I-Arterbral Artery Dissection Efunyanwe Ngethuba leMvavanyo yeChiropractic

Ukwamkela ulwazi olulandelayo olungezantsi, abantu abangaphezu kwezigidi ezili-2 balimala ngeengozi zemoto ngamnye kunyaka kunye nakwezinye iziganeko, uninzi lwabantu ababandakanyekayo bafumaneka nge-whiplash kunye / okanye ukulimala kwentanyeni ngumqeqeshi wezempilo. Xa isakhiwo esiyinkimbinkimbi sentamo sixinzeleleka, umonakalo wezinto kunye nezinye iingxaki zonyango zingenzeka. Umthambo we-vertebral dissection, okanye i-VAD, ibonakaliswe ngothutho olunjenge-flap-in-like in the lining inside of the vertebral artery in charge of supply blood to the brain. Emva kokulila, igazi lingangena eludongeni lobungqina kwaye lenze i-clot yegazi, lugqithise udonga lwe-artery kwaye luvame ukuphazamisa ukuhamba kwegazi.

 

Ukutyhubela iminyaka yamava esenza ukhathalelo lwe-chiropractic, i- VAD inokuhlala ilandela emva koxinzelelo entanyeni, njengaleyo yenzeka kwingozi yemoto, okanye ukwenzakala kwe-whiplash. Iimpawu ze-artebral artery dissection zibandakanya iintlungu zentloko kunye nentamo kunye neempawu zestroke okanye ezingapheliyo, ezinje ngobunzima bokuthetha, ukungahambelani kakuhle kunye nokulahleka kombono. I-VAD, okanye i-artebral artery dissection, ifunyaniswa ngokubanzi ine-CT okanye iMRI yokujonga okwahlukileyo.

 

Abstract

 

Umfazi oneminyaka engama-30 ubudala waziswa kwisebe likaxakeka ngesiquphe sokuphulukana okwethutyana kombono wasekhohlo. Ngenxa yembali yentloko ye-migraine, wakhululwa ngokuxilongwa kwe-migraine ye-migraine. Kwiintsuku ezimbini kamva, wafuna ukhathalelo lwe-chiropractic ngenxa yeempawu eziphambili zentlungu ebuhlungu entanyeni. I-chiropractor ikrokrela ukuba kunokwenzeka ukuba i-vertebral artery dissection (VAD). Akukho buqhetseba obenziweyo; Endaweni yoko, i-MR angiography (MRA) yentamo yafunyanwa, etyhila i-VAD ekhohlo ekhohlo kunye nokwakheka kwangoko kwe-thrombus. Isigulana sabekwa kunyango lweasprini. Phinda i-MRA yentamo ye-3? Kwiinyanga kamva iveze isisombululo se-thrombus, ngaphandle kokuqhubela phambili ukubetha. Eli tyala libonisa ukubaluleka kwabo bonke ababoneleli bezempilo ababona izigulana zineentlungu zentamo kunye nentloko ukuba ziqwalasele ukubonakaliswa kweempawu zeVAD enokwenzeka.

 

imvelaphi

 

I-Vertebral artery dissection (VAD) ekhokelela ekubethweni yinto engaqhelekanga kodwa enokuba sisifo esibi. Iziganeko zestroke ezinxulumene nenkqubo ye-vertebrobasilar iyahluka ukusuka kwi-0.75 ukuya kwi-1.12 / 100? Inkqubo ye-pathological kwi-VAD ihlala ibandakanya ukusasazeka kodonga lwe-artery elandelwa ngamanye amaxesha emva kokumiliselwa kwe-thrombus, enokuthi ibangele ukuvaleka komzimba okanye ikhokelele ekubambeni, kubangele ukuvalelwa kwelinye okanye nangaphezulu amasebe akude kumthambo we-vertebral, kubandakanya ne-basilar umthambo, onokuba yintlekele. I-VAD idla ngokwenzeka kwizigulana ezinobuntu, ubuthathaka bokwexeshana eludongeni lwemithambo. Ubuncinane i-000% yamatyala, iimpawu zokuqala zibandakanya iintlungu zentamo kunye okanye ngaphandle kwentloko.

