Iingxaki zeCerebrovascular Disorders

Izifo ze-Cerebrovascular liqela elikhethiweyo lemiqathango engakhokelela kwisiganeko / i-cerebrovascular / s, oko kukuthi ukubetha. Ezi ziganeko zichaphazela ukunikezelwa kwegazi kunye nemithwalo yengqondo. Nge�ukukhutshwa, ukungasebenzi, okanye ukubola�kuyenzeka, oku kuthintela iiseli zobuchopho ekubeni zifumane ioksijini eyaneleyo, nto leyo enokubangela ukonakala kwengqondo. Izifo ze-Cerebrovascular zingakhula ngeendlela ezahlukeneyo. Ezi ziquka i-vein thrombosis (DVT) kwaye i-atherosclerosis.

Iintlobo zesifo se-cerebrovascular: Stroke, ukuhlaselwa kwe-ischemic, aneurysms, kunye neentsholongwane ze-vascular

Esi sifo se-US cerebrovascular disease sisona sihlandlo esiqhelekileyo sokufa.

Iingxaki zeCerebrovascular Disorders

Ubungqina

• Yenza ~ 2% yesisindo somzimba
• Ibalelwa kwi-10% yokusetyenziswa kweoksijini emzimbeni
• Iiakhawunti malunga ne-20% yokusetyenziswa kweglucose emzimbeni
• Ufumene ~ 20% yemveliso yenhliziyo
• Ngomzuzu, kufuna i-50-80x yegazi nge-100g yezinto eziyimfutho yengqondo yengqondo kunye ~ 17-40x yegazi nge-100g yento emhlophe
• If ukunikezelwa kwegazi kwingqondo yi <15cc nge-100g yeethishu, ngomzuzu, ukungasebenzi kakuhle kwe-neurologic
• Njengazo zonke izicubu, ixesha elide likhona i-ischemia, kunokwenzeka ukuba kukho ukufa kweseli kunye ne-necrosis
• Ingqondo ixhomekeke kwi-constant oxygen, ne-glucose
• Imizuzu ye-3-8 yokubanjwa kwentliziyo ingabangela ukulimala kwengqondo engapheliyo!

Ukugunyazwa Kwebhanki

• I-hypotension ye-Systemic yenza i-cerebral vasodilation esebenzayo ukuvumela ukuphuma kwegazi ngaphezulu kwengqondo
• Ingqondo ingakwazi ukukhipha oksijini okwaneleyo ukusuka kwingqondo xa uxinzelelo lwe-systolic yi-50 mmHg
• Ukunciphisa i-Atherosclerotic kunokuvelisa i-vasodilation esebenzayo ukuzama ukunciphisa uxinzelelo olungaphezulu
• Ukunyuswa kwengcinezelo yegazi kunokubangela ukuba i-vasoconstriction, ukunciphisa ubuncipheko bokuqhwaba
• Ukuba umndilili woxinzelelo lwe-systolic> 150 mmHg ixesha elide, le mbuyekezo inokungaphumeleli
• Ikhefu lexinzelelo lexinzelelo

Ukunikezelwa ngegazi kwiNtloko

madeinkibera.com/lingual-arterie-anatomie

Utshatyalalwano lokuBambisana

• Kwi-occlusion ngokukhawuleza efana ne-atherosclerotic thrombosis, ukujikelezwa kwezinto zokubambisa kunexesha lokuphuhlisa
• Isangqa se-Willis sidibanisa iinkqubo ze-carotid kunye ne-basilar
• Iingqungquthela zokuxhumana zangaphambili nezangaphandle zibonelela ngokubonelela
• I-Anastomoses phakathi kwezinto eziphambili ze-cerebral kunye ne-cerebellar kwabanye abantu
• Uxhumano lwangaphakathi kunye nolwangaphandle lwe-carotid ye-artery ngokusebenzisa i-ophthalmic & maxillary arteries

Isangqa sikaDowis

• Udibanisa inkqubo ye-vertebrobasilar kunye ne-internal carotid system
• Ngethuba ekunikezeni ukujikelezwa kokubambisa okunceda, yindawo enokuyithintela kakhulu kwi-Berry Aneurysms engakhokelela kwisifo esibuhlungu

xh.wikipedia.org/wiki/Circle_of_Willis

Ukunikezela ngegazi kwiBongo

teachingmeanatomy.info/neuro/vessels/arterial-supply/

UMaxillary kunye neOphthalmic aa.

