Ubuchopho ngokwemvelo bulinganisela phakathi kwe-hemispheres kwesokunxele nesekunene. Enkampanini ye-computed tomography (CT) ebuka phansi ebuchosheni kusukela phezulu kwekhanda, kunemvula egijima phakathi kwezinhlangothi zombili zobuchopho obuphakathi komzimba. Umthambo womgogodla uvela emkhatsini webuchopho obuphakathi futhi uqhubeka phansi phakathi nendawo.
Ukushintsha kwe-midline kwenzeka lapho okuthile kuqhuma lesi sikhungo semvelo sesimo sobuchopho ngakwesokudla noma ngakwesobunxele. Kuyinto emayelana nesibonakaliso emva kokuhlukunyezwa kwekhanda.
I-Midline Shift ne-Intracranial Pressure
Ubuchopho bugcina izinga lokucindezeleka kwemvelo ngaso sonke isikhathi. Ingcindezi evamile ngaphakathi kwe-skull i-5-15 mm / hg. Le ngcindezi yokuqala idalwe ngamanzi, izicubu kanye nokugeleza kwegazi ngaphakathi kwe-skull bkull.
Ukuhlukunyezwa kwekhanda kungakhuphula ngokushesha futhi ngokuphawulekayo ukucindezela okungahambi kahle (ICP). Uma kunemfutho enamandla ekhanda, imithwalo yegazi ihlukana futhi iphuluke ngaphakathi nangaphakathi nobuchopho. Njengoba inhliziyo iqhubeka ishaya igazi elisha ebuchosheni, igazi elengeziwe eliphuma emifuleni yegazi ephukile liqala ukubuthelela. Lokhu kuphakamisa ukucindezela kobuchopho jikelele kanye nokuqoqwa kwegazi okubizwa ngokuthi i-hematoma , kuqala ukuphikisana nezicubu zobuchopho.
Ezinye izimbangela zokukhula kwe-ICP ngemuva kokuhlukunyezwa kwekhanda zihlanganisa ukuvuvukala kobuchopho kuzungeze indawo yokulimala, isimo esabizwa ngokuthi i-hydrocephalus eqoqweni lomswakama emaqenjini obuchopho, nokutheleleka.
Ukushintsha kwe-midline kwenzeka lapho ingcindezi eyenziwa yi-buildup yegazi nokuvuvukala ezungeze izicubu ezikhungethwe ubuchopho kunamandla okwanele ukuchofoza lonke ubuchopho phakathi nendawo. Lokhu kubhekwa njengesimo esiphuthumayo sezokwelapha futhi kuyisignali esabekayo.
Ukuxilongwa
Isivivinyo esivame kakhulu ukukhomba ukushintsha kwe-middleline yi- CT scan .
Kodwa-ke, kwezinye izimo, ukuhlolwa kwe-CT akunakwenzeka ngoba isiguli asizinzile, noma ngoba izilinganiso ezivamile zifunwa ukulandelela ukuqhubeka kwegazi. Kulezi zimo, i-sonography ye-bedside ingasetshenziselwa ukuxilonga nokulandelela ukuthuthukiswa kwe-shift midline.
Kunezinhlaka ezintathu ezibalulekile ezihlolwe lapho kutholakala ukuba khona kwe-midline shift: i-septum pellucidum, i-ventricle yesithathu, ne-pineal gland.
- I-septum pellucidum : i-membrane elincanyana egijima ngqo phakathi nendawo yobuchopho
- I-ventricle yesithathu : isikhala esigcwele uketshezi lwe-cerebrospinal olujulile phakathi kobuchopho
- Ingwenya ye-pineal : i-gland encane elele ngemuva kwe-ventricle yesithathu
Izindawo zalezi zakhiwo ezingu-3 zobuchopho zikhonza njengamaphuzu okubhekisela ku-scan radiological. Uma ngabe kukhona okungahambisani nalokhu, lokhu kubonisa ukuthi ukucindezela ngakolunye uhlangothi lobuchopho kushukumisa ubuchopho ngaphandle kwesimo.
Ukwelapha
Ukwelashwa okubaluleke kunazo zonke uma ukushintsha kwe-midline kukhona kunciphisa ukucindezela okuqhubekela phambili ebuchosheni. Uma iqoqo legazi liyimbangela, njenge-hematoma engaphansi komhlaba, kuzodingeka ukuhlinzwa ukuze ususe i-clot yegazi bese umisa ukuphuma kwegazi.
Ama-antibiotics asetshenziselwa ukuphatha ukutheleleka kanye ne-steroids ingasetshenziselwa ukunciphisa ukuvuvukala.
Isibikezelo
Ucwaningo oluthile luhlolisise imiphumela yokushintshwa kwe-midline kwimiphumela yesikhathi eside. Njengoba ukushintsha kwe-midline kwenzeka ngenxa yokuphuma kwegazi nokucindezela, inani lokuphuma kwegazi, indawo yokulimala, kanti izinga lonke locindezelekile olunebuchopho yizo zonke izinto ezibalulekile.
Uma ubuchopho buhamba, lokhu kubangela ukuhlukumeza kwezinye izakhiwo njengoba zidonsa futhi zikhishwe endaweni yazo yemvelo. Ukushintsha okukhulu kwe-midline, kubiza kakhulu izinkinga futhi kube nengozi yokufa.
Imithombo:
Bartels, RH, & Meijer, FJ (2015). Ukushintsha kwe-midline ngokuphathelene nobukhulu be-hematoma eyingozi kakhulu ye-subdural ibikezela ukufa. BMC Neurology , 15 1-6 6p. i-doi: 10.1186 / s12883-015-0479-x
Liu, R., Li, S., Su, B., Tan, CL, Leong, T., Pang, BC, & ... Lee, CK (2014). Ukutholakala ngokuzenzakalelayo kanye ne-quantification ye-shift midline shift usebenzisa imodeli ye-anatomical marker. I-Medical Imaging And Graphics yekhompyutha , 38 1-14. doi: 10.1016 / j.compmedimag.2013.11.001