Umvelaphi weNtloko yeNtlungu | El Paso, TX.

imvelaphi: Oyena nobangela uxhaphakileyo we�migraines / intloko�Inokunxulumana neengxaki zentamo. Ukusuka ekuchitheni ixesha elininzi ujonge phantsi kwilaptop, kwidesktop, kwi-iPad, kwaye nasekuthumeleni imiyalezo rhoqo, ukuma okungalunganga kwexesha elide kunokuqala ukubeka uxinzelelo entanyeni nangaphezulu ekhokelela kwiingxaki ezinokubakho. kubangela intloko. Uninzi lwalo hlobo lweentloko luya kwenzeka ngenxa yobunzima phakathi kwamagxa ehlombe, okubangela ukuba izihlunu zibe phezulu kumahlombe ukuze zomeze kwaye zenze intlungu ibe yintloko.

Umvelaphi weNtlungu

• Ivela kwiintlungu ezinobulunga entloko
• Ubuncinane obukhulu bomthamo (iintlungu / i-temp) ezingenanto
• Meninges
• Ivazi yegazi
• Izakhiwo ze-Extracranial
• TMJ
• Amehlo
• Sinuses
• Imisipha yamathambo kunye nemigqa
• Izakhiwo zamazinyo
• Ingqondo ayinayo i-receptors yeentlungu

I-Spinal Trigeminal Nucleus

• Iimbindi zeTrigeminal
• Ubuso bentsholongwane
• Glossopharyngeal nerve
• Iigulane
• I-C2 nervous (Greater occipital nererve)

Amagxobhozo

dailymedfact.com/neck-anatomy-the-suboccipital-triangle/

Ukwazisa ngeeNociceptors

• Iziphumo kwi-allodynia kunye ne-hyperalgesia

slideplayer.com/9003592/27/images/4/Mechanisms+eyanyaniswa+ne+peripheral+sensitization+ to+pain.jpg

Iintlobo zeentloko

Umbi:

• Ukunxiliswa kwabantu
• Intracranial izilonda
• Iintloko ze-Vascular
• Ukuphulwa komlomo wesibeleko okanye ingxaki
• nguqulo
• Glaucoma

Benign:

• Migraine
• Intloko yeentloko
• Neuralgias
• Intloko yesifo
• Intloko yesibini
• I-post-traumatic / post-concussion
• “I-analgesic rebound” intloko ebuhlungu�
• Psychiatric

HA Ngenxa yezilonda ze-extracranial

• Iisines (intsholongwane, isisu)
• Izifo zentambo yomlomo wesibeleko
• Iingxaki zamazinyo
• Ngokubambisana kweTemoromandibular
• Izifo zentloko, njl
• Iliso (glaucoma, uveitis)
• I-extracranial arteries
• Izilonda zesisu

HA Iiflegi ezibomvu

Isikrini seeflegi ezibomvu kwaye uqwalasela iintlobo ze-HA ezinobungozi ukuba zikhona

Iimpawu eziqhelekileyo:

• Ukuhla ukusinda
• Ubuhlungu bubavusela ebuthongweni
• Fever

Izimpawu ze-neurologic okanye iimpawu ezingavumelekanga:

• Ukuqala ngokukhawuleza okanye ukuqhuma
• Uhlobo olutsha okanye oluvuthayo lwe-HA ngokukhethekileyo kwizigulane ezisebekhulile
• HA ubuhlungu obuhlala kwindawo efanayo

Imbali yomlomo wangaphambili

• Ngaba le yeHA yokuqala owakhe waba nayo?
  Ngaba le yeyona HA imbi wakha waba nayo?

Iziphumo zengozi:

• Imbali yomhlaza, i-immunocompromised, njl.