Iingxaki zeCerebrovascular Disorders

• Abantu abadala base-700,000 e-US banomdlavuza ngamnye ngonyaka
• Isizathu sesithathu esibangela ukufa e-US
• ~ Abantu abayi-2 abakhubazekile ngenxa yokubetha
• Ngokuqhelekileyo kakhulu kubantu abakhulileyo
• Izifo eziMnyama / iziShekemic
• 80% yazo zonke izibetho
• Indawo eqhelekileyo ye-occlusion i-artery carotid yangaphakathi ngaphaya kwe-bifurcation ye-carotid ejwayelekile.
• Atherothrombotic
• Embolic
• Inqanawa encinane
• Izifo eziHlumayo

I-Occlusive / Ischemic Stroke

• Kungenziwa ngenxa yombane okanye OKUYIMPILO
• Ubume bombuso buninzi kakhulu
• Ngenxa yokunqongophala kwegazi kunye neoksijini yokufikelela kwindawo ethile yengqondo
• Ukuqala ngokukhawuleza kweephene ze-neurologic, ezihambelanayo nokusasazwa komthi othile
• Iintsilelo ziya kwahluka kuxhomekeka ekubeni yeyiphi na i-artery ethe yaphazamiseka

Occlusion Occlusion

• Hyperviscocity
• emzimbeni
• Thombocytosis
• Iiseli zegazi ezibomvu okanye ezimhlophe zibala
• Polycythemia
• Hypercoagulability
• I-homocysteine ​​ephakamileyo
• Ukuhamba okungapheliyo okanye ukuhamba kwendiza
• Iziphazamiso ze-Genetic clotting factor
• Ukukhulelwa
• Cancer
• Ukufakwa endaweni kweHormone kunye nokusetyenziswa kwe-OCP

Atherothrombotic

• Iingxaki ze-neurologic zingaphantsi kwexesha okanye ziphucule ngokukhawuleza emva kwexesha
• Izizathu ezinokwenzeka / iintlobo:
• Ukuchithwa kwe-tunica intima kunye ne-tunica adventitia
• Kungenzeka kwizigulane ezincinci ezineengxaki zenyama
• Izixhobo zokuvuvukala zibeka kwaye zakha kwiindonga zeenqanawa
• I-LDL i-Oxidized deposit in walls

Embolic

• Iingxaki ze-neurologic zenzeka ukuba zenzeke ngokukhawuleza
• Izicubu ezixoshiwe kwi-dissection ye-tunica intima kunye ne-tunica adventitia
• Naliphi na i-thrombus ekhutshweyo ingaba yindawo yokuvala / ukuvala i-lumen yeenqanawa ezincinci

Isitya esincinci

• Lipoyalinosis
• Udonga lomkhumbi olonzakeleyo kunye neebhaluni
• Angiopathy
• Ukuhlanganiswa kwamaprotheni e-amyloid kwiindonga zetyana
• Eyona nto ixhaphakileyo kwizigulana> iminyaka engama-65 ubudala
• Ubangela ukunciphisa (okukhokelela kwi-ischemia) kodwa kunokubangela ukuba iinqanawa zitshatyalaliswe (ezikhokelela ekusikeni kwegazi)
• Iyahambelana nesifo i-Alzheimer's
• Ukuvutha
• Spasmotic

