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The vagus nerve, also known as the tenth Cranial nerves (CN X), plays a crucial role in the autonomic nervous system, which is responsible for regulating involuntary functions within the human body. This nerve carries both sensory and motor fibers and serves as a major pathway that connects the brain to various organs, including the heart, lungs, and digestive tract. As a key part of the parasympathetic nervous system, the vagus nerve helps regulate essential involuntary functions like heart rate, breathing, and digestion. By controlling these processes, the vagus nerve contributes to the body's "rest and digest" response, helping to calm the body after stress, lower heart rate, improve digestion, and maintain homeostasis.
The vagus nerve consists of two branches: the right and left vagus nerves. In the neck, the right vagus nerve contains approximately 105,000 fibers, while the left vagus nerve has about 87,000 fibers, according to one source. However, other sources report slightly different figures, with around 25,000 fibers in the right vagus nerve and 23,000 fibers in the left.
The vagus nerve is the longest nerve of the autonomic nervous system in the human body, consisting of both sensory and motor fibers. The sensory fibers originate from the jugular ganglion and nodose ganglion, while the motor fibers are derived from neurons in the dorsal motor nucleus of the vagus and the nucleus ambiguus.
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.
Right Vagus Nerve: The right vagus nerve gives rise to the right recurrent laryngeal nerve, which hooks around the right subclavian artery and ascends into the neck between the trachea and esophagus. The right vagus then crosses anterior to the right subclavian artery, runs posterior to the superior vena cava, descends posterior to the right main bronchus, and contributes to cardiac plexus, pulmonary plexus, and esophageal plexuses. It forms the posterior vagal trunk at the lower part of the esophagus and passes through the diaphragm to enter the abdomen through the esophageal hiatus.
Left Vagus Nerve: 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 by way of the esophageal hiatus of the diaphragm.
This means that the vagus nerve is responsible for such varied tasks as heart rate, gastrointestinal peristalsis, sweating, and quite a few muscle movements in the mouth, including 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.
Efferent vagus nerve fibers innervating the pharynx and back of the throat are responsible for the gag reflex. In addition, 5-HT3 receptor-mediated afferent vagus stimulation in the gut due to gastroenteritis is a cause of vomiting. Stimulation of the vagus nerve in the Cervix (as in some medical procedures) can lead to a vasovagal response.
The vagus nerve also plays a role in satiation following food consumption. Knocking out vagal nerve receptors has been shown to cause Polyphagia (greatly increased food intake). Neuroscientist Ivan De Araujo and colleagues have shown that the vagus nerve transmits reward signals from the body to the brain, potentially explaining how stimulation of the nerve leads to emotional changes.
At this location, neuroscientist Otto Loewi first demonstrated that nerves secrete substances called 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 muscarinic receptors () such as atropine and 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.
Research has shown that women having had complete spinal cord injury can experience through the vagus nerve, which can go from the uterus and cervix to the brain.
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.
VNS may also be achieved by one of the : 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. Patients with supraventricular tachycardia, atrial fibrillation, and other illnesses may be trained to perform vagal maneuvers (or find one or more on their own).
Vagus nerve blocking (VBLOC) therapy is similar to VNS but used only during the day. In a six-month open-label trial involving three medical centers in Australia, Mexico, and Norway, vagus nerve blocking helped 31 obese participants lose an average of nearly 15 percent of their excess weight. , a yearlong double-blind, phase II trial had begun.
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 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.
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. 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.
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.
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.
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