I-Ataxia Nesidenge | | El Paso, TX.

Ataxia sisifo se-nervous system. Iimpawu zinokulinganisa ezo zokunxila/zokunxila, kunye � nentetho engacacanga, ukukhubeka, ukuwa, kunye nokungakwazi ukugcina ulungelelwaniso. Oku kuvela ekuwohlokeni kwe-cerebellum, eyinxalenye yengqondo enoxanduva lokulungelelanisa intshukumo. Sisifo esichaphazela abantu bayo yonke iminyaka. Nangona kunjalo, ubudala bokuqala kweempawu bunokwahluka, ukusuka ebuntwaneni ukuya kwiminyaka yobudala. Iingxaki ezivela kwesi sifo zinokuba yingozi, zide zibe buthathaka kunye nobomi obufutshane.

Iimpawu ziyakwazi ukuhluka kumntu kumntu, kunye nohlobo lwe-Ataxia. Ukuqala kwesimo kunye nokuqhubela phambili kuyahluka ngokufanayo. Iimpawu zingaphuthuka ngokukhawuleza, ngaphezu kwemashumi eminyaka okanye ngokukhawuleza, ngaphezu kweenyanga ezimbalwa. Iimpawu eziqhelekileyo ukungabikho koqhagamshelwano, intetho edibeneyo, inkathazo yokutya, ukugwinya, ukuhamba kwamehlo okungaqhelekanga, ukutshabalalisa izakhono zokuhamba, ukuhamba kanzima, ukungahambi kakuhle, ukugubha, kunye neengxaki zeentliziyo. Abantu abane-Ataxia bafuna iiphulovu, abahambahambayo, kunye / okanye i-scooters ukunceda ekuhambeni.

Ataxia

Ukulahlekelwa koLawulo olupheleleyo lweeMboleko zeBhodi, ngokukhethekileyo iGait

Imbali Ye-Ataxia

• Kude kube nini?
• Iyacotha ukuqala? Ngaba sisifo esiya sisiba mandundu?
• Ukuqala ngamandla? Stroke?
• Kwenzeka nini?
• Ukuba wenziwe mandundu kukuhamba kwiindawo ezingalinganiyo, okanye ngombono omda? Ataxia yovakalelo?
• Ngaba zikhona naziphi iimpawu ezikhoyo?
• I-Vertigo, ubuthathaka, ubunzima, utshintsho lweenkqubela, njl njl
• Ngaba abanye baphawule ukuphazamiseka kwezinto?
• Ukuba akukho, qwalasela imbangela ye-psychogenic
• Ingaba inguqu yezinto ezibonakalayo zichazwa ngeengxaki zomzimba ezinjengentlungu okanye ubuthathaka?
• I-Antalgic gait, limp, njl

• Ubuthathaka

• Ukuba buthathaka kwezihlunu ezikufutshane�? Myopathy?
• Ngaba ubuthathaka bemisipha obude? Neuropathy?
• Iimpawu zeMNN?
• Iimpawu zeLMN?
• Ngaba isiguli siwile? Okomngciphekweni wokuwa?
• Ngaba iAAAAA iyanciphisa i-ADL?

ibhalansi

• Usebenzisa
• Inkqubo yeVestibular
• Inkqubo yeCerebellar
• Ulwazi olunolwazi olumkelekileyo
• Ulwazi olubonakalayo
• Amandla emoto kunye nokulungelelanisa

System Vestibular

• Ngokuqhelekileyo, ukuba ingxaki ikhona kwi-vestibular system isigulane siya kuba neentlanzi, mhlawumbi sibe ne-vertigo okanye nystagmus
• Ayikwazi ukuhamba umgca ochanekileyo
• Xa uhamba, uya kuthanda ukuya kwelinye icala

Ukuvavanya I-Vestibular System

• Uvavanyo lwe-Fukuda Stepping Test

• Iimpawu zokunyamezela ezisezantsi zivule amehlo kunye neengalo eziphakanyisiwe kwii-90 degrees phambi kwazo
• Ukuba zijikeleza ngaphezu kwe-30 degrees = ezilungileyo
• Umonde uya kujikeleza ukuya kwicala le-distibular dysfunction

• Uvavanyo lweRhomberg

• Ukuba isigulane sishiya isiqhelo esahlukileyo rhoqo xa amehlo abo avaliwe, oku kungabonakalisa ukungasebenzi kwe-vestibular

