I-Triad of Symptoms, i-MRI, ne-Lumbar Isikhathi sokuthola i-NPH
Ukucindezela okuvamile i-hydrocephalus ukukhuliswa kwezikhala ezibuchopho, ezibizwa ngokuthi i- ventricles , eziqukethe uketshezi lwe-cerebrospinal - uketshezi olucacile olugeza ubuchopho nomgogodla futhi ngokuvamile lubizwa ngokuthi i-CSF efingqiwe.
Ingcindezi evamile i-hydrocephalus ibangela ubunzima ukuhamba, ukucabanga, nokulawula isisu. Izimpawu zingathuthuka uma i-neurosurgeon ibeka amanzi ebizwa nge-shunt ezingxenyeni ze-ventricles ukuze i-CSF igqekeze esiswini esikhundleni sokugeleza ngaphansi kwekholomu yomgogodla.
Noma iyiphi inqubo ye-neurosurgical inomthelela owodwa, noma kunjalo, futhi izinzuzo zokubeka i-stent enjalo ye-NPH aziqiniseki ngaso sonke isikhathi - ngakho-ke i-NPH ebalulekile ihlolwe kahle. Ngisho nangemva kwalesi sinyathelo, ezinye iziguli zingase zithuthukise okuningi ngokubekwa okumile kunezinye.
Abacindezeli bokucindezela okuvamile Hydrocephalus
Ungacabanga ukuthi uhamba ngokuhlinzwa okwenzeka engozini, futhi ungathuthuki ngoba izimpawu zikhona ngenxa yesifo esithile njalo? Lokhu kuyingozi kakhulu e-NPH ngoba izimpawu zivame kakhulu kubantu abadala asezikhungweni ngenxa yezizathu ezahlukene.
Ukuhlukumezeka ukuhamba, isibonelo, kungenzeka ngenxa yesifo somgogodla , izinkinga zomzimba, izinkinga zombono, noma i-peripheral neuropathy. Ukungabikho kwe-urinary nakho kuvame kakhulu ekugugeni ngezizathu ezihlukahlukene. Ukukhubazeka kwengqondo kungahle kube ngenxa yezifo ezivamile kakhulu ezifana nesifo se-Alzheimer's. Okunye ukuwohloka komqondo kunganciphisa ingozi yokuhamba ngezinkinga, ezifana no-Lewy ukuwohloka komzimba, ukugula kwengqondo kaParkinson, noma ukucindezeleka kwengqondo.
Abaningi balabo abaxoshayo bangabandakanywa ngokucophelela ngokuhlolwa kwezempilo okuphelele. Isibonelo, i- Lewy yokugula komzimba noma isifo sikaParkinson singabangela izinkinga ezifanayo zokuhamba, kodwa zivame ukuba nomthelela omncane kune-NPH, futhi zivame ukuba nezinye izici ezifana nama- visualization ebonakalayo.
Enye inkinga ukuthi ukungena kwe-NPH akuvimbeli abantu ekubeni nengqondo engaphezulu, ikakhulukazi isifo se-Alzheimer .
Phakathi kwamaphesenti angama-20 kuya kwangu-60 abantu ababenengqondo ebuchosheni ngesikhathi sokuthungathwa kwatholakala ukuthi bane-pathology ye-Alzheimer's. Labo abanethemba lokubona i-dementia ukuxazululwa ngokufakwa kwe-shunt bangase badumale ngoba i-Alzheimer ayithuthuki nge-neurosurgery enjalo.
Izivivinyo ze-Neuropsychological and Laboratory
Izinyathelo zokuqala ekuxilongweni kwe-NPH cishe zizogxila ezinkomba ezinjenge-dementia. Ukubheka okujwayelekile kuyobandakanya ukuhlolwa kwe-laboratory yegazi ngezizathu ezingase ziguquke, ezifana nokuntuleka kwe-vitamin B12 noma isifo se-thyroid.
