Diffuse axonal Kukuvara: Zviratidzo, zviratidzo uye kuongorora chirwere

cranial kunotevera kunogona dzakakomba kwazvinoita uropi, vachena nyaya. Ivowo, anogona kukura chakakomba uye kazhinji kusingarapiki zvirwere kuti zvingakanganisa upenyu hwevanhu. Next, funga mumwe nemigumisiro izvi - diffuse axonal kukuvara, chii, pane njodzi ezvinhu akadaro.

tsananguro

Tinofanira kutanga kupa pfupi kupatsanura pakati nzendo dehenya kukuvara:

• Easy. Kukuvara uku pamwe zvishoma kukuvara uye chipaparadzungu.
• Avhareji. Panyaya iyi, ukuru akuvara hwokuratidza sezvo nemwero.
• Heavy. Panguva iyi, kudzvinya uye diffuse axonal kukuvara uropi. Kukuvara apo akapfeka ane inertial hunhu.

tsananguro

Diffuse axonal Kukuvara (WCT) ndiyo hombe kuparadzwa pezvakaitwa masero etsinga pamwe koshesa hemorrhages diki. Maererano kurapwa, pathological pfungwa achiumbwa pamuganhu vachena uye chena nyaya. Diffuse axonal Kukuvara (WCT) Sezvineiwo akazoita mararamiro uye basa nepfungwa rechipfuwo. Murwere ezvinhu, pasina mubvunzo, anogona kunzi kwazvo. Izvi kunyanya nokuti kuti pane ngozi hwake. Kana kukuvara kunoitika kupwanywa, kuzvimba zvikamuka, pane subdural hygroma. Akanetseka CSF water drainage kubva ventricular vematunhu, kazhinji dzakaonekwa mwoyo kutsemuka. Izvi zviitiko kuitika pamberi nekukudziridza diffuse axonal uropi. Kukuvara kazhinji kwazvo zvokuti haana nguva dzose zvinoita kudzorera yekare muviri basa. Akuvara kashoma, sezvo tsika inoratidza nayo anodzokera ayo yapfuura wenguva mamiriro. Mushure kurapwa uye kunaya varwere diffuse axonal pfungwa kukuvara vanofanira kuona chiremba wako nguva dzose. Inspections zvinokosha kudzora muviri mamiriro uye mangwanani kuziva miedzo kudzikira.

Diffuse axonal Kukuvara: zviratidzo, zviratidzo, kuongorora chirwere

Sei munhu pathological ezvinhu? Vazhinji Kukuvara uropi, diffuse axonal kukuvara zvikurukuru, achiperekedzwa kwenguva refu pakoma. Ichi kunoitika panguva yokukuvara yacho dehenya. Uyezve, pane kuchinja mune tsandanyama matauriro. Diffuse axonal Kukuvara chirwere pamwe meningeal uye kuratidzwa kwakakomba chokumisa. Chave unopinza kuderera kumanikidzwa uye kuparara. Murwere vakarega mabasa ose vanofunga matangi. Chaanoziva zvinogona rebei, chiremba fungidziro mumamiriro ezvinhu akadaro, sezvo mutemo, hakusi zvakanaka chaizvo. Pane mukana kuti murwere afe, uye pasina Pandakapengenuka. Mune imwe Muchiitiko, murwere Vanotarisira kuti abude pakoma, asi pashure zvakakwana kwenguva yakareba. Kufenda anogona kugara kwemavhiki 2-3. Chaanoziva angaperekedzwa kuchinja Hemisférios Cerebrais uropi mashandiro. Panyaya iyi, murwere ane noruzhinji marwadzo.

