Ukushaywa yisifo ukufa kwezicubu zobuchopho, okuvame ukukhiqizwa ukuphazamiseka kwegazi ukuya engxenyeni yobuchopho. Izinkinga ezivamile ze-vascular ezingase ziholele ekutheni zifakwe isifo sofuba zihlanganisa i-thrombosis (i-clotting) yemithwalo yegazi ebuchosheni, i- embolus (i-clot yegazi ehambela ebuchosheni futhi ifake khona), nezinkinga zendawo ezibandakanya imithwalo yegazi ebuchosheni, njenge- aneurysm noma ukuvuvukala.
Ngemuva kokuba othile ehlaselwe isifo, udokotela uzama ukucacisa imbangela ethile, ngoba imbangela eyinhloko yesifo sokushaya isifo kaningi ibonisa ukuthi ukwelashwa okungcono kunakho konke. Ezingamaphesenti angama-40 amacala, nokho, asikho isizathu esithile esingaziwa. Ukushaywa kwesifo esingaziwa kuthiwa yi-cryptogenic stroke. (Igama elithi "cryptogenic" lisho nje ukuthi imbangela iyinkimbinkimbi, noma ididekile.)
Ngabe Izikhwama Zibizwa Nge-Cryptogenic?
Ngemuva kokushaya, ngezinye izikhathi kungaba nzima ukubona ukuthi ukuphazamiseka kwegazi okwakhiqiza isifo kubangelwa i- clot yegazi eyakhiwa endaweni (i-thrombus), i-clot yegazi eya eya ebuchosheni ukusuka kwenye indawo ( ukumbumbulu ), noma enye inkinga yemisipha.
I-stroke akufanele ibizwa ngokuthi i-cryptogenic kuze kufike ukuhlolwa okuphelele ngaphandle kokunikeza imbangela ethile. Ngokuvamile, ukuhlolwa okunjalo kufanele kufaka phakathi ukucabangela ubuchopho (nge- CT scan noma i- MRI scan ), ukucabanga ngemithwalo yegazi enikeza ubuchopho (izifundo ze-carotid duplex noma i- transcranial Doppler ), futhi mhlawumbe i- angiography .
Ngaphezu kwalokho, isifundo esiphelele se- echocardiographic senhliziyo kufanele senziwe, sifuna imithombo ye-cardiac ye-embolus. Imithombo yenhliziyo engase ibe khona ihlanganisa i-blood clots enhliziyweni (ngokuvamile e-atrium kwesokunxele), i- patent foramen ovale (PFO) , i- patrium foram septum , i-fibrillation ye-atrial , noma i- metral valve prolapse (MVP) .
Uma kungenasizathu esiye sabonakala ngemuva kwalokhu kuhlolwa okuphelele, lesi siza sibhekwa njenge-cryptogenic.
Izimbangela zangempela zokushaywa kwe-cryptogenic (uma zingabonwa) ziningi, futhi abantu ababizwa ngokuthi babe nesifo sokushaya i-cryptogenic yiqembu eliyingqayizivele. Njengoba isayensi yezokwelapha ithuthukisa ikhono layo lokubona imbangela yokushaywa kweziguli ngabanye, inani labantu okuthiwa bane-stroke cryptogenic liyowa.
Ubani Othole Ukushaywa Kwe-Cryptogenic?
Iphrofayli yeziguli eziye zahlushwa yi-cryptogenic strokes ngokuvamile zifana neziguli eziye zahlaselwa izimbangela zezimbangela ezibonakalayo. Bajwayele ukuba ngabantu asebekhulile abanezici eziyingozi zokugula kwesifo senhliziyo.
Imivimbo ye-Cryptogenic ibonakala ngokulinganayo kumadoda nabesifazane. Kungenzeka ukuthi kuvame kakhulu kubantu abamnyama nase-Hispanics. Nakuba ukushaywa kwe-cryptogenic kubantu abancane (abangaphansi kweminyaka engama-50) bathola ukunakwa okuningi odokotela nasezincwadini zezokwelapha, ucwaningo lubonisa ukuthi ukusatshalaliswa kweminyaka yobuhlungu bezinkinga ze-cryptogenic kufana nokushaywa kwe-cryptogenic. Okokuthi, ikhono lokubona imbangela yokushaya isifo kubantu abasha kufana nokufana nabantu asebekhulile.
Uyini Umbono Ngemuva Kokushaywa Kwe-Cryptogenic?
Ngokuvamile, ukuchazwa kwesiguli esiye sabhekana nesifo sokushaya i-cryptogenic kubonakala sengathi kungcono kakhulu kunezingxabano ezingekho-cryptogenic.
Noma kunjalo, isilinganiso seminyaka engu-2 sesilinganiso esiphambene nesisindo samaphesenti angu-15 kuya kwangu-20.
Njengoba ukwelashwa ukuvimbela isifo esivamile kuncike imbangela yesifo (i-anticoagulation ne-warfarin ngemva kokushaya kwesisu, i-antiplatelet therapy ne-aspirin noma i-clopidogrel ngemva kokushaywa yisifo sofuba), ukwelapha okungcono kakhulu ngemuva kokushaya kabuhlungu akucacile. Ukuvumelana phakathi kwabachwepheshe kuleli phuzu, noma kunjalo, kuxhomeke ekusebenziseni ukwelashwa kwe-antiplatelet.
