Vagus nerve

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Vagus
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Vagus nerve
viscera
Identifiers
Latinnervus vagus
MeSHD014630
NeuroNames702
TA98A14.2.01.153
TA26332
FMA5731
Anatomical terms of neuroanatomy]

The vagus nerve (

digestive tract.[1]
It comprises two nerves—the left and right vagus nerves—but they are typically referred to collectively as a single subsystem.

The vagus is the longest nerve of the

nodose ganglion, whereas the motor fibers come from neurons of the dorsal motor nucleus of the vagus and the nucleus ambiguus.[2]
The vagus was also historically called the pneumogastric nerve.

Structure

Upon leaving the

afferent nerves mostly conveying sensory information about the state of the body's organs to the central nervous system.[3]

The right and left vagus nerves descend from the cranial vault through the jugular foramina, penetrating the carotid sheath between the internal and external carotid arteries, then passing posterolateral to the common carotid artery. The cell bodies of

visceral afferent fibers of the vagus nerve are located bilaterally in the inferior ganglion of the vagus nerve
(nodose ganglia).

The vagus runs parallel to the common carotid artery and internal jugular vein inside the carotid sheath.

Vagus nerve
Vagus nerve

The right vagus nerve gives rise to the right

right main bronchus, and contributes to cardiac, pulmonary, and esophageal plexuses. It forms the posterior vagal trunk at the lower part of the esophagus and enters the diaphragm through the esophageal hiatus
.

The left vagus nerve enters the thorax between

left common carotid artery and left subclavian artery and descends on the aortic arch. It gives rise to the left recurrent laryngeal nerve, which hooks around the aortic arch to the left of the ligamentum arteriosum and ascends between the trachea and esophagus. The left vagus further gives off thoracic cardiac branches, breaks up into the pulmonary plexus, continues into the esophageal plexus, and enters the abdomen as the anterior vagal trunk
in the esophageal hiatus of the diaphragm.

Branches

Nuclei

The vagus nerve includes axons which emerge from or converge onto four nuclei of the medulla:

  1. The dorsal nucleus of vagus nerve – which sends parasympathetic output to the viscera, especially the intestines
  2. The nucleus ambiguus – which gives rise to the branchial efferent motor fibers of the vagus nerve and preganglionic parasympathetic neurons that innervate the heart
  3. The solitary nucleus – which receives afferent taste information and primary afferents from visceral organs
  4. The spinal trigeminal nucleus – which receives information about deep/crude touch, pain, and temperature of the outer ear, the dura of the posterior cranial fossa and the mucosa of the larynx

Development

The

sensory division originates from the cranial neural crest.[4]

Function

The vagus nerve supplies motor

adrenal glands), from the neck down to the second segment of the transverse colon. The vagus also controls a few skeletal muscles
, including:

This means that the vagus nerve is responsible for such varied tasks as

speech (via the recurrent laryngeal nerve). It also has some afferent fibers that innervate the inner (canal) portion of the outer ear (via the auricular branch, also known as Arnold's or Alderman's nerve) and part of the meninges.[5] The vagus nerve is also responsible for regulating inflammation in the body, via the inflammatory reflex.[6]

vasovagal response
.

The vagus nerve also plays a role in satiation following food consumption.[8] Knocking out vagal nerve receptors has been shown to cause hyperphagia (greatly increased food intake).[9] Neuroscientist Ivan De Araujo and colleagues have shown that the vagus nerve transmits reward signals from the body to the brain,[10][11] potentially explaining how stimulation of the nerve leads to emotional changes.

Cardiac effects

H&E stained fibers of the vagus nerve (bottom right) innervate the sinoatrial node tissue (middle left)

Parasympathetic innervation of the heart is partially controlled by the vagus nerve and is shared by the

bradyarrhythmias. When hyperstimulated, the left vagal branch predisposes the heart to conduction block at the atrioventricular node
.

At this location, neuroscientist

neurotransmitters, which have effects on receptors in target tissues. In his experiment, Loewi electrically stimulated the vagus nerve of a frog heart, which slowed the heart. Then he took the fluid from the heart and transferred it to a second frog heart without a vagus nerve. The second heart slowed without electrical stimulation. Loewi described the substance released by the vagus nerve as vagusstoff, which was later found to be acetylcholine
.

Drugs that inhibit the

scopolamine, are called vagolytic because they inhibit the action of the vagus nerve on the heart, gastrointestinal tract, and other organs. Anticholinergic drugs increase heart rate and are used to treat bradycardia
.

