Ekubhebhetselisa ukulimala axonal: Izimpawu, izimpawu kanye ukuxilongwa

ukuhlukumezeka cranial kungaholela umonakalo ebuchosheni, grey ndaba. Nazo ngokufanayo, kungabangela ukuthuthukiswa izifo ngokuvamile engelapheki ezinzima futhi okusongela ukuphila komuntu. Ngokulandelako, cabangela omunye yale miphumela - ngokukhukhumala kwentamo ukulimala axonal, ukuthi kuyini, kunalokho ingozi kwesimo esinjalo.

Uhlolojikelele

Okokuqala sidinga ukunikeza ngezigaba emfushane izigaba ukulimala skull:

• Easy. Lokhu ukulimala kuhambisana ukulimala okuncane futhi abangele ukulimala ebuchosheni.
• Isilinganiso. Kulokhu, degree of ukulimala kwachazwa ngokuthi ngokulinganisela.
• Heavy. Kulesi sigaba, nokukhama futhi ehlasela umzimba axonal okulimala ebuchosheni. Ukulimala ugqoke uhlamvu inertial.

incazelo

Ehlasela umzimba ukulimala axonal (WCT) kuyinto okukhulu ekubhujisweni izinqubo ezinzwa nge evelele nokopha ezincane. Ngokusho lwasemtholampilo, kwakhiwa focus sokugembula is emngceleni ndaba grey nomhlophe. Ehlasela umzimba ukulimala axonal (WCT) kwehlisa izinga lokuphila futhi umsebenzi ngokwengqondo kwe-isisulu. isimo wesiguli, akungabazeki, angabhekwa ezinzima. Lokhu kungenxa kakhulu ngenxa yokuthi kukhona usongo olukhulu ekuphileni kwakhe. Lapho ukulimala kwenzeka nokulimala, ukuvuvukala eba, kukhona hygroma subdural. Siyabhubha CSF outflow kusukela zone ventricular, ngokuvamile Kutholwe ukwa ecindezelekile. Lezi zenzakalo zenzeka phambi ekuthuthukiseni ngokukhukhumala kwentamo ukulimala kobuchopho axonal. Ukulimala ngokuvamile nzima kakhulu kangangokuba kwakungasekho hhayi kuzo zonke izimo kungenzeka ukubuyisela umsebenzi umzimba ubudala. Isisulu kuyaqabukela, njengoba umkhuba imibukiso, sibuyisela esimweni saso sangaphambilini evamile. Ngemva ukwelashwa kanye nokuvuselelwa iziguli ukulimala ngokukhukhumala kwentamo axonal ingqondo kudingeka ubone udokotela wakho njalo. Ukuhlola ayadingeka ukulawula isimo umzimba futhi kusenesikhathi ukuwohloka.

Ekubhebhetselisa ukulimala axonal: izimpawu, izimpawu, uphethwe

Kanjani isimo sokugembula? Abaningi okulimala ebuchosheni, ehlasela umzimba ukulimala axonal ngokukhethekile, ephelezelwa ikhoma isikhathi eside. Lesi simo kwenzeka okwamanje yokulimala ugebhezi. Ngaphezu kwalokho, kukhona ushintsho oluphawulekayo endleleni imisipha ithoni. Ekubhebhetselisa axonal ukulimala syndrome meningeal ephelezelwa futhi ukubonakaliswa okwedlulele ekunqandeni. Kuye kwaba ukwehla elibukhali ingcindezi futhi nciphisa. Isiguli inqanyulwe imisebenzi wonke amathangi becabanga. Coma isikhathi eside kakhulu, onalesi sifo emitholampilo usesimweni esinjalo, njengoba umthetho, akuyona evumayo kakhulu. Kukhona kungenzeka ukuthi isiguli ongase afe, ngaphandle ngiphaphama. Kwesinye simo, isiguli ekwazile ukuphuma ikhoma, kodwa ngemva kwesikhathi ngokwanele eside. Ukuquleka ingahlala amasonto 2-3. Coma kungase kuhambisane nezinguquko kule ama- cerebral imisebenzi ubuchopho. Kulokhu, isiguli ubuhlungu isici.