vegetative mamiriro

Diffuse axonal kukuvadzwa uropi inozivikanwa nokukurumidza Kuchinja kunotoda mufananidzo. Saka, chaanoziva anogona vachipinda vegetative mamiriro kana transistor. Akaora, diffuse axonal uropi richiratidzwa dzakasiyana. Nepo vamwe humwewo nezvingoro aine zvakakwana yakakwirira velocity. Vegetative mamiriro kunoratidzwa kushanda disconnection munzvimbo yacho Hemisférios Cerebrais. Hunogona kupfuurira kwemwedzi inoverengeka. Panguva vegetative mamiriro, pane zviratidzo dzichipfekeka vanotaura vari subcortical-hunde hurongwa wouropi. Zvirwere zviri pezvakaitwa inokosha chinokurwadzai pakuonekwa bulbar, pupillary nezvimwe nezvingoro zvakafanana. Kana kuchinja tsandanyama inzwi pozdnotonicheskie kuitika uye kujeka unodzivirira norudaviro. Izvi zvinosanganisira, kunyanya zvinosanganisira chinyamunhari chinorwadza mu okumusoro maoko nemakumbo, kuwedzera amplitude ari kufamba musoro wake akakotamisa, maoko nekubvunda, postures dzakaoma muviri. Sezvataurwa pamusoro apa, mashoko kurapwa anokuzviratidza siyana nokukurumidza. Kweawa Somuenzaniso, tingasangana akasiyana pathological hunenge. Panoongororwa kuchinja vegetative ezvinhu varwere sokuti dyskinesia, ataxic gait, pane kutaura uye zvirwere zvepfungwa. Pakati yokupedzisira, zvinokosha kuziva aspontannost, kukanganwa, tsika okuneta.

The mberi weboka pathological muitiro

Diffuse axonal uropi kukuvara musoro yakasiyana achichinja kubva chaanoziva refu vari kuramba vegetative mamiriro inopfuura. Izvi zvinoratidzwa kuratidzwa itsva, iyo haana kurarama asati. Somuenzaniso, murwere anogona kunyanya kuisa aitarire kudzima kana sei zviwane. Kana vegetative hurumende anopfuurira kwenguva yakareba, wakaratidza zviratidzo mutsva chirwere. Zvikurukuru pane kwezvokudya carpal tsandanyama fibrillation richiripo tsandanyama. Muchiitiko ichi pane kufambira mberi paroxysmal inoti. Vakapa tachycardia, Flushing, BP, uye dzimwe mwero zviratidzo. Naizvozvo akacherekedza kudzikira. Diffuse axonal kukuvara zvino achiperekedzwa tsandanyama kuomarara, discoordination, gipomimiya, oligofaziey, bradykinesia, discoordination, ataxia. Rinogara kuti murwere nomusoro. Kachitanga emetic urwere, pane zvinetso pamwe kurereka musoro uye gumbo Extensions, pane nomutsipa mukukutu tsandanyama. Varwere vakawanda Paaiita hyperthermia (Kurohwa cortical akacherechedza kubva zvakakwana unopinza kuwedzera tembiricha) ptyalism, vakawedzera vangadikitira. Saka, tinogona kugumisa kuti diffuse axonal kukuvara chinokurwadzai kusingarapiki pathological pezvakaitwa mumuviri.

Kuongorora murwere

Diffuse axonal kukuvara iri dzakaonekwa chete pachishandiswa CT uye MRI. nzira izvi kubvumira kudzidza kuona akataurwa pamusoro zvemamiriro kuwedzera muviri hyperemia kana edema nokuda compression yacho ventricles. Yakanyorwa uye zvimwe zvinowedzerwa zviratidzo. Achibatsirwa CT nyanzvi vane mukana kuongorora kunotoda mufananidzo uye kuita kudzidzira kufamba for yeramangwana. MRI anoratidza pathological zvose kuchinja ari, kushatiriswa kukwana kana rakakura ropa pematanho diffuse axonal kukuvara. Kukura munhu pathological mamiriro akatsunga uyewo pahwaro rinobva resonance tomographic kuverengwa. Migumisiro kubvumira kusarudza Zvakanyanya Kunaka Panguva Yepamuviri kurapa murwere. kuongororwa zvakarurama pahwaro lumbar ponji. nzira Izvi zvinokosha zvikuru nokuti mangwanani kuziva miedzo subarachnoid ropa. With ponji iyi kunoratidza predominance yakakwirira intracranial kumanikidzwa. nzira iyi contraindicated mu varwere intracranial vhoriyamu pezvakaitwa anokonzera uropi dislocation.