 

Izigulane ezininzi ezine-VAD zingasetyenziswa kwizigaba zakuqala ziza kubakhuthaza befuna ukuxhamla intlungu yentloko kunye nentloko, ngaphandle kokuqonda ukuba bafumana i-VAD. Kwiinkoliso ezininzi, isigulane esilandelayo siphinde siphumelele. Kuze kube kutshanje, kwacatshulwa ukuba i-dissection (kunye ne-stroke elandelayo) yabangelwa unyango lwe-cervical manipulative (CMT). Nangona kunjalo, nangona uphando lwexesha lokuqala lufumene ubudlelwane phakathi kokutyelela kwi-chiropractor kunye nesifo sohlangothi esilandelayo ku-VAD, idatha yakutshanje ibonisa ukuba olu lwalamano aluyiyo i-causal.

 

Ingxelo yolu hlobo ibonisa imeko apho isigulane esinokungazifumani kwi-VAD ekuziphendukeleni kwintsebenziswano kwintetho ye-chiropractor yentlungu yentloko kunye nentloko. Emva kwembali epheleleyo kunye noviwo, i-chiropractor igxeka i-VAD kwaye ayizange yenze i-CMT. Endaweni yoko, isigulane sathunyelwa ukuphonononga okuqhutywe phambili, okufumanisa ukuba i-VAD iyaqhubeka. Ukucatshungulwa kokukhawuleza kunye ne-antiticoagulant unyango kwakucatshangelwe ukuba kuye kwayeka ukuqhubela phambili kwintlungu.

 

Ukunikezelwa kweNkundla

 

Umfazi oneminyaka eyi-30 kungenjalo umfazi ophilileyo waya kwi-chiropractor (DBF), enika ingxelo ngentlungu esekunene yentamo kwingingqi ye-suboccipital. Isigulana sixele ukuba, kwiintsuku ezi-3 ezidlulileyo, wayeye kwisebe lezonyango elingxamisekileyo (ED) ngenxa yokulahleka ngesiquphe kombono wasekhohlo. Iimpawu ezibonakalayo ziphazamise ukukwazi kwakhe ukubona ngamehlo asekhohlo; Oku kwakukhatshwa bubuninzi '' kwinkophe yakhe yasekhohlo. Malunga neeveki ezi-2 ngaphambi kolu tyelelo lwe-ED, wayenamava esihlungu sentamo emacala asekhohlo ngentloko ebukhali ekhohlo. Uye wachaza nembali yentloko ye-migraine ngaphandle kweprodrome. Ukhululwe kwi-ED ngoxilongo lwe-migraine ye-ocular. Wayengazange afunyanwe ngaphambili ene-ocular migraine, kwaye wayengazange afumaneke nakuphi na ukuphazamiseka okubonakalayo kunye ne-migraines yakhe yangaphambili.

 

Kungekudala emva kokuba iimpawu zamehlo ezisekhohlo zisonjululwe, ngequbuliso waba neentlungu zentamo esekunene ngaphandle kokucaphuka, awayefuna unyango lwe-chiropractic. Uye waxela nesiqendu sethutyana sokuphazamiseka kwembono esekunene esenzeka kwangalo mini. Oku kwachazwa njengokufiphala ngesiquphe okwethutyana kwaye kwasonjululwa kwangoko kwangoko ngemini yokubonisa kwakhe uviwo lwe-chiropractic. Xa wazisa kuvavanyo lokuqala lwe-chiropractic, wakhanyela ukuphazamiseka okwangoku okubonakalayo. Uye wathi akakhange afumane nakuphi na ukuba ndindisholo, iparaesthesia okanye ilahleko yemoto kwiindawo eziphezulu okanye ezisezantsi. Waphika i-ataxia okanye ubunzima ngokulinganisela. Imbali yezonyango yayimangalisa xa kuzalwa iinyanga ezi-2 ngaphambi kokubonisa okokuqala. Utshilo ukuba iintloko zakhe zazinxulunyaniswa nokuya kwakhe exesheni. Imbali yosapho yayimangalisa ngokunyuka okuzenzekelayo kwe-thoracic aortic aneurysm kudadewabo omdala, owayeneminyaka engama-30 ubudala xa i-aneurysm yakhe yenzekile.