isimo vegetative

Ekubhebhetselisa ukulimala axonal zobuchopho libhekene yokuguquka esithombeni emtholampilo. Ngakho, ikhoma ungaya kusimo vegetative noma Transistor. Emtholampilo, ehlasela umzimba ukulimala kobuchopho axonal ebonakaliswa ngezindlela ezahlukene. Nakuba ezinye ubonisa enye nge velocity sezingeni eliphezulu. isimo vegetative elinesimo Ukukhipha ukusebenza endaweni ama- cerebral palsy. Kungaba iqhubeka izinyanga eziningana. Ngezinye isimo vegetative, zikhona izimpawu ukungakhuli ukusebenza subcortical-stem izakhiwo zobuchopho. Disorders izinqubo ezibalulekile kuphakamisa bulbar ukubukeka, pupillary kanye nokunye ukuboniswa efanayo. Uma uguqula imisipha ithoni pozdnotonicheskie zenzeka futhi usithe impendulo zokuzivikela. Lezi zihlanganisa, ngokukhethekile, zihlanganisa amajaqamba ezingalweni nasemilenzeni engenhla nengezansi, okwandisa amplitude we ukunyakaza nekhanda lakhe ekhotheme, izandla ethuthumela, postures eziyinkimbinkimbi zomzimba. Njengoba kushiwo ngenhla, ukubonakaliswa emitholampilo ziyahlukahluka ngokushesha okukhulu. Ihora, isibonelo, bangezwa ezahlukene ikhaliphe sokugembula. Ekukhombeni izinguquko iziguli vegetative isimo livela dyskinesia, Gait ataxic, kukhona inkulumo nokuphazamiseka engqondweni. Phakathi nalokhu kwesibili, kuyafaneleka aspontannost, ukulahlekelwa amandla okukhumbula, ukukhathala zokuziphatha.

I okunye Yiqiniso yenqubo sokugembula

Ekubhebhetselisa axonal okulimala ebuchosheni ezahlukene inguqulelo okunengqondo kusukela equlekile eside endaweni eziphikelelayo vegetative isimo lezivakashi. Lokhu kuboniswa ukubonakaliswa entsha, okuyinto ebingekho ekuqaleni. Ngokwesibonelo, isiguli singase ngokungafanele ukugxila shazi kulokolokoza noma basabela ezintweni ezenzeka ngaphandle. Uma isimo vegetative uyaqhubeka isikhathi eside, kwembula izimpawu ezintsha lesi sifo. Ikakhulukazi, kukhona ukungondleki imisipha carpal imisipha fibrillation zomzimba. Kulokhu kukhona okusheshayo intuthuko paroxysmal uthi. Bethula tachycardia, ngamanzi, umfutho wegazi ophakeme, kanye nezinye izimpawu ongaphilile. Ngemva kwalokho imakwe ukuwohloka. Ehlasela umzimba ukulimala axonal manje ephelezelwa imisipha ukuqina, discoordination, gipomimiya, oligofaziey, bradykinesia, discoordination, ataxia. Kuyinto njalo ngenxa yekhanda lesiguli. Ucala kutfutfukisa emetic syndrome, kukhona ubunzima zilethwa ukutsheka ikhanda nasemlenzeni izandiso, kukhona imisipha Intamo yayo iqina. Iziguli eziningi libhekene komzimba (imivimbo cortical waphawula kusuka ukwanda ngokwanele elibukhali lokushisa) ptyalism, ukujuluka anda. Ngakho, singaphetha ngokuthi ngokukhukhumala kwentamo ukulimala axonal kuphakamisa izinqubo engelapheki sokugembula emzimbeni.

Ukuhlola isiguli

Ehlasela umzimba ukulimala axonal kutholwa kuphela esebenzisa CT nama-MRI. Lezi zindlela ukuvumela cwaningo observation ezibukwayo we Ukwanda okungavamile umzimba hyperemia noma edema ngenxa yokucinana we ventricles. Eqoshiwe nezinye izimpawu esebenzisa. Ngosizo CT ochwepheshe nethuba ukuhlola isithombe emitholampilo isibikezelo eqinisekile lekusasa. MRI libonisa yonke izinguquko sokugembula, cuphuluza ukopha esinqunyiwe zisabalele ezihambisana ngokukhukhumala kwentamo ukulimala axonal. Ubukhulu BoMbuso isimo sokugembula kunqunywa futhi ngesisekelo magnetic resonance tomographic ukufundwa. Imiphumela ukuvumela ukukhetha yokwelapha eliphezulu nesineke. ukusazi ngokunembile isifo esikuphethe phezu wokubhoboza isisekelo lumbar. Le nqubo kubaluleke kakhulu ukuze kusenesikhathi ukopha subarachnoid. Nale wokubhoboza kusikisela predominance ophezulu intracranial. Le nqubo is contraindicated in iziguli ivolumu intracranial izinqubo ezibangela ubuchopho dislocation.