Izinto ezinobungozi kwi-Stroke ebonakalayo

• U xinzelelo
• Isifo sikashukela
• Ukukhubazeka kweenhliziyo
• Ukushiya ngakwesobunxele (i-Patent foramen ovale, iVSD, i-tetralogy of fallot, njl)
• I-fibrillation ye-Atrial
• Isifo seValve / iigraves zenhliziyo
• Ubudala
• ukutyeba
• Hyperlipidemia
• I-LDL ephezulu kunye ne-HDL ephantsi
• Indlela yokuphila
• Ugwayi / utshaya ugwayi
• Isimo se-oxidation esiphezulu
• I-homocysteine ​​ephakamileyo
• Igalelo le-folic acid esezantsi, i-B6 kunye neB12
• Idibana ne-LDL cholesterol
• I-Hyperviscocity kunye ne-hypercoagulability ichaza njengoko kuboniswe kwisilayidi sangaphambili

Ukuhlaselwa kwe-Ischemic encinci (TIA)

• Iziganeko eziguquguqukayo ezipheleleyo ze-neurologic deficient ngenxa yokungafihli kwemisipha engapheli ngaphezu kwemizuzu ye-30 ngexesha
• Ngamanye amaxesha unokugcina iiyure ze-24 okanye ngaphezulu
• Isiqingatha sezigulane ezithwaxwa yi-stroke epheleleyo ngaphambili,
• I-20-40% yezigulane ezine-TIA ziya kuqhubeka zihlaselwa ngokupheleleyo
• Kubalulekile ukuchonga izigulane nge-TIAs ukuba zikwazi ukulawulwa ngokufanelekileyo kunye nezinto ezinobungozi ezinokuthi zinciphise

Imbali yentsilelo yeThutyana yeNeurologic kwisigulana> 45 y / o

• DDx
• I-TIA inokwenzeka kakhulu
• Migraine
• Ukugxininisa
• BPPV
• Meniere
• Ukutyhila izifo
• I-arteritis yesikhashana
• Hypoglycemia
• Ukuxhamla
• Iimpembelelo eziphambeneyo

I-Carotid Artery Disease

• Isicaka se-systolic esiphezulu esifakwe kwi-artery carotid singabonisa i-carotid stenosis
• Kudinga ukuhlolwa kwe-ultrasound ye-duplex
• Izilonda ezinciphisa ukukhanya> i-70% inokubangela ischemia
• Iziganeko ezininzi ze-carotid azibangeli i-ischemia ngenxa yokuphuculwa kwephuhliso okuvumela ukuba kubekho ukuqhutyelwa kwemigudu yokuqhutyelwa kwintsebenziswano kunye nokuphuhliswa
• Ukwenza izinto ngokukhawuleza okanye ukubumba kunokuvelisa iingxaki nge <70% stenosis
• Ungenelelo ngoncedo kufuneka luqwalaselwe kwizigulana ezine-> 70% stenosis kunye neempawu ze-TIA

Stroke ebonakalayo

• Ukuba kukho ukuqala kokusilela kwe-neurologic ecacileyo, isigulane kufuneka sibe ne-CT ukulawula isisu
• Ukuba i-hemorrhage igqityiwe ngaphandle, i-activminogen i-activator i-activator kufanele inikwe kwiiyure zokuqala ze-4.5
• Akufanele kunikwe emva kwexesha ngenxa yokuba kunokunyusa umngcipheko wokuphuma kwegazi ngexesha lokupheliswa kwesisu seengqondo
• Emva kweli xesha lokuqala, i-thrombolysis egxininisekisiweyo okanye ukukhutshwa komatshini we-embolus

Intracranial Hemorrhage

• I-20% yamatyala enxeba
• U-HA okhulu okanye ukuhlanza kubonisa ukuphazamiseka kokugqithisa
• Ezimbini iindidi
• Ukuqhekeza ngokungaqhelekanga
• U xinzelelo
• Aneerysms zeArterial
• Iimpembelelo eziphambeneyo
• Ukuphazamiseka kwegazi
• Umkhumbi uyancipha ngenxa ye-angiopathy yama-amyloid
• Ezibuhlungu