 

uphando

 

Ngokusekwe kwimbali yokuvela ngesiquphe kwentlungu ephezulu yomlomo wesibeleko kunye nentloko enophazamiso olubonakalayo kunye ne-ocular numbness, i-DC yayixhalabile malunga nokuba kunokwenzeka kwe-VAD kwangoko. UMr angiography ongxamisekileyo (MRA) wentamo nentloko, kunye neMRI yentloko, wayalelwa. Akukho luvavanyo lomlomo wesibeleko okanye ubuqhetseba obenziwa ngenxa yokusola ukuba iintlungu zentamo zazinxulumene ne-VAD endaweni yesifo se-chanmechanical somlomo wesibeleko.

 

I-MRA yentamo ibonakalise ukuba umthambo we-vertebral wasekhohlo wawumncinci kwaye ungahambelani kulungelelwaniso, ususela kwinqanaba le-C7 cephalad ukuya kwi-C2, ngokuhambelana nokusasazeka. Kwakukho i-patent lumen eyinyani kunye nekhofu ejikelezileyo ye-T1 hyper-intensity, ehambelana nokusasazeka kunye ne-subintimal thrombus ngaphakathi kwe-lumen yamanga (Amanani 1 kunye? 2). I-MRI yentloko kunye nangaphandle kokungafaniyo, kunye ne-MRA yentloko ngaphandle kokuthelekisa, zombini zazingamangalisi. Ngokukodwa, kwakungekho ukwandiswa okungafunekiyo kwe-dissection okanye ubungqina be-infarction. MF perfusion yengqondo ayibonisanga kuphazamiseka kugxilwe kugwenxa.

 

 

 

Ukuxilongwa ngokungafani

 

U-ED ukhuphe isigulana ngoxilongo lwe-migraine ye-ocular, ngenxa yembali yakhe yentloko ye-migraine. Nangona kunjalo, isigulana sathi iintloko zentloko ekhohlo zazingafani nento endakha ndayibona ngaphambili. Imigraines yakhe yangaphambili yayinxulunyaniswa nomjikelo wakhe wokuya esikhathini, kodwa hayi ngalo naluphi na utshintsho olwenzekayo. Wayengazange afunyaniswe ngaphambili ene-ocular migraine. I-MRA yommandla womlomo wesibeleko ityhile ukuba isigulana eneneni sinesibetho esibuhlungu esenziwe nge-thrombus kumthambo we-vertebral wasekhohlo.

 

impatho

 

Ngenxa yesifo esibuhlungu esinokubakho esayanyaniswa ne-VAD ebukhali kunye nokwakheka kwe-thrombus, isigulana samkelwa kwinkonzo ye-neurology ye-stroke yokujonga esondeleyo imithambo-luvo. Ngexesha lokwamkelwa kwakhe, isigulana asikhange siphinde sibuyekezwe kukusilela kwemithambo-luvo kwaye zaphucuka iintloko. Ukhutshiwe ngosuku olulandelayo ngokuxilongwa kwe-VAD yasekhohlo kunye nohlaselo lwexeshana lwe-ischemic. Wayeyalelwe ukuba aphephe ukuzilolonga ngamandla kunye nentlungu entanyeni. I-aspirin yemihla ngemihla (i-325? Mg) yamiselwa, ukuba iqhubeke kangangesithuba seenyanga ezi-3 6 emva kokukhutshwa.

 

IsiPhumo kunye nokuLandela

 

Emva kokukhutshwa kwinkonzo yokubetha, isigulana asiphindanga saphazamiseka entlokweni okanye ukuphazamiseka okubonakalayo, kwaye iimpawu zentlungu yasemva kwentsimbi zisonjululwe. Ukuphindaphinda ukucinga kwenziwa kwiinyanga ezi-3 emva kokunikezelwa, okwabonisa ukuphuculwa komgangatho wesibeleko somthambo oshiyekileyo we-vertebral ngesisombululo se-thrombus ngaphakathi kwe-lumen false (Umzobo 3). Ukulinganisa kwegumbi lokungasebenzi kakuhle kuhlala kuyinto eqhelekileyo, ngaphandle kobungqina bethuba lokuphumla okanye i-perfusion asymmetry.