CT zvinoguma kusachengeteka kukuru nguva

Diffuse axonal uropi dzinoratidzwa nemuumbi kuwedzera nhengo kana mwero vhoriyamu. Uyewo, iyo yairambidzwa ari kuchengetwa, uye mune zvimwe zviitiko vakakwana compression III uye lateral ventricles, matangi convexital nechigadziko uye subarachnoid dzezvimwe. Aichinja zvinyama arambe achirema, sezvinoita mutemo, vane normodensitivnym hunhu, asi inogona kuchengetwa kuwedzera kana kudzikisa. Munyaya chena, corpus callosum, chokumisa uye subcortical ezvirevo kazhinji kuwana duku zvatichiri hemorrhages. Tapota ziva kuti CT mufananidzo murwere anogona kuramba nemakore siyana zvinodiwa. Dynamics wevarwere uyo akaratidza diffuse axonal zvakuvadza uropi, dzinoratidzwa pave atrophic kwacho. Zvikurukuru, zvinonzi akacherechedza ventriculomegaly, nokuwedzera convexital basal uye subarachnoid dzezvimwe. At dzinouya pashure zvinokuvadza (pashure pemavhiki anenge 3-4) kazhinji ari kuchengetwa kuunganidza cerebrospinal mvura iri frontal dzoga, interhemispheric kutsemuka uku (mu Anterior ayo zvikamu kunyanya). Inogona kubviswa mukufamba Kudzikamiswa chepfungwa uye chetsinga chinzvimbo. Izvi husina kunanga hunoratidza kuti yavaipora vhoriyamu pashure uropi. Dzechimwe Kukuvara uropi vana kakawanda uye kupfuura vakuru kukanda mushonga.

Zvakawanikwa of CT

Maererano nomufananidzo anogona kuva nehasha kutonga kuvapo kana kusavapo intracranial neBP. Kana CT haina rakashandurwa tangi nechigadziko uye ventricle, kana kuratidzwa aripo zvakakomba dzavo compression kwemupristi mukana i. Izvi ingava musoro kugadzwa vachiongorora intracranial kumanikidzwa wayo kururamiswa yaizotevera. Kana CT zvakajeka kuonekwa CSF water drainage turakiti, kunyanya ventricle uye matsime, ICP, kazhinji mukati mugomba. Kunenge kuti matanho zvainanga kwayo rutapudzo, achava rinobatsira akuvara. Varwere akaratidza chinokosha osmotic homeostasis nyonganyonga yakakonzerwa chikuru kana yechipiri kukuvara hunde uye hypothalamic-pituitary hurongwa. In varwere mwero hyperosmolar wehurumende vakachengeta nani. zvaitika, mamwe akazivisa chaizvo kakawanda rufu kunoitika.

pathogenesis

Macroscopic ongororo inoratidza hapana zvinyama inoparadza kuchinja basal dzokunze hukawanika. Panguva iyoyo vari chena nyaya pane nzvimbo yakadzika maronda. Vanogonawo kuonekwa hemorrhages munzvimbo dzakasiyana nzvimbo uropi. Chichabvisawo aongororwe histologically. It anogona kuvapo "axonal balls." zvinhu izvi zvinoumba nzvimbo discontinuity ari etsinga harinzwi. Uyezve, histological kuongorora kwakaratidza kuchinja sepombi hunhu dzinoparadza pamwe zvichiitika varicose thickenings. A mwedzi pashure kunyangarika mabhora kukuvara nekutarisa kushandiswa nekuwanda macrophages vari shandurudzo wongoramba. Uyezve kuchinja kuitika munyika myelin mumuhara, kuramba pathological pezvakaitwa zviri Tutsinga tunofambisa mashoko utwu pamusoro peripheral zvikamu tsinga. Uyewo kuva etsinga uye musana fibers.