Aneurysm Sites

• Intraparenchymal isisu
• I-50% - Amasebe aseLenticulostriate e-central artery cerebral
• Ichaphazela i-putamen kunye ne-capsule yangaphandle
• I-10% - Amasebe atshabalalayo e-posterior cerebral artery
• Ichaphazela i-thalamus
• I-10% - Amasebe atshabalalayo amacandelo e-cerebellar ephezulu
• Ichaphazela i-cerebellum
• I-10% - Amasebe eParamediya we-basilar artery
• Ichaphazela i-basilar pons
• I-20% - Iinqanawa ezahlukeneyo ezichaphazela imimandla emhlophe
• Ukutshatyalaliswa kwesisu
• I-Berry aneurysms ekunxibelelaneni iibhendi zamatri

Ukuphazamiseka kwezibilini

• Thrombocytopenia
• Leukemia
• Iimpawu zonyango ezingaphezulu kwama-antiticoagulant

Izinto ezinobungozi kwiStyroke eHemorrhagic

• U xinzelelo
• Aneerysms zeArterial
• Iimpembelelo eziphambeneyo
• Ukuphazamiseka kwegazi
• Umkhumbi uyancipha ngenxa ye-angiopathy yama-amyloid
• Intlungu yentlekele

Izibonakaliso zesisu: Fundisa izigulane

chrcsf.org/expert-tips-to-help-with-detecting-the-early-signs-of-stroke/

Iimpawu eziqhelekileyo eziqhelekileyo

• Vertigo
• Ukutshatyalaliswa okanye ukulahleka kombono
• Ataxia
• Diplopia
• Ukubambisana okanye ukungahambisani nendawo kunye nokuphungulwa kwemoto
• Syncope
• Ubuthathaka ekuhanjisweni kwentsholongwane ye-cranial nerve kwicala enye yentloko kunye ne-hemiparesis yenkalo (umonakalo we-brainstem)
• Umonakalo kwi-sensory cranial nerve kunye ne-Horner's syndrome kwelinye icala lentloko kunye nokulahleka kwe-contralateral intlungu kunye nemvakalelo yobushushu emzimbeni (umonakalo wengqondo esecaleni)

Iimpawu zexesha elide zixhomekeke kwiNgingqi echaphazelekayo

• I-Monocular obscuration ebonakalayo (i-amaurosis fugax) emele i-retinal ischemia
• Hemiparesis
• Ulwaphulo lwentando
• Iintsilelo ezibonakalayo kwintsimi
• Dysphasia
• I-aphasia eyamkelekileyo (isilonda sendawo ye-Wernicke)
• Expressive aphasia
• Ukungahoywa komthetho (i-logeal lobe lesion)
• Iingxaki zokuxhaswa (i-Supplementarymotorcortex lesion)
• Ubunzima ngokubheka ngokuzithandela kwinqanaba eliphambili (Iimpawu zesilwanyana zangaphambili)
• Ukulahleka kweememori zesikhashana (i-lobes temporal period).

Ama-Syndromes eStem

roho.4senses.co/stroke- syndromes / common-stroke- syndromes-chapter-9-textbook-of- stroke-medicine.html

Ukubuyiswa kwesisu

• I-Rehab idinga kuxhomekeke kwingingqi yeengcambu zengqondo ezithintekile ngengozi
• Unyango lo kuthetha
• Ukulungiswa kwemilenze yokusebenza
• Ukuzilinganisa kunye nokuzibandakanya
• Ikhuthaza ukulungiswa kwe-neuroplastic
• Iimpawu zingaphucula kwiintsuku zokuqala ze-5 ngenxa yokunciphisa i-edema
• I-Edema inokubangela ukukhutshwa kwe-foramen magnum enokubangela uxinzelelo lwengqondo kunye nokufa � abaguli abanale ngxaki banokufuna i-craniectomy. (ukuncamela Okokugqibela)

imithombo

UAlexander G. Reeves, A. kunye noSwenson, R. Ukuphazamiseka kwenkqubo yeNervous. UDartmouth, 2004.
I-Swenson, i-R. Cerebrovascular Disorders. 2010