 

 

ingxoxo

 

Inkqubo ye-pathophysiological ye-VAD icingelwa ukuba iqale ngokudodobala kwezicubu kumda we-medial-adventitial we-artebral artery, ekhokelela kuphuhliso lwe-microhaematomata ngaphakathi kodonga lwe-artery kwaye, ekugqibeleni, iinyembezi. Oku kunokukhokelela ekuvuzeni kwegazi eludongeni lwe-arterial, kubangele ukubonwa kwe-lumen kunye nokwakheka kwe-thrombus kunye nokudityaniswa, okukhokelela ekubetheni okunxulumene nelinye lamasebe omthambo we-vertebral. Le nkqubo ye-pathological iyafana naleyo ye-carotid artery dissection, i-thoracic aortic dissection kunye ne-coronary artery dissection. Zonke ezi meko zihlala zikhona kubantu abadala abancinci kwaye abanye bacinge ukuba banokuba yinxalenye yenkqubo yesiqhelo ye-pathophysiological. Iyaphawuleka kule meko kukuba udade osele ekhulile wesigulana wayenamava we-thoracic aortic aneurysm (mhlawumbi idiski) kubudala obufanayo (30? Iminyaka) njengoko esi sigulana besinamava e-VAD yakhe.

 

Nangona i-dissection idla ngokukhawuleza, i-compromin lumine kunye neengxaki ze-VAD zingahlakulela ngokukhawuleza iimpawu ezibonakalayo kunye nokubonisa, kuxhomekeke kwisigaba sesifo. I-dissection ngokwayo, eyenza ixesha elithile ngaphambi kokuqala kwe-neural ischaemia, inokubangela ukuvuselela i-nociceptive receptors ngaphakathi kwintsimbi, ukuvelisa intlungu edlalwa yintsimi yomlomo okanye intloko. Kuphela emva kokuba inkqubo ye-pathophysiological iqhubekela phambili kwinqanaba lokuzaliswa kwamagqabantshintshi okanye ukubunjwa kwe-thrombus nge-embalisation ye-distal yenza ukubonakaliswa ngokupheleleyo kwe-infarction. Nangona kunjalo, njengoko kuboniswe kulo mzekelo, iimpawu zengqondo zingathuthuka ekuqaleni kwenkqubo, ingakumbi kwiimeko apho i-lumen yangempela ibonisa ukukhanya okubalulekileyo kunciphisa okwesibini ukuya koxinzelelo.

 

Zininzi izinto ezinomdla kweli tyala. Okokuqala, kugxininisa ukubaluleka kweeklinikhi zomgogodla ukuba ziqaphele ukuba into enokubonakala ngathi iyinyani ye-chanmechanical yentlungu kunokuba yinto enokuba yingozi ngakumbi, njenge-VAD. Ukuqala ngesiquphe kwentlungu yesifo se-suboccipital, kunye okanye ngaphandle kwentloko, kunye nokuhamba ne-brainstem enxulumene neempawu zengqondo, kuya kufuneka ulumkise ugqirha malunga ne-VAD. Njengoko kwimeko echazwe apha, izigulane ezinembali ye-migraine ziya kuchaza ngokuqhelekileyo iintloko zentloko ezahlukileyo kwi-migraine yazo yesiqhelo. Uvavanyo olunonophelo lwe-neurological kufuneka lwenziwe, kukhangelwa ukusilela kwe-neurological efihlakeleyo, nangona uvavanyo lwe-neurological luza kuhlala lubi kumanqanaba okuqala e-VAD.

 

Okwesibini, intlungu yeempawu eziphakamisa inkxalabo yokuba isigulane sinokufumana i-VAD eqhubekayo. I-symptom triad ibandakanya: (1) ukuqala ngokukhawuleza kwentlungu ebuhlungu yengqondo yomlomo; (I-2) intloko ekhutheleyo eyayihluke ngokuthe ngqo kwintsholongwane yesigulane ye-migraine; kunye (kunye ne-3) iimpawu ze-brain-related neurological (ngesimo sokuphazamiseka kwexesha elibonakalayo). Kucacile, ukuhlolwa ngokunyamekela kweengxaki zegazi kwakungekho nto. Nangona kunjalo, imbali yayinokhathalela ngokwaneleyo ukunyusa uphando ngokukhawuleza.