Treatment: Overview

Varwere vakaratidza diffuse axonal kukuvara, kurapwa riri basa kunzwisisa kuti zvinosanganisira nzira dzakawanda. Zvikurukuru, varwere vanofanira kuitisa refu zvokuimba kufefetedza (kufefetedza) zvine mwero hyperventilation muoti. Basa multimodality jekiseni kuitika kushandiswa kwezvinodhaka vasoactive uye nootropics, kuramba nokugarika metabolic pezvakaitwa kushandisa vachiongorora (enteral) uye parenteral kudya kunovaka. Kuvhiya kupindira Kazhinji haana basa nokuti hapana substrate, ndiko kuti chinofanira kubviswa. Kuvhiya bata nyore kuonekwa nevamwe abnormalities mberi kupa mupristi kumanikidza uropi uye yenhengo dzayo. Nokuda mukuru kuitika extracranial yematambudziko (pulmonary uye pyoinflammatory, zvinganaka) dziri kuchirapa mukufamba zvinodhaka antibacterial uye immunocorrecting mabasa.

The Zano kuchirapa kupindira

Varwere diffuse axonal kukuvadzwa kwouropi muchipatara muchipatara. Pokugadzwa zvakaoma pamusoro zviyero kuchirapa uye rehabilitative hunhu. In zano, zvikurukuru, chinosanganisira:

• Ventilator kuramba kugadzikana nokushanda kufema hurongwa.
• Tube dzichifura.
• Yevanorwara zvikuru mushonga.
• Kuramba zvinoitika Urume uye electrolyte mwero.
• Mune zvimwe zviitiko, kushandiswa neurotransmitters, ari biogenic muviri.
• Kuchirapa muviri, kutsigira resumption pamusoro dzose kushanda maoko nemakumbo, kudzivisa zvirwere mapfundo.
• Speech jekiseni ndedzekubatsira inzwi basa Kudzikamiswa.

Avhiyiwa inoda kwete kukurumidza kupora nguva pashure kwenguva refu muchipatara. Kudzikamisa nechepakati tsinga, uropi aripire havachanyatsogoni basa, mhanyisa kumhanya vapore inofanira kugadzwa vascular uye neuroprotective nevamiririri. Inogonawo zvinoda kushandiswa biogenic muviri, zvinodhaka kukanganisa zvinyama muviri uye, maererano zviratidzo, neurotransmitters (zvinoreva "Madopar", "L-Dopa," "Lac" uye vamwe), uye zvinodhaka anticholinesterase. Kana DAP pasina kudikanwa kugadzwa hormone mishonga.

mataridzikiro

The ndingangokuvara mushonga varwere WCT achavaponesa kwakakura kukuvara axons, kuvapo edema, mukana kubatana pathological urongwa extracranial. Paaiita inobudirira kunzwisisa kuchirapa kupindira mune pfupi yakanaka Mugumisiro kazhinji. With akaramba-refu chaanoziva kunowedzera ngozi yematambudziko. Pakukumbira nayo kunowedzera mukana wokuti rwakashata zvaitika, ukuwo, ipfupi uye mukana nokupora. Zvakafanana rinokosha kudzama uye pakoma. The kwakanyanya ndiko, zvakaipisisa mugumisiro. Mukuru wechikoro anogona kunzi mukana zvizere kana kukwana kuzoita vakarasika chepfungwa mashandiro ari regression pamusoro chetsinga zvirwere, kunyange vanenge kukuvara apo murwere mushure refu chaanoziva vakaumba vegetative mamiriro zvechigarire kubva shomanana mwedzi. Fani iyi zvingaratidza kuva mukana wokuti reversibility uye muripo neurotransmitter uye STRUCTURAL zvirwere kuti zvinokonzera kuramba vachivavhiringidza ose dzichipfekeka muuropi pashure diffuse axonal kukuvara.