Urogenital and hormonal effects

Excessive activation of the vagal nerve during

emotional stress, which is a parasympathetic overcompensation for a strong sympathetic nervous system response associated with stress, can also cause vasovagal syncope due to a sudden drop in cardiac output, causing cerebral hypoperfusion. Vasovagal syncope affects young children and women more than other groups. It can also lead to temporary loss of bladder control
under moments of extreme fear.

Research has shown that women having had complete spinal cord injury can experience orgasms through the vagus nerve, which can go from the uterus and cervix to the brain.[12][13]

Insulin signaling activates the adenosine triphosphate (ATP)-sensitive potassium (KATP) channels in the arcuate nucleus, decreases AgRP release, and through the vagus nerve, leads to decreased glucose production by the liver by decreasing gluconeogenic enzymes: phosphoenolpyruvate carboxykinase, glucose 6-phosphatase.[14][15]

Clinical significance

Stimulation

clinical depression.[16] Several noninvasive VNS devices that stimulate an afferent branch of the vagus nerve are available. GammaCore is recommended by The National Institute for Health and Care Excellence (NICE) for cluster headaches.[17]

VNS may also be achieved by one of the vagal maneuvers: holding the breath for 20 to 60 seconds, dipping the face in cold water, coughing, humming or singing, or tensing the stomach muscles as if to bear down to have a bowel movement.[18] Patients with supraventricular tachycardia,[18] atrial fibrillation, and other illnesses may be trained to perform vagal maneuvers (or find one or more on their own).[citation needed]

Vagus nerve blocking (VBLOC) therapy is similar to VNS but used only during the day. In a six-month

double-blind, phase II trial had begun.[19]

Vagotomy

Vagotomy (cutting of the vagus nerve) is a now obsolete therapy that was performed for peptic ulcer disease and now superseded by oral medications, including H2 antagonists, proton pump inhibitors and antibiotics. Vagotomy is currently being researched as a less invasive alternative weight-loss procedure to gastric bypass surgery.[20] The procedure curbs the feeling of hunger and is sometimes performed in conjunction with putting bands on patients' stomachs, resulting in an average of 43% of excess weight loss at six months with diet and exercise.[21]

One serious side effect of vagotomy is a vitamin B12 deficiency later in life – perhaps after about 10 years – that is similar to pernicious anemia. The vagus normally stimulates the stomach's parietal cells to secrete acid and intrinsic factor. Intrinsic factor is needed to absorb vitamin B12 from food. The vagotomy reduces this secretion and ultimately leads to deficiency, which, if left untreated, causes nerve damage, tiredness, dementia, paranoia, and ultimately death.[22]

Researchers from Aarhus University and Aarhus University Hospital have demonstrated that vagotomy prevents (halves the risk of) the development of Parkinson's disease, suggesting that Parkinson's disease begins in the gastrointestinal tract and spreads via the vagus nerve to the brain.[23] Or giving further evidence to the theory that dysregulated environmental stimuli, such as that received by the vagus nerve from the gut, may have a negative effect on the dopamine reward system of the substantia nigra, thereby causing Parkinson's disease.[24]

Vagus nerve pathology

The sympathetic and parasympathetic components of the autonomic nervous system (ANS) control and regulate the function of various organs, glands, and involuntary muscles throughout the body (e.g., vocalization, swallowing, heart rate, respiration, gastric secretion, and intestinal motility). Hence, most of the signs and symptoms of vagus nerve dysfunction, apart from vocalisation, are vague and non specific. Laryngeal nerve palsy results in paralysis of an ipsilateral vocal cord and is used as a pointer to diseases affecting the vagus nerve from its origin down to termination of its branch of the laryngeal nerve.

  • Sensory neuropathy

The hypersensitivity of vagal afferent nerves causes refractory or idiopathic cough.

Arnold's nerve ear-cough reflex, though uncommon, is a manifestation of a vagal sensory neuropathy and this is the cause of a refractory chronic cough that can be treated with gabapentin. The cough is triggered by mechanical stimulation of the external auditory meatus and accompanied by other neuropathic features such as throat irritation (laryngeal paresthesia) and cough triggered by exposure to nontussive triggers such as cold air and eating (termed allotussia). These features suggest a neuropathic origin to the cough.[25]

  • Motor neuropathy

Pathology of the vagus nerve proximal to the laryngeal nerve typically presents with symptom hoarse voice and physical sign of paralysed vocal cords. Although a large proportion of these are the result of idiopathic vocal cord palsy but tumours especially lung cancers are next common cause. Tumours at the apex of right lung and at the hilum of the left lung are the most common oncological causes of vocal cord palsy. Less common tumours causing vocal cord palsy includes thyroid and proximal oesophageal malignancy.