 

Xa kukhankanywa i-VAD kodwa akukho zibonakaliso ezingenangqiqo ezikhoyo, ukubonakaliswa kwe-vascular immediate is shown. Nangona uvavanyo lokujonga i-VAD luhlala luphikisana, i-MRA okanye i-CTA yizo zifundo zokuxilonga ezikhethiweyo zanikezela i-anatomic ecacileyo kunye nokukwazi ukuvavanya iingxaki (kubandakanya ukungena kwintsholongwane kunye nokutshintshwa kweengcamango zengqondo). Abanye baxhasa ukusetyenziswa kwe-Doppler ultrasound; Nangona kunjalo, uncedo olungapheliyo lunikezelwa kwinqanaba le-vertebral umthamo entanyeni kunye nokuvavanywa okuncinci kwemithambo ye-vertebral cephalad ukuya kwimvelaphi. Ukongezelela, ukubonakalisa i-ultrasound akunakwenzeka ukuba uvumele ukubonwa kwe-dissection ngokwayo kwaye ngoko kungabikho ukungabikho kokubakho kwamathuba omzimba.

 

Okwesithathu, eli tyala linomdla ekukhanyeni kwempikiswano malunga nokuphathwa komlomo wesibeleko njengonobangela we-VAD. Ngelixa iingxelo zamatyala zibonise abaguli abanamava okuhlaselwa sisifo sokubethwa okunxulumene ne-VAD emva kokunyanzelwa komlomo wesibeleko, kwaye izifundo zolawulo zifumene umbutho wobalo phakathi kokundwendwela iingcali zonyango kunye nokubetha okunxulumene ne-VAD, uphando olwenziweyo lubonakalisile ukuba umbutho awungonobangela. UCassidy okqhubekayo wafumanisa ukuba isigulana esifumana ukubethwa sisifo ngokubhekisele kwi-VAD kunokwenzeka ukuba sityelele ugqirha wokuqala wokutyelela i-chiropractor ngaphambi kokuba sibethwe. Ababhali bacebise ukuba eyona nkcazo inokubakho yokuhlangana kwamanani phakathi kotyelelo lwee-chiropractors kunye ne-VAD elandelayo kukuba isigulana esidibana neempawu zokuqala ze-VAD (iintlungu zentamo kunye okanye ngaphandle kwentloko) kufuna unyango kwezi mpawu (kwi-chiropractor, iprayimari ugqirha, okanye olunye uhlobo lwengcali), emva koko ufumana ukubetha, ngokuzimeleyo kulo naliphi na inyathelo elithathiweyo ngugqirha.

 

Kubalulekile ukuba uqaphele ukuba, ngelixa bekuxeliwe imeko ye-carotid artery dissection emva kokunyanzelwa komlomo wesibeleko, izifundo ze-case control azifumananga lo mbutho. Iimpawu zokuqala ze-carotid dissection (iimpawu ze-neurological, kunye nentamo kunye nentloko engaphantsi kwe-VAD), i-aortic dissection (ukuqala ngokukhawuleza kwentlungu, i- ingaring pain) kunye ne-coronary artery dissection (ubuhlungu obukhulu besifuba, i-ventricular fibrillation) kubangela ukuba umntu afune kwangoko ukhathalelo lwe-ED, endaweni yokufuna ukhathalelo lwe-chiropractic. Nangona kunjalo, i-VAD ineempawu zokuqala ezibonakala zinobungozi iintlungu zentamo kunye nentloko-ezizimpawu ezo ezibangela ukuba abaguli bafune ukhathalelo lwe-chiropractic. Oku kunokuchaza ukuba kutheni i-VAD kuphela inxulunyaniswa notyelelo koochwephesha, ngelixa ezinye iintlobo zesahlulo zingenjalo; abaguli abanezinye iimeko, ezineempawu ezoyikisayo, ababonakalisi kugqirha bezonyango.