System Cerebellar

• I-Cerebellar gaits ikhona ngokubanzi-siseko kwaye ngokubanzi iquka ukuphazamiseka kunye nokwahlula
• Isigulana siya kuba nobunzima bokwenza uvavanyo lwaseRhomberg ngamehlo avulekileyo okanye avaliweyo, kuba azikwazi ukuma kunye neenyawo.
• Ulwazi oluchaseneyo lunceda ukwenza uvavanyo malunga nokuba umzimba usekuphi
• I-Ventral iphephenicerebellar tract
• I-trasal spinocerebellar tract
• Cuneocerebellar phecana
• I-Olivocerebellar ipheshana
• Amaphecana asebenzayo anokuthatha ulwazi olumkelekileyo ukulungisa utshintshi kunye nesimo sokugcina ibhalansi

Ukuvavanya I-Cerebellar System

• Uvavanyo lokudlala ipiyano kunye novavanyo lokubamba ngesandla

• Bobabini bavavanya dysdiadochokinesia
• Zomibini iimvavanyo, isigulane siya kuba nobunzima bokuhambisa isilenze kwicala le-cerebellar ukungasebenzi

• Uvavanyo lweminwe-impumlo

• Isigulane sinokuthi sihlaziye / u-hypo metric ekuhambeni
• Ukutshukunyiswa kwenjongo kunokutyhilwa

Isikhundla Sokuhlangana

• Ubungqina bokuba nolwazi luyakuncitshiswa, ngakumbi kwizigulane ezisebekhulile kunye nezigulane ezine-neuropathy

Ulwazi loLwazi

• Izigulane ezinezikhundla ezilahlekileyo zengqondo ziyaxhomekeka kwiinkcukacha ezibonakalayo zokuncedisa.
• Xa igalelo elibonakalayo lisusiwe okanye lincitshisiwe, ezi zigulana ziye zaba neataxia ebaxiweyo.

Amandla oMbane noLungelelwaniso

• Ukuba isigulane sinciphise ukulawulwa kwe-lobe yangaphambili singaphelela nge-apraxia ye-gait, apho kunzima khona ukulawulwa kwemigudu yokuhamba
• Iingxaki ze-Extrapyramidal ezifana ne-Parkinson zibangelwa ukungakwazi ukulawula umbane
• Ubuthakathaka obunobumba obunobumba ngenxa ye-myopathy kuza kuvelisa i-pattern ye-gait engavamile

Ngokuqhelekileyo Kubonakala Iimpawu Zingaqhelekanga

• Ixabiso lokunyuka

• Hemiplegia
• Ngokuqhelekileyo ngenxa yokubetha
• I-Bilaterally (i-Diplegic gait), ibangele inyawo
• Igalelo eliqhelekileyo lezilwelwe zecerebral palsy

• Ukuqhaqha

• Amanyathelo amancinci ngenxa yobuncwane
• Zivame ukubonakala kwiPilinson

• I-Myopathicgait (uddling)

• Ubonwa kwiintlupheko zobuthakathaka obuthathaka obuthathaka

• I-Steppage gait / Gait neuropathic

• Umlenze uphakanyiswa kwi-hip, ngaphandle kwe-dorsiflexion kwi-ankle
• Ngokuqhelekileyo kubonwe kwizigulane ezinokunyuka kweenyawo ngenxa yesilonda se-LMN
• Wide-BasedCerebellargait

Ukuphungulwa kwemivuzo

 

Utywala

Ukuvalelwa Kokulahleka Kokulinganisela

• Iintlobo eziphambili ze-4

• Vertigo
• Iipheripheral
• Central
• I-Pre-Syncope / Intloko yokukhanya
• IDisquilibrium
• Okunye / uhlobo olumanzi

Vertigo yePeripheral

• Okuqhelekileyo kune-vertigo ephakathi
• Ngenxa yomonakalo kwindlebe yangaphakathi okanye i-CN VIII
• Ngokuqhelekileyo ivelisa ukuhamba kweeyame ezingavamile
• I-Nystagmus � Isenokuba ithe tyaba okanye ijikeleza
• Ngokuqhelekileyo zinyamekile kwindalo, ngesigaba esheshayo nesicothayo
• Ebizwa ngokuba sisikhokelo sesigaba sokukhawuleza
• I-Vertigo idla ngokugqithiseleyo xa isigulane sibheka kwicala lesantya sokuzila se-nystagmus
• Ubunzima be-nystagmus ngokuqhelekileyo luhambelana nobukhulu be-vertigo
• Azikho ezinye iimpawu / iimpawu ze-CNS ukungasebenzi
• Umonde unokuba neentlanzi okanye ubunzima bokuhamba, kodwa ngenxa yokungasebenzi komzimba
• Umonde unakho ukulahlekelwa kwindlebe okanye i-tinnitus ngenxa yokuba umsebenzi we-CN VIII okanye umsebenzi wokuhlola uwonakele
• Ngokuqhelekileyo izizathu ziyingozi, kubandakanywa
• I-Benign paroxysmal post vertigo (BPPV)
• Vertigo yeCervicogenic
• I-labyrinthitis enobuchule / i-Vestibular neuronitis
• Isifo sikaMeniere
• Perilymph fistula
• I-Acoustic Neuroma

