteochondrosis and cardiovascular disorders is indicated by the appearance of pain in the region of the heart during movements of the cervical spine, upper limb and its relief after the treatment measures used in osteochondrosis.
Spinal syndromes arise due to circulatory disorders due to vascular compression. Distinguish between the syndrome of median (bilateral) ventral compression with conduction or only segmental disorders and the syndrome of unilateral (ventrolateral) compression, when the front horn, the pyramidal and spinothalamic pathways on the ipsilateral side are involved.
Spinal circulation disorders occur when the vertebral arteries, their branches – the radicular arteries, long extra cerebral vessels, primarily the anterior spinal artery, turn off. Y. Yu. Popelyansky observed spinal syndromes in 25% of patients in whom atherosclerosis of the vessels accompanied cervical osteochondrosis.
Vascular spinal and vascular radicular disorders can occur in the form of vascular radicular and vascular radicular-spinal syndromes. The resulting myelogen ischemia is transient, acute (it is often accompanied by the development of ischemic strokes in the basins of the anterior and posterior spinal arteries and their branches) and chronic, occurring in the form of amyotrophic lateral sclerosis, lesions of the anterior (by the type of subacute poliomyelitis), lateral (by the type of lateral sclerosis of Strumpel) ) and the rear pillars.
Sometimes there is a compression of the spinal cord itself . This is observed with significant prolapse of the disc, combined with the development of reactive changes in the vessels and membranes of the spinal cord in the form of pachymeningitis.
Many authors rightly emphasize the great importance of cervical osteochondrosis in the occurrence of CHF (A.P. Zinchenko, Y. Yu. Popelyansky, A.M. Irokhorsky, A. Yu. Ratner, G.A. Akimov et al.).
Under our supervision were 230 patients with CHD. In 65 of them, transient disorders of cerebral circulation developed against the background of hypotension, and in the rest against the background of a normal level of blood pressure and hypertension.
All patients underwent neurological, ophthalmological and otoneurological examinations , radiography of the skull and cervical spine. In a number of patients, rheography, bulbography and angiography were used, and cerebrospinal fluid was also examined.
The reason for the development of circulatory disorders was: cerebral arteriosclerosis, cervical osteochondrosis, damage to the vessels of the brain stem of an infectious-allergic genesis, a combination of cerebral arteriosclerosis and cervical osteochondrosis. The symptomatology of circulatory disorders in the vertebrobasilar basin is more diverse than with damage to the carotid artery.
In case of CHF, neurological disorders can be transient (in case of chronic circulatory failure leading to discirculatory encephalopathy) or persistent (in case of stroke).
Transient circulatory disorders in the vertebro-basilar pool are characterized by symptoms such as decreased vision, double vision, ptosis, confusion and loss of consciousness, impaired memory, hemiparesis, dysarthria and dysphagia, sensory disorders on the face, limbs or half of the body, dizziness, vomiting, staggering while walking, headache. Each of these features is not specific. The appearance of bilaterally intermittent symptoms such as darkening in the eyes and narrowing of the visual fields, dysarthria, dysphagia or dizziness confirms the diagnosis of CHF.
So, according to E.V. Schmidt , alternating syndromes were found only in 0.25% of patients with transient circulatory disorders.
Headache in patients with CHF was persistent or paroxysmal in nature, in 17% of patients it was combined with earache. The headache in the vast majority of cases could be triggered by turning or tilting the head. In about half of the patients, it was one-sided, more often appeared at night or in the morning. In most patients, pain began in the cervical-occipital region and spread anteriorly to the mastoid-temporal, parietal and frontal regions with radiation to the eye and ear; paroxysmal pain was often accompanied by cochleovestibular disorders (tinnitus, dizziness, spontaneous nystagmus, nausea, etc.).