 

Eli tyala ngumzekelo omhle wesigulane kunye ne-VAD eqhubekayo ebonisa i-chiropractor ngenjongo yokufuna ukukhululeka kwiintlungu zentamo. Ngethamsanqa, i-chiropractor yayinobuqili ngokwaneleyo ukuqinisekisa ukuba iimpawu zesigulana azizange zibonise ukuba "umatshini" wengxaki yomlomo wesibeleko, kwaye uphando olufanelekileyo lwenziwa. Nangona kunjalo, ukuba ukukhwabanisa kuye kwenziwa, i-VAD esele iqhubekile ukusuka kwimbali yendalo inokuthi ityholwe ngokukhohlisa, emva kokuba ifunyenwe kwi-MRA imaging. Ngethamsanqa, kule meko, i-chiropractor yakwazi ukuncedisa ekubhaqweni kwangaphambili kunye nonyango, kwaye emva koko i-stroke yayinokuthi ithintelwe.

 

Amaphuzu okuFunda

 

• Ityala linikezelwa apho isigulane sibona ityropratri, ngelixa lifuna unyango intlungu yentamo, kwaye imbali yaphakamisa inkxalabo malunga ne-artebral artery dissection (VAD).
• Esikhundleni sokubonelela unyango oluthile, i-chiropractor ibhekisele isigulane kwisithombe esiphezulu, esiqinisekisileyo ukuxilongwa kwe-VAD.
• Icala libonisa ukubaluleka kokunikela ingqalelo kwiimeko ezizifihlakeleyo zembali kwizigulane ezine-VAD.
• Ikwasebenza njengomzekelo wesigulane nge-VAD ekuqhubekeni ekufuneni iinkonzo ze-chiropractor malunga neempawu zokuqala zesifo.
• Kule meko, ukufumanisa kwangaphambili ukusabalalisa kwenzeka kwaye isigulane sinokubuyiselwa ngokupheleleyo ngaphandle kwesifo esilandelayo.

 

Imibulelo

 

Ababhali bangathanda ukuvuma ukuncedwa nguPeter Cote, DC, PhD, ngoncedo lwakhe ngokuhlolisisa le ngqangi.

 

Imihlathi

 

Abaxhasi: Bonke abalobi bayavuma ukuba bancedise oku kulandelayo ekungenisweni kwalo mbhalo: umklamo kunye nokuyila, ukuyila umbhalo wesandla, ukuhlaziywa okubalulekileyo kwincwadi yesandla, ukuphononongwa kwincwadi kunye neenkcukacha, nokufunda ubungqina bombhalo wokugqibela.

 

Injongo yokunyanzela: Akukho nto ipapashwe.

 

Imvume yomonde: Ku funyenwe.

 

Iprovenance kunye nokuhlolwa koontanga: A nga thunyelwa; uhlolo lwangaphandle.

 

Ulwazi oluchazwe kwiziko leSizwe loLwazi lweBiotechnology (NCBI). Ubungakanani beenkcukacha zethu zikhawulelwe kwi-chiropractic kunye nokulimala kwemigudu kunye nemeko. Ukuxoxa mba, nceda uzive ukhululekile ukubuza Dr. Jiménez okanye uqhagamshelane nathi 915-850-0900 .

 

Ikhankanywe nguDkt. Alex Jimenez

 

 

Imixholo eyongezelelweyo: Ubungakanani

 

Impilo kunye nokuphila kakuhle kubalulekile ekugcineni ukulinganisela kwengqondo kunye nomzimba emzimbeni. Ukutya ukutya okunokulinganisela kunye nokuthatha inxaxheba kwimisebenzi engokwenyama, ukulala ixesha elinempilo ngokuqhelekileyo, ukulandela iziphumo ezingcono zezempilo kunye neempilweni zokugcina unokukunceda ekugcineni ulondoloze impilo yonke. Ukutya ezininzi iziqhamo nemifuno kunokuhamba ixesha elide ekuncedeni abantu ukuba baphile.

 

 

INGXELO EBALULEKILEYO: UKUPHATHA KWE-EXTRA: Ukunyanga i-Sciatica Pain