Ukulufaka phantsi

• Ukuba ukunyakaza, ngokukodwa kwentloko / intanyeni yandisa i-vertigo, cinga:
• BPPV
• I-Vertebrobasilar ishicilelo engakwaziyo
• Vertigo yeCervicogenic
• Ukuba isandi siza kwiziqephu, qwa lasela:
• isifo sikaMeniere
• Perilymph fistula

Imibuzo yeVergogo Hx

• Ngaba isiyezi sakho sivakala ngathi ukhwele ipaki yokonwabisa?
• Ngaba uye uba nesicaphucaphu xa unesiyezi?
• Ngaba ujika?
• Okanye ihlabathi lijikeleza?

Benign Paroxysmal Positional Vertigo (BPPV / BPV)

• Unokuhlakulela ngokukhawuleza, ngokukodwa kubantu abadala
• Kungenzeka ngenxa yexinzelelo lwentloko
• Iziqulatho ze-Vertiginous ezinxulumene nokuhamba okuthile:
• Ukujonga kwishelufu ephezulu (�top-shelf vertigo�)
• Bending phezu
• Ukuqhaqha phezu kombhede
• Ukusekwa kwe-vertigo kuqala imizuzwana embalwa emva kokuhamba, kwaye isombululo kwisithuba somzuzu
• Uvavanyo lokuxilonga
• I-Dix-Hallpike Maneuver
• Inkqubo yokwelashwa
• Epley Maneuver
• I-Brandt-Daroff Exercises
• Ngaba unokuzigqibo ngokuzenzekelayo njengama-crystals, kodwa kungathatha inyanga kunye ne-otoliths ezitsha zingasuswa

Vervicogenic Vertigo

• Kuvela emva kokulimala kwentloko / intamo, kodwa ayiqhelekanga
• Ngokuqhelekileyo ihamba neentlungu kunye / okanye umqobo wokuthintela
• I-vertigo ngokuqhelekileyo kunye ne-nystagmus iya kuba nzima kuneBPPV
• I-Vertigo iqala ngenguqu kwisimo sentloko kodwa ingaphumeleli ngokukhawuleza njengoko yenzayo kwi-BPPV

I-Vertebrobasilar Artery Ukungakwazi

• Kuye kwenzeka ukuba umthambo we-vertebral uxineke ngexesha lokujikeleza kwentloko / ukongezwa
• Ukusetyenziswa kwe-vertigo kulibazisekile ngaphezu kwe-BPPV okanye i-vertigo yesivumelwano, kuba ischemia iya kuthatha imizuzwana ye-15 ukuze ivele
• Uvavanyo lwama-orthopedic lunokunceda ekuhloleni
• Ibarre? -Ukuxoka?
• Uvavanyo lweDeKlyn / Hallpike Maneuver
• Vavanyo lweHautant
• Uvavanyo lwe-Underberg
• I-Vertebrobasilar Emva kokusebenza kweManeuver

I-Labyrinthitis eyiyo / iVestibular Neuronitis

• Akuqondwa kakuhle, kodwa bakholelwa ukuba kuvuvukala kwimvelaphi
• Ilandela ukusuleleka kwintsholongwane okanye ivele ibonakala ingenazo zizathu
• Ulwahlulo olulodwa, olulodwa lwe-vertigo
• Uxazulula kwiintsuku ukuya kwiiveki ezimbalwa kwaye ngokuqhelekileyo akahlali

Isifo sikaMeniere

• Uxinzelelo olwandayo kwi-endolymph lubangela ukugqithwa kwembombo kunye nomxube we-endolymph kunye ne-perilymph
• Iziganeko zokugqibela zemizuzu ye-30 ukuya kwiiyure eziliqela, de kube kufumaneke ukulingana phakathi kwamanzi
• Ngokuhamba kwexesha, izidumbu ze-episodes zonakalisa iisalbula kunye neengqamlezo zeenwele ze-cochlear
• I-low-pitch buzzing tinnitus
• Ukulahlekelwa kokuvalelwa kweetoni eziphantsi