Ingozi / Isifo seentloko

Ukunxiliswa kwabantu

• Ukutshatyalaliswa kwesisu
• I-Meningitis kunye ne-meningoencephalitis

Izilonda zesisu

• Neoplasms
• Intracerebral hemorrhage
• Izidumbu zengxowankulu okanye i-epidural hemorrhage
• Abscess
• Hydrocephalus

Iintloko ze-Vascular

• I-arteritis yesikhashana
• Ukuxhamla komzimba (umz., Uxinzelelo olubi kakhulu, i-pheochromocytoma)
• Iimpazamo zeArteriovenous kunye nokwandisa ii-aneurysms
• Lupus cerebritis
• I-sinous thrombosis

Ukuphulwa komlomo wesibeleko okanye ingxaki

• Ukwaphuka okanye ukutshatyalaliswa
• I-Occipital neuralgia
• Umthambo we-vertebral dissection
• Chiari malformation

nguqulo

• Hypoglycemia
• Hypercapnea
• I-carbon monoxide
• Anoxia
• IAnemia
• I-Vitamin A

Glaucoma

Imihla yokumisa imitha

• Ngokuqhelekileyo ngenxa ye-Aneurysm
• Ngokukhawuleza iqala intlungu
• Ngokuvuthiweyo ukuhlanza
• Umonde ubonakala egula
• Ngokuqhelekileyo i-nuchal rigidity
• Jonga i-CT kwaye mhlawumbi ukugqitywa kwe-lumbar

Meningitis

• Umonde ubonakala egula
• Fever
• Ukunyaniseka kwe-Nuchal (ngaphandle kwabadala kunye nabantwana abancinci)
• Khangela ukutshitshiswa kwe-lumbar - ukuxilonga

Neoplasms

• Akunakwenzeka isizathu se-HA kumlinganiselo wesigulane
• Iintlungu zentloko engenabuhlungu kunye nentlungu
• Okubi kakhulu kusasa
• Mhlawumbi unokufunwa ngumoya onamandla
• Ukuba iimpawu ezigxininisiweyo, iimpawu zokubamba, iziganeko ze-neurologic, okanye ubungqina bokunyuswa kwengcinezelo engaphezu kwezinto ezikhoyo zikhona umthetho wethu wesifo se-neoplasm

Iimpawu zemiSebenzi yeeNkcazo

• Ngenxa yengozi yempembelelo, ukuxhwaleka okanye iimpazamo kwi-coagulation
• Ngokuqhelekileyo kubakho kwimiba yentlekele enkulu yentloko
• Ukusetyenziswa kweempawu zingaphi iiveki okanye iinyanga emva kokulimala
• Ukwahlukana ukusuka kwintloko yesigxina
• I-post-Concussive HA ingaphikelela kwiiveki okanye kwiinyanga emva kokulimala kwaye ihambisane noxinzelelo okanye i-vertigo kunye nezinguqu zengqondo ezinzulu, eziya kuphelisa

Ukwandisa i-Intracranial Pressure

• Papilledema
• Kungenza ukuba utshintsho olubonakalayo

openi.nlm.nih.gov/detailedresult.php?img=2859586_AIAN-13-37- g001&query=papilledema&it=xg&req=4&npos=2

Ixesha lexeshana (iGiant-Cell) Arteritis

• > Iminyaka eyi-50 ubudala
• Polymyalgia rheumatic
• Malaise
• Iintlungu ezihlanganyelweyo
• Myalgia
• Iintloko ezingapheliyo
• Ububele obukhulu kunye / okanye ukuvuvukala kwimibhobho yexesha le-occipital
• Ububungqina bokungapheli komyinge ekuhanjisweni kwamasebe eenqwelo
• ESR ephezulu

Ummandla wesibeleko HA

• Ukuxhwaxeka kwekhanda okanye kunye neempawu okanye iimpawu zengcambu yomlomo okanye intambo yoxinzelelo
• Umyalelo woMyalelo weNkundla okanye iC CT ngenxa yokuphulwa okanye ukuchithwa
• Ukungazinzi komlomo
• Umyalelo we-colervical spine x-ray kunye nokujonga kwandiso

Ukulawula iH HA eyingozi

• Imithetho yethu yexinzelelo enzima okanye entanyeni, ukuxhatshazwa okanye iimpawu zeengxaki ze-neurologic, kunye nezifo ezingadluliselwa kwi-meningitis okanye kwi-abscess brain
• Hlola umkhuhlane
• Linganisa uxinzelelo lwegazi (inkxalabo ukuba yi-diastolic> 120)
• Uvavanyo lwe-Ophthalmoscopic
• Hlola intamo ngokunyaniseka
• Ukuqulunqa iziqhamo ze-cranial.
• Gcwalisa uviwo lwe-neurologic
• Ukuba kufuneka i-oda izalise inani le-cell cell, i-ESR, i-cranial okanye i-imaging yomlomo wesibeleko

Isifo okanye Isifo?