Ukuhlolwa kwe-neuropsychological kuzokwenziwa ukuqinisekisa ukutholakala kwezinkinga zengqondo, nakuba kungekho ukuhlolwa okulodwa okungaqinisekisa i-NPH. Amaphethini avamile ahambisana ne-NPH ahlanganisa ukuphuza emisebenzini ephelelwe isikhathi nokusebenza kabi emisebenzini yokunakwa kanye nokusebenza okuphezulu. Kodwa-ke, omunye ukukhubazeka komqondo, njengengqondo ye-vascular dementia noma i-Lewy yomqondo wengqondo yomzimba, kungabangela ushintsho olufanayo ekuhlolweni.
Ukufanekisa Ukubukeka Kwemagnetic Ukuthola I-NPH
Ngencazelo, iziguli ezinomshini ovuthiwe we-hydrocephalus zizoba ne-ventricles enkulu ekufundweni kwe-neuroimaging njengemifanekiso yamagnetic resonance (MRI) noma i-computed tomography (CT) . I-ventricles ivame ukukhudlwana njengoba ubuchopho behlehlela ekugugeni okuvamile noma kwenye i-dementias, kepha ku-NPH ukukhuliswa kwe-ventricular akufani nalokho okunye kobuchopho.
Kodwa-ke, okunye kokwesaba isahlulelo engxenyeni ye-neuroradiologist nokuphatha udokotela, futhi imibono ingahluka ngaleli phuzu. Ezinye izilinganiso ezishicilelwe ze-ventriculomegaly zikhona futhi zingaqondisa izincomo zodokotela kwezinye izimo, kepha lezi ziqondiso azivumelananga yonke indawo.
Amanye ama-MRIs ezigulini ezine-NPH show zinciphisa isignali lapho i-CSF igeleza ihambisa isiteshi esincane esibizwa ngokuthi i-Sylvia aqueduct ngokusebenzisa i-brainstem. Lokhu kucatshangelwa ukuthi kumelela ukugeleza okuphakeme okuphezulu. Ngenkathi lokhu kutholakala kungashiwo, ucwaningo oluningi alukhombisi ukuhlanganiswa okucacile phakathi kwalokhu kutholakala nokuthuthukiswa ngemuva kokuhlinzeka nge-neurosurgery.
I-MRI iyasiza futhi ekuhloleni izilonda zamakhanda ezimhlophe okungenzeka zibangelwa izifo zamathambo. Ngakolunye uhlangothi, izinguquko zesignali ku-MRI eduze kwe-ventricles zingabonisa izifo zesisulu noma ukuvuza okuketshezi ngenxa ye-NPH ngokwayo. Ucwaningo oluningi luye lwabonisa ukuthi kuncane amathuba okuba nomphumela omuhle ngokugxila uma kunezinkinga eziningi zamhlophe, nakuba izincwadi zihlukile ngalokhu. Ukusabela okunciphise ukugxila kweziguli ezinezilonda ezimhlophe kungase kube ngoba isignali yendaba emhlophe imelela isiteji esiphezulu se-NPH, noma inqubo yesifo ehlukile, njenge-dementia ye-vascular.
Ukususa i-CSF ukuze ihlolwe ukucindezela okuvamile kwe-Hydrocephalus
"I-standard standard yegolide" yokuxilongwa kwe-NPH yindlela yokuthuthukisa izimpawu nge-ventricular shunting. Lelizinga lingenasisekelo, kodwa, ukuze kuphakanyiswe inqubo enobungozi efana nokubeka indawo udokotela kumele aqiniseke kakhulu ukuthi isiguli sinesifo se-NPH. Asikho futhi isivumelwano salokho okuchaza ukuthuthukiswa okuphawulekayo kwezimpawu, noma isikhathi esingakanani ukulinda emva kokubeka isikhala ngaphambi kokuba lezo zithuthukisi zibonwe. Ngaphezu kwalokho, impendulo empofu ekukhunjweni ingabangelwa yizinkinga ezingaphezu kokungazi kahle-ngokwesibonelo, isiguli singase sibe nesifo sengqondo somqondo owengeziwe.