CT imiphumela esikhathini acute

Ekubhebhetselisa ukulimala kobuchopho axonal elinesimo ukwanda ngokuphawulekayo e isitho noma ivolumu ngokulinganisela. Futhi, umkhawulo okubonakalayo, futhi kwezinye izimo kokucindezelwa ephelele III kanye ventricles lateral, imithombo isizinda convexital nezikhala subarachnoid. Izinguquko kwezicubu kwabantu, njengoba umthetho, yiba umlingisi normodensitivnym, kodwa ukwanda noma ukwehla kungabonakala nasemkhakheni. Ngo ndaba ezimhlophe, Corpus callosum, ekunqandeni kanye izakhiwo subcortical Avame ukutholakala nokopha encane ebalulekile. Sicela uqaphele ukuthi CT isithombe isiguli sihlale ibanga lobudala izindinganiso. Dynamics iziguli ababonisa ukulimala ngokukhukhumala kwentamo axonal zobuchopho, libhekene ukuthuthukiswa inqubo atrophic. Ikakhulukazi, ziphawuleka ventriculomegaly, ukunwetshwa convexital basal izikhala subarachnoid. Ngezinye ezinkathini zakamuva emva ukulimala (emva mayelana 3-4 amasonto) ngokuvamile siyenzeka ekuqongeleleni cerebrospinal fluid ezindaweni frontal, ZaseLaki interhemispheric (e anterior yayo izingxenye ngokukhethekile). It luqedwe ngokuhamba kuqiniswa kwengqondo futhi isimo zezinzwa. Lokhu kuwubufakazi bokuthi ongaqondile ivolumu emumva ukulimala kobuchopho. Obungapheli okulimala ebuchosheni ezinganeni kaningi futhi ingcono kakhulu kunanoma abadala ukunikeza therapy.

Okutholwe CT

Ngokusho iphethini kungaba cishe ahlulele khona noma ukungabi khona nomfutho wegazi ophezulu intracranial. Uma CT akuyona elihunyushwe base ithangi futhi i-ventricle, noma ukubonakaliswa samanje kokucindezelwa zabo ezimbi eliphezulu okungenzeka NGA. Lokhu kungaba ngempela kunengqondo ukufakwa Uphenyo ingcindezi intracranial nokulungiswa kwalo okwalandela. Uma CT kusobala ebonakalayo CSF outflow pheshana, ikakhulukazi i-ventricle amathangi nemithombo, ICP, okungenzeka kakhulu ngaphakathi emgodini. Cishe akunakwenzeka ukuthi izinyathelo ezihlose ukunciphisa yayo, kuyoba wusizo isisulu. Iziguli yabonisa abalulekile osmotic homeostasis disorder okubangwa samabanga aphansi noma umonakalo stem futhi izakhiwo hypothalamic-pituitary. In iziguli hyperosmolar ngokulinganisela isimo waphawula imiphumela esihle, njengoba kungabantu abangaphezulu liphinyiselwe ngokuvamile kakhulu ukufa kwenzeka.

pathogenesis

luhlolo Macroscopic akwembuli lutho izicubu izinguquko elibhubhisayo basal evele yangaphandle. Ngesikhathi esifanayo e ndaba ezimhlophe kunezindawo izilonda ezijulile. Lemisebenti ingaphindze Kutholwe nokopha sendawo ezindaweni ezahlukene zobuchopho. Luyakukhahlela kahle futhi zihlolwe histologically. Kungaba ukuthola ubukhona "amabhola axonal." Lezi zici bakha izindawo discontinuity ku eziyimpumelelo emsipheni. Ngaphezu kwalokho, ukucabangela histological wembula izinguquko amasilinda uhlamvu elimazayo nge abasafufusa varicose thickenings. Ngemva kwenyanga ukunyamalala amabhola ukulimala kanye ekwandeni macrophage ezonini ekuguqulweni. kunoshintsho zenzeka emgodleni myelin, Ngokuqhubeka izinqubo sokugembula e izinzwa ezingxenyeni neuropathy isimiso sezinzwa. Futhi ukuthuthukisa emsipheni spinal cord zesivikelo sesifuba.