Cluster headaches

NICE in the UK recommend VNS for cluster headaches.[26]

History

Etymology

The

vague, and divagation come from the same root). Sometimes the right and left branches together are spoken of in the plural and are thus called vagi (/ˈv/ VAY-jy
). The vagus was also historically called the pneumogastric nerve since it innervates both the lungs and the stomach.

Additional illustrations

  • Inferior view of the human brain, with the cranial nerves labeled.
    Inferior view of the human brain, with the cranial nerves labeled.
  • Section of the neck at about the level of the sixth cervical vertebra
    Section of the neck at about the level of the sixth cervical vertebra
  • Transverse section of thorax, showing relations of pulmonary artery
    Transverse section of thorax, showing relations of pulmonary artery
  • The arch of the aorta, and its branches
    The arch of the aorta, and its branches
  • Dura mater and its processes exposed by removing part of the right half of the skull, and the brain
    Dura mater and its processes exposed by removing part of the right half of the skull, and the brain
  • The tracheobronchial lymph glands
    The tracheobronchial lymph glands
  • Section of the medulla oblongata at about the middle of the olive
    Section of the medulla oblongata at about the middle of the olive
  • Hind- and mid-brains; postero-lateral view
    Hind- and mid-brains; postero-lateral view
  • Upper part of medulla spinalis and hind- and mid-brains; posterior aspect, exposed in situ
    Upper part of medulla spinalis and hind- and mid-brains; posterior aspect, exposed in situ
  • The right sympathetic chain and its connections with the thoracic, abdominal, and pelvic plexuses
    The right sympathetic chain and its connections with the thoracic, abdominal, and pelvic plexuses
  • The celiac ganglia with the sympathetic plexuses of the abdominal viscera radiating from the ganglia
    The celiac ganglia with the sympathetic plexuses of the abdominal viscera radiating from the ganglia
  • The position and relation of the esophagus in the cervical region and in the posterior mediastinum, seen from behind
    The position and relation of the esophagus in the cervical region and in the posterior mediastinum, seen from behind
  • The thyroid gland and its relations
    The thyroid gland and its relations
  • The thymus of a full-term fetus, exposed in situ
    The thymus of a full-term fetus, exposed in situ
  • Deep dissection of vagus nerve
    Deep dissection of vagus nerve
  • Vagus nerve – dissection
    Vagus nerve – dissection

See also

References

  1. PMID 35051375
    .
  2. . Retrieved 30 May 2019 – via NCBI Bookshelf.
  3. .
  4. ^ "General Visceral Afferent Fibers - an overview | ScienceDirect Topics".
  5. S2CID 78277439
    .
  6. ^ Haseltine, William. "Electrically Stimulating The Vagus Nerve May Be Able To Reverse Chronic Inflammation". Forbes. Retrieved 26 October 2023.
  7. ^ Mandal A (25 September 2013). "Vomiting Mechanism". News Medical. Archived from the original on 4 January 2015. Retrieved 27 June 2015.
  8. PMID 18482776
    .
  9. .
  10. .
  11. .
  12. ^ "Exploring the Mind-Body Orgasm". Wired. 10 January 2007. Archived from the original on 19 September 2015.
  13. S2CID 9202518
    .
  14. .
  15. .
  16. .
  17. .
  18. ^ a b Davis, MD CP (22 August 2005). Shiel Jr WC (ed.). "Supraventricular Tachycardia". eMedicineHealth.com. Archived from the original on 16 December 2008. Retrieved 28 November 2008.
  19. ^ "Device blocking stomach nerve signals shows promise in obesity" (Press release). Mayo Clinic. Archived from the original on 8 March 2009. Dr. Camilleri says a follow-up double-blinded study, which will involve up to 300 patients at multiple medical centers including a limited number from Mayo Clinic, will be important for gauging the device's true effectiveness.
  20. ^ "Ulcer surgery may help treat obesity – Diet and nutrition". NBC News.
  21. ^ "Could nerve-snip spur weight loss?". CNN.com. Turner Broadcasting System. Archived from the original on 13 July 2007.
  22. ^ "The Pernicious Anemia Society". Archived from the original on 24 July 2010.
  23. ^ "Parkinson's disease may begin in the gut". Aarhus University. Medical Xpress. Archived from the original on 27 June 2015.
  24. PMID 28446653
    .
  25. .
  26. ^ https://www.nice.org.uk/guidance/mtg46/documents/final-scope

External links

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