Vagus nerve paralysis

Vagus nerve paralysis Vagus nerve or cranial nerve X is a mixed nerve, somatomotor, visceromotor and sensitive. He controls the activity of muscles of the larynx, pharynx and activities of most internal organs (heart, lungs, abdominal organs). 
Somatomotorii fibers originate in the lower ends of the nucleus ambiguous and throat muscles in the lower constrictorului, innervating soft palate and vocal chords. In terms of growth, the nucleus of the dorsal branches to innervate the heart so annoyingly vague, bronchus, esophagus, stomach, intestine, liver and pancreas. The innervation of the vegetative organs is by parasympathetic fibers. 

Sensory fibers are composed of fibers and fiber somatosensory viscerosenzitive. Somatosensory fibers originate in the jugular ganglia and are distributed Plexiform and laryngeal mucosa, the lining part of the throat, soft palate, the posterior wall of the auditory meatus and a small area of skin to return the flag located ear. Viscerosenzitive fibers consist of fibers coming from related thoracic and abdominal viscera and ensure sensitivity of heart and carotid sinus. 

Vagus nerve causes damage 
Branches may be affected pharyngeal diphtheria. Meningeal level, the vagus nerve can be affected by neoplastic and infectious processes. At bulbar tumors, vascular lesions and motor neuron disease are major causes of damage to the annoyingly vague. Other causes of damage to the vagus nerve are inflammatory lesions of herpes zoster. Polymyositis and dermatomyositis usually producing hoarseness and dysphagia by affecting the muscles of the pharynx and larynx directly, can lend itself to confusion with the vagus nerve damage. In case of intrathoracic trauma or tumors, often recurrent nerves are damaged, especially the left side. Intrathoracic diseases that can cause paralysis of the appellants are: aortic arch aneurysms, dilatation of the left atrium (mitral or aortic stenosis in), mediastinal tumors and those of the main bronchi. 

Clinical behaviour
Vagus nerve paralysis is seen clinically by motor problems, sensory and autonomic. If a lesion is unilateral hemiparesis appears velopalatina, soft palate is down, hypotonic. Lueta is deflected by the healthy. Have trouble swallowing liquids, they refluand the nose, the voice becomes nazonata. 

Unilateral paralysis of the larynx leads to impaired phonation, consisting of voice, vocal cord paralysis bitonal the same side. In terms of touch, there is a wave hemianestezie palate and the upper third of the anterior and posterior pillars, and the corresponding half of the pharynx. There is a loss of production vomiting reflex on the affected side. Velopalatin reflex, which consists of lifting the reflex contraction to achieve the tide wave is diminished or even abolished by the lesion. There may also be a loss of sensitivity to external auditory meatus and behind the ear pavilion. 
In bilateral lesions of the vagus nerve serious disturbances occur for liquid swallowing, phonation disorders with pronounced dysphonia that can go up to aphonia. Also in the bilateral lesions of nerve X and autonomic disturbances occur. Autonomic disorders is manifested by rapid pulse or bradycardia, severe respiratory disorders bronhoplegie. If it takes a long time, these symptoms may lead to anoxemie and bronchopneumonia. Respiratory and circulatory disorders of the vagus nerve palsy usually indicates a poor prognosis. Bulbar syndromes in amyotrophic lateral sclerosis, polio, poliradiculonevritei, siringobulbiei, tumors and bleeding bulbar bulbar end up most often by disorders of the respiratory and circulatory function. 

Headquarters vagus nerve damage 
  - If the vagus nerve is affected intramedullary, then the ipsilateral cerebellar dysfunction, loss of sensation and thermal pain in the ipsilateral half of face and upper and lower limb controloateral. It also meets and an ipsilateral Horner syndrome. Horner's syndrome consists of ptosis, miosis and sweat limited to the face. 
- In case of injury based extramedullary spinal accessory nerves are frequently affected and glosofaringian, appearing torn posterior hole syndrome. This syndrome is characterized by a group of disorders caused by nerve paralysis glosofaringian, vague and spinal injuries in the hole ripped through the rear. These disorders are the hemianestezia hemiparalizia and soft palate, pharynx and larynx, unilateral paralysis of the trapezius and sternocleidomastoid muscle. Vernet's syndrome is also called. 

- If the lesion is extracranial, or posterior laterocondilian retroparotidian space, there may be a combination of paralysis of cranial nerves IX, X, XI and XII and a Horner syndrome.