I-PFO Controversy
Esinye sezici eziphikisanayo zokushaywa kwe-cryptogenic ngumbuzo wokuthi zibangelwa kaningi kangakanani i-Patent Foramen Ovale (PFOs), okunye okubizwa ngokuthi yigodi enhliziyweni.
Ngokungangabazeki ezinye izingxabano ze-cryptogenic zikhiqizwa ngama-clots egazi awela i-PFO, angena ekujikelezeni, futhi ahambe eya ebuchosheni. Kodwa-ke, lesi simo asivamile, kuyilapho i-PFO ijwayelekile kakhulu. (PFOs ingabonakala kubantu abangaba ngu-25% kubo bonke abantu nge-echocardiography.)
Mhlawumbe, ngenxa yalesi sizathu, izifundo eziye zahlola izinzuzo ezikhona zokusebenzisa amadivaysi okuvalwa kwe-PFO ezigulini eziye zahlaselwa yi-cryptogenic strokes ziye zadumaza - akukho ukunciphisa ukushaywa okulandelayo. Ngesikhathi esifanayo, izinqubo ezisetshenziselwa ukuvala i-PFOs ziveza iziguli ukuba zibe nemiphumela emibi kakhulu.
Kungenzeka ukuthi kwezinye iziguli, ukuvala ama-PFO kungase kuzuze. Kodwa ngalesi sikhathi, akukho ndlela eqinisekisiwe yokunquma ukuthi iziphi iziguli ezine-cryptogenic stroke kanye ne-PFO ezizozuza ngokuvalwa kwe-PFO.
Kodwa-ke, ucwaningo lwamuva lubonisa ukuthi ngokusebenzisa ucwaningo lwe-Doppler , ngokubambisana nesifundo se-bubble, odokotela bangase baqale ukuthola lezo ziguli lapho izigameko ze-cryptogenic ezibangelwa yi-PFO. Kuzofundwa izifundo ezengeziwe ukuze kuhlolwe ukuthi ukuvala i-PFO kuzonciphisa ukushaya okulandelayo kulezi ziguli.
Okubaluleke kakhulu ukuthi ukuvalwa kwesimo se-PFOs ezigulini ezine-stroke ze-cryptogenic akunakulungiswa namuhla. I-American Academy of Neurology ngo-2016 yaxwayisa ngokungavumeli ukuvalwa kwe-PFO kubantu abaye bahlaselwa yi-cryptogenic strokes.
I-Fridaying Atrial kanye ne-Stroke ye-Cryptogenic
I-fibrillation ye-atrial iyimbangela eyaziwayo ye-stroke e-embolic, futhi iziguli ezine-fibrillation e-atrial ngokuvamile zidinga ukuba zichazwe.
Ubufakazi bamuva bubonisa ukuthi inqwaba yeziguli ezine-cryptogenic stroke ingaba "ne-subclinical" i-fibrillation ye-atrial - okungukuthi, iziqephu ze-fibrillation e-atrial ezingabangeli izimpawu ezibalulekile, ngakho-ke zingabonakali. Ngaphezu kwalokho, kukhona idatha ebonisa ukuthi ukuqapha kwenhliziyo okuhlala isikhathi eside kungase kube usizo ekuboniseni i-fibrillation e-atrial subclinical ezigulini eziye zine-cryptogenic stroke. Kulezi ziguli, kungenzeka ukuthi, njengamanye iziguli ezine-fibrillation ye-atrial, i-anticoagulation cishe inganciphisa ingozi yesifo esivamile.
Imithombo:
> Cujec B, i-Polasek P, i-Voll C, i-Shuaib A. i-Transesophageal Echocardiography ekuqaphelisweni komthombo we-Cardiac of Embolism in Stroke Patients. Ugwadule 1991; 22: 727.
> Lansberg MG, O'Donnell MJ, Khatri P, et al. Ukwelashwa kwe-Antithrombotic and Thrombolytic for Stroke Ischemic: Ukwelashwa kwe-Antithrombotic kanye Nokuvimbela I-Thrombosis, 9th: I-American College of Chest Physicians Iziqondiso Ezivela Emtholampilo Yokuzikhandla. I-Chest 2012; 141: e601S.
> Messe SR, Gronseth G, Kent DM, Et al. I-Practice Advisory: I-Stroke ejwayelekile ne-Patent Foramen Ovale (Ukubuyekezwa kweParamenti yokuSebenza) Umbiko weKhombandlela Yokuthuthukiswa, Ukusabalalisa Nokusebenza Kwenkomfa Ye-American Academy of Neurology. I- Neurology Ishicilelwe ku-intanethi ngoJulayi 27, 2016. 10.1212 / WNL.0000000000002961
Mohr, JP, Choi, WC, Grotta, JC, et al. Isifo: I-Pathophysiology, Ukuxilongwa, Nokuphathwa, I-4th Edition, uChurchill Livingstone, eNew York 2004.