I-Meniere's Disease vs. Syndrome

• I-Meniere's syndrome kuxa iimpawu zesifo sikaMeniere zifunyaniswa zisesibini kwenye imeko, efana nale:
• Hypothyroidism
• Acoustic neuroma
• I-ISHDS ye-canal dehiscence (Supermalcular dealcence channel)
• Perilymph fistula
• Isifo sikaMeniere siyinto engaqhelekanga

Perilymph Fistula

• Ukuvuza okuncane ngenxa yentlekele, ngakumbi i-barotrauma
• Inokubonakala ifana kakhulu nesifo seMeniere's/syndrome
• Ikhutshwe ngokutshintshwa kwengcinezelo
• Ukukhwela kweenqwelo
• Ukuqhuba ukukhuphuka
• Uphawu lukaHennebert
• I-Vertigo okanye isiqhelo se-nystagmus esiye senziwa ngokutywinwa kweendlebe (njengokufaka i-otoscope)

Central Vertigo

• Engaqhelekanga kune-vertigo yomzila
• Ebangelwa umonakalo kumaziko okucwangciswa kolwazi lwe-vestibular in the brain and sterex cerebral
• Ngokwesiqhelo �isiyezi� asibi kakhulu kakhulu kune-peripheral vertigo
• Nystagmus
• Idla ngokuba qatha ngakumbi kunenkcazelo/isikhalazo sesigulana
• Ngamanye angaya kwiindlela ezininzi, kubandakanywa ngokuthe tye
• NgoMeyi okanye angenakho ezinye iziphumo ze-CNS kwiimviwo
• Akukho tshintsho kwiindlebe ezilindelekileyo

Izizathu ziquka:

• Izifo ze-Cerebrovascular (ezifana nokuhlaselwa kwe-ischemic)
• Isifo sokugubhuka
• Malnold-Chiari Malformation
• Ukulimala kwi-brainstreet brainstyle okanye vestibulocerebellum
• Isimo seMigraine

I-Pre-Syncope Hx Qustions

• Ngaba kuvakala ngathi uza kuphelelwa?
• Ingaba utywina luvakalelwa njani xa uvuka ngokukhawuleza?

Pre-Syncope

• �Intloko ekhanyayo�
• CardiacOrigin
• Iziphumo zokuphazamiseka
• Arrhythmias
• Holter iliso lokuhlola
• I-Postural / Orthostatic hypotension
• Kwangathi ibe sesibini kwezinye iingxaki (isifo sesifo sikashukela, i-adrenal hypofunction, i-Parkinson, imithi ethile, njl.
• Vasovagal episodes
• Iqondo lentliziyo elincinci ngexinzelelo lwegazi eliphantsi
• Ngokuqhelekileyo kuziswa ngokuxinezeleka, ukuxhalaba okanye ukuxhatshazwa
• Migraine
• Ngenxa yokungazinzi kwesifo
• Igazi leeshukela isifo

IDisequilibrium Hx Imibuzo

• Ngaba isiyezi sibakho kuphela xa umi ngeenyawo?
• Ngaba kulunge xa ​​ubamba / ubamba into ethile?

IDisquilibrium

• Ngokuqhelekileyo kubantu abadala
• Ngenxa yokuphulwa kwamatyala
• Ukuthotyelwa kokugqibela
• Ukuxhaswa ngumbono ophantsi
• mnyama
• Amehlo avaliwe
• Iilahleko zokulahleka ezibonakalayo
• Ukuphuculwa ngokuthinta into ehleliweyo
• I-Subjective of dizziness ihlala iphucula ngecebo lokuncedisa i-gait (i-cane, walker, njl)

Ezinye izizathu

• Ukukhathazeka kwengqondo
• Rhoqo isigulana siya kusichaza isiyezi �ukudada �
• Ukulawula ukukhutshwa kwe-hyperventilation kunye nezinye iintlobo zesisu

imithombo

Blumenfeld, Hal. I-neuroanatomy ngokusebenzisa iiKliniki zeeKliniki. Sinauer, 2002.
UAlexander G. Reeves, A. kunye noSwenson, R. Ukuphazamiseka kwenkqubo yeNervous. UDartmouth, 2004.