Ngenxa yokuthi ukufakwa kwe-shunt kuyinto engavamile, izindlela zokuhlukumeza ze-CSF ezingezansi zijwayele ukuzama ukuqinisekisa ukuthi ukuthuthukiswa kwesiguli kuyathuthuka. Lezi zindlela zihlanganisa ukukhishwa kwe-lumbar noma i-lumbar drain. Futhi, futhi, akukho okulinganiselwe kulokho okuchaza ukuthuthukiswa okuphawulekayo, okushiya odokotela ukuba bathembele esahlulelweni sabo kanye "nemithetho embalwa yesithupha."
Ukukhishwa kwe-lumbar kungenziwa ehhovisi likadokotela futhi kuhilela ukususwa kwesamba esikhulu se-CSF (phakathi kuka-30 kuya ku-50 cubic centimeters). Ukuthuthukiswa okuvame kakhulu kunokuhamba kweziguli, ngesivinini esisheshayo esisheshayo nobude obude. Ukuhlolwa kokucubungula nakho kungenziwa, kuhlanganise nokuhlolwa kokunakekelwa kanye nenkumbulo. Ukuthuthukiswa kulezi zilinganiso ezingamaminithi angu-30 kuya kwesigamu sehora ngemuva kokuba inqubo ibonise inzuzo yokugwema.
Indlela ehlukile ihilela ukubeka isikhala esikhashana endaweni, lapho i-CSF ingavuza khona ngamamitha ayizi-5 kuya ku-10 ngehora. Ucwaningo luye lwabonisa ukuthi lokhu kungaba yindlela enhle kakhulu yokumaka labo abazophendula ngokuzikhandla, nakuba ezinye izifundo zikhomba ukuthi iziguli eziningi ezingaphuthuki ngokukhipha zingase zithuthuke ngokuzikhandla.
Izindlela ezimbalwa ezisetshenziswa kabanzi zokuxilongwa kwe-NPH zibandakanya ukuqapha ukucindezelwa okungahambi kahle noma ukuhlolwa kwe-CSF ukumnika amandla, kepha ukuhlukumeza kwalezi zinqubo kubeka umkhawulo ukusetshenziswa kwabo okuwusizo. I-Cisternography, esebenzisa ama-radioisotopes ukuphenya ukugeleza kwe-CSF, ayibonwanga ukuthi ukubikezela imiphumela ngokubeka ukufakwa kwe-shunt. Amanye amasu okucabanga njengamasu amasha we-MRI noma ukuphuma kwe-photon eyodwa (CT) i-SP (TRE) idinga ukuphenywa okuqhubekayo ukuze kutholakale ukuthi bangasebenzisa kanjani ukuhlolwa kwe-NPH.
Ngaphansi
Ukuxilongwa kwe-NPH kuxhomeke emlandweni oqapheleko nokuhlolwa komzimba ukuqala ukukhipha ezinye iziphazamiso ezingabangela intambo efanayo yokudangala komqondo, ukungaqiniseki komnotho nokungahambisani nomzimba. I-MRI izobonisa ama-ventricle amakhulu abhekwa njengama-engxenyeni okunye kobuchopho, futhi angaphinde afake ezinye izincazelo zezokwelapha ezingase zibe khona. Ukukhishwa kwesibindi noma ukugoba okuhamba phambili okuholela ekuthuthukiseni izimpawu kuphakamisa kakhulu i-NPH yangempela engase izuze ekubekeni kwe-shunt nge-neurosurgeon.
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QAPHELA: Ulwazi olukulesi sayithi lunguzinhloso zemfundo kuphela. Akufanele isetshenziswe njengengxenye yokunakekelwa ngumuntu udokotela olayisenisi. Sicela ubheke udokotela wakho ukuze ahlolwe futhi aphathwe noma yiziphi izimpawu noma isimo sezokwelapha .