Ukwelashwa: Uhlolojikelele

Iziguli owabonisa ngokukhukhumala kwentamo ukulimala axonal, impatho inikezwa eziyinkimbinkimbi ukuthi kuhlanganisa izindlela eziningana. Ikakhulukazi, iziguli kudingeka ukuqhuba isikhathi eside ukupholisa mechanical (ukupholisa) e ngokulinganisela hyperventilation imodi. Inikezwe yokwelapha multimodality ehlanganisa ukusetshenziswa kwezidakamizwa vasoactive futhi nootropics, ukugcina uzinzo izinqubo umzimba usebenzisa i-probe (enteral) kanye nokudla parenteral. kokungenela Steel ngokuvamile alinikeziwe ngoba akukho substrate, okuyinto zisuswe. Steel zokukhwabanisa ukuthola kuwusizo yezinye kwezinso ethuthuka ukuhlinzeka umfutho ophakeme kobuchopho kanye nezakhi zalo. Ngenxa yezinga eliphezulu yezinkinga extracranial (yamaphaphu futhi pyoinflammatory, okungcono) kufakwe Yiqiniso oqabulayo izidakamizwa elwa namagciwane kanye nemisebenzi immunocorrecting.

Isikimu ezelaphayo

Iziguli ngokukhukhumala kwentamo axonal okulimala ebuchosheni esibhedlela esibhedlela. Ukusungulwa kwe eyinkimbinkimbi izilinganiso zokwelapha kanye nokuhlenga nemvelo. Esikhathini scheme, ikakhulukazi, kuhlanganisa:

• Mpilo ukulondoloza operation esitebeleni umgudu wokuphefumula.
• Tube yokudla.
• labagula kakhulu imithi.
• Ukulondoloza evamile ibhalansi uketshezi electrolyte.
• Kwezinye izimo, ukusetshenziswa neurotransmitters, le evuselela biogenic.
• umzimba zokwelapha, ukuthuthukisa resumption of ukusebenza evamile nasemilenzeni, nokuvinjelwa kwezifo amalunga omzimba.
• kokwelashwa izintshumayelo kuqiniswa umsebenzi izwi.

Ngemva kokuhlinzwa akuhileli isikhathi ukululama okusheshayo ngemva esibhedlela isikhathi eside. Ukuze ekulinganiseni isimiso sezinzwa esiyinhloko, ubuchopho olungaba isinxephezelo umsebenzi kahle, ukusheshisa ijubane ukuvuselelwa kufanele kube ukuqokwa kwe semithambo namanxusa neuroprotective. Iphinde kungadinga ukusetshenziswa evuselela biogenic, izidakamizwa ezithinta izicubu umzimba futhi, ngokusho izinkomba, neurotransmitters (elisho ukuthi "Madopar", "L-Dopa," "Lac" kanye nabanye), kanye nezidakamizwa anticholinesterase. Uma DAP asikho isidingo ukuqokwa yokwelapha hormone.

ukuba nombono ongafani ngeke

Amathuba iziguli ikhambi ne WCT kweyeme ubukhulu bale ukulimala axons, khona edema, kungenzeka ajoyine i-izinqubo sokugembula extracranial. Lapho efeza ephumelelayo eziyinkimbinkimbi ezelaphayo e nenkathi emfushane umphumela omuhle kungenzeka. Nge baqhubeka eside ikhoma kwandisa ingozi izinkinga. Lapho inkontilaki kaNgcobo kwandisa amathuba nemiphumela engemihle, ngokulandelana, encishisiwe kanye nokwenzeka yokutakula. Okunye futhi okubaluleke ngokufanayo ukujula ikhoma. Olunesisindo esikhudlwana lwaluba njengoba linjalo, njengeliyiZwi sibi umphumela. Uthishanhloko angabhekwa kungenzeka yokutakula ngokugcwele noma kancane balahlekelwa imisebenzi ngokwengqondo lapho ekuhlehleni kuphazamiseka izinzwa, ngisho ezimeni umonakalo lapho isiguli emva equlekile eside kwakhiwa isimo vegetative okuthatha amasonto ambalwa izinyanga. Lesi simo esiyingqayizivele sibangelwa zingase zibonise ukuthi amathuba reversibility futhi isinxephezelo neurotransmitter neziyaluyalu kwesakhiwo ezilawula izinhlekelele ezibangelwa eziphikelelayo womsebenzi obusebenzayo ebuchosheni ngemva ekubhebhetselisa ukulimala axonal.