<Iintsuku ezili-15 ngenyanga = Episodic

> Iintsuku ezili-15 ngenyanga = ezingapheliyo

Migraine HA

Ngokuqhelekileyo ngenxa yokuhlutha okanye ukuhanjiswa kwe-vasculature ye-cerebral

I-Serotonin Kwi-Migraine

• I-AKA 5-hydroxytryptamine (i-5-HT)
• I-Serotonin iya kugqitywa kwi-epraode
• IV 5-HT inokumisa okanye ukunciphisa ubunzima

Migraine ngeAura

Imbali ubuncinane bokuhlaselwa kwe-2 ezalisekisa imigaqo elandelayo

Enye yezi zilandelayo zibonakaliso ezipheleleyo:

• Visual
• I-Somatic sensory
• Intetho okanye ubunzima beelwimi
• imoto
• Isiqu seBrain

I-2 yeempawu ezilandelayo ze-4:

• 1 uphawu lwe-aura lusasazeka ngokuthe ngcembe ngaphezulu kwe-5 min, kunye / okanye 2 iimpawu zenzeka ngokulandelelana
• Isibonakaliso ngasinye se-aura sigcina i-5-60 min
• I-1 uphawu lwe-aura ayihambelani
• I-Aura ihamba kunye okanye ilandelwe kwi <60 min ngentloko
• Akukho bhetele kubhalwe ngenye i-ICHD-3 ukuxilongwa, kunye ne-TIA ingabandakanywa

Migraine ngaphandle kweAura

Imbali ubuncinane be-5 ukuhlaselwa kwezi zilandelayo:

• Uhlaselo lweentloko luhlala ku-4-72 h (ungakhange ulashwe okanye ungaphathwa ngempumelelo)
• Unilateral intlungu
• Ikhwalithi yokukhangela / ukukhwela
• Ukuxinwa kweentlungu ezinzulu
• Ukugqithiswa okanye ngokubangela ukuphepha ekusebenzeni rhoqo ngokomzimba
• Ngethuba leentloko zentlungu kunye / okanye uvakalelo ukukhanya kunye nesandi
• Akukho bhetele kubhalwe ngenye i-ICHD-3 ukuxilongwa

Intloko yeCluster

• Unobateral unbateral orbital, u-supraorbital kunye / okanye intlungu yesikhashana
• �Njengomkhenkce endihlaba esweni�
• Ubuhlungu bugcina imizuzu ye-15-180

Ubuncinane enye yezinto ezilandelayo kwicala lentloko:

• Ijoyi yokudibanisa
• Ukukhupha ubuso
• Ulwabiwo
• Miosis
• Ukudibanisa kwamanzi
• Ptosis
• Rhinorrhea
• Idipidi edema
• Imbali yeentloko ezifanayo ngexesha elidlulileyo

Ukuxhatshazwa kwentloko

Intlungu yentloko ihamba kunye nezi zilandelayo:

• Ukucindezela / ukuqinisa (umgangatho ongeyena)
• �Ndiziva ngathi ndinebhanti ejikeleze intloko yam�
• Indawo ehlala kuyo
• Akunakunyanyiswa ngumsebenzi oqhelekileyo

Intloko kufuneka ilahleke:

• Isihlunu okanye ukuhlanza
• Ifotophobia kunye nefonophobia (enye okanye enye ikhona)
• Imbali yeentloko ezifanayo ngexesha elidlulileyo

Intloko yeNtloko

• Intloko ebakho ngeentsuku ezili-15 ngenyanga kwisigulana esinesifo esivele sikhona
• Ukusetyenziswa gwenxa rhoqo kwe-> iinyanga ezintathu zelinye okanye amachiza amaninzi anokuthathwa ngenjongo yokunyanga iintlungu ezibuhlungu kunye / okanye iimpawu zentloko
• Ngenxa yokusetyenziswa kakubi ngamachiza / ukurhoxiswa
• Akukho bhetele kubhalwe ngenye i-ICHD-3 ukuxilongwa

imithombo

UAlexander G. Reeves, A. kunye noSwenson, R. Ukuphazamiseka kwenkqubo yeNervous. UDartmouth, 2004.