I-Dysautonomia ne-Trouble ne-Autonomic yeNervous System
Isimiso sezinzwa ezizimele silawula imisebenzi ebalulekile yomzimba njengezinga lenhliziyo nokucindezelwa kwegazi okusigcina siphile ngaphandle kokucabanga kwethu ngabo. Cishe noma yisiphi isifo sezokwelapha singathinta isimiso sezinzwa ze-autonomic ngandlela-thile, nakuba izifo ezimbalwa zihlasela isimiso sezinzwa ezizimele kuphela. Ngezansi ezinye zezinhlobo ezivame kakhulu zesistimu yezinzwa ezizenzekelayo, noma i- dysautonomia :
Ukukhubazeka Okumangalisayo Kwe-Autonomic
Ukukhubazeka okuzenzekelayo, okuchazwe okokuqala ngo-1975, kuhlala kungavamile kakhulu kodwa kuyisibonelo esihle sokwenzekayo lapho yonke imisebenzi yezinzwa ezizimele isengozini. Izimpawu zifika ngaphezu kweviki noma amasonto ambalwa ngokulahlekelwa okuphelele kwemisebenzi eminingi yokuzimela futhi zihlanganisa amehlo omile, hypotension orthostatic , ukuntuleka kwesibindi, ukungabi namandla, isisindo esingenakubumba nesibilini, nokuhlukunyezwa kwesisu nesisu. Zombili izintambo eziphazamisekile nezizwelayo ziyathinteka, nakuba ezinye izinzwa zisinda. Ukukhishwa kwe-lumbar kungabonisa iphrotheni ephakeme ku- CSF . Isizathu asitholakali sitholakale, nakuba kungenzeka ukuthi isifo esizimele ngokufana nesifo se- Guillain-Barre syndrome . Ukwelashwa okungcono kakhulu akucaci, nakuba abanye baye batusa ngcono emva kokushintshaniswa kwe-plasma, noma ukuphathwa kwe-IVIG.
Idiopathic Orthodotic Hypotension
Isifo esingajwayelekile esidabulisayo, idiopathic orthostatic hypotension iqala maphakathi nokuphila kwesikhathi sekwephuzile futhi ihilela izilonda kule-neurons ezwelayo enobuhlungu, okuvimbela inhliziyo ukuba ingasheshi uma kudingeka.
Lokhu kungavamile kakhulu; i-dysautonomia ejwayelekile ephakathi kwe-preganglionic ehlanganisa ukuwohloka kwengxenye yomgogodla owodwa lapho i-autonomic nerve fibers ihamba khona uphondo lwe-lateral. Kunoma yikuphi, ukwelashwa kuqala ngezinguquko ezingapheli zokuphila, kubandakanya ukugqoka izingcindezi zezingcindezi, futhi ukuguquka kancane kancane ukusuka ekuhleleni ukuya ekumeni.
Uma lokhu kunganele, imithi efana ne-midodrine noma i-florinef ingadingeka.
I-hypotension yesi-Orthostatic yesibili
Kule ndlela evelele kakhulu ye-dysautonomia, i-peripheral neuropathy, njengaleyo etholakalayo kusifo sikashukela , ibuye ifinyelele isimiso sezinzwa ezizimele ze-peripheral. Kuneminye yezimbangela ezihlukahlukene, kuhlanganise nokusetshenziswa kotshwala obunzima, ukuphuluka kokudla okunomsoco, noma ukuchayeka okunezingozi.
I-dysautonomia ehamba ne-neuropathy yesifo sikashukela ivame kakhulu futhi ingabonisa ukungabi namandla, isifo sohudo, nokuqothulwa, ngaphezu kwe-hypotension ye-orthostatic. Lezi zimpawu zingase zibe nzima kakhulu noma zingase zingabi naso njengoba izinguquko ezithinta izinzwa ezibangelwa yisifo sikashukela se-peripheral neuropathy. Kubalulekile futhi ukuqaphela ukuthi lezi zindlela ze-neuropathia zengqondo ngezinye izikhathi zandulela ukuhlolwa kwesifo sikashukela, kanti ezinye izivivinyo ze-laboratory ezisetshenziselwa ukuxilonga isifo sikashukela, njengezinga le-hemoglobin A1c, lingase libe ngaphansi kohlobo olujwayelekile. Ngamanye amazwi, izinzwa ze-peripheral zingase zizwele kakhulu kunezivivinyo zokuxilonga ezisetshenziswa odokotela ukuthola isifo sikashukela.
Ezinye izinhlobo ze-peripheral neuropathy, njengalezo ezibangelwa i- amyloidosis , zinama-dysautonomiya anamandla nakakhulu. I-neuropathy ezuzwe njengefa eyabangelwa yisifo se-Fabry (i-alpha-galactosidase ukuntula) ingabangela futhi i-dysautonomia eyaziwa.
I-Riley-Day Syndrome
Nakuba cishe ingxenye yesine yabantu abaneminyaka engaphezu kwengu-65 banezinhlobo ezithile ze-dysautonomia njengoba kuboniswe yi-orthostatic hypotension, i-dysautonomia ayitholakali kakhulu kuncane kakhulu. Okunye okuhlukile yi-dysautonomia ezuzwe njengefa okuthiwa i-Riley-Day syndrome.
I-Riley-Day Syndrome izuzwe njengefa ngokweqile, okusho ukuthi abazali bangase bangathinteki nakuba ingane isifo. Izimpawu zihlanganisa ukungezwani kwe-postural, ukucindezeleka kwegazi , i-hyperhidrosis, ukuhlanza nge-cyclic, ikhono lomzwelo, nokunciphisa ukuzwela kobuhlungu. Lezi zimpawu zibangelwa ukwehluleka kokufuduka kwamaselula ngesikhathi sokuthuthukiswa.
I-Trauma ne-Autonomic System yeNervous
Izinzwa zomzwelo zigijima ngentambo yomgogodla kulokho okuthiwa yi-intermediolateral cell columns. Uma lezi zinsika ziphazanyiswa ngenxa yokuhlukunyezwa nge-hypotension, ukulahlekelwa ukujuluka, ukukhubazeka kwesisu, nokukhubazeka kwamathumbu kungaholela; lokhu kwaziwa ngokuthi ukuphazamiseka komgogodla. Ukunika i-naloxone kubonakala kunciphisa ezinye zezibonakaliso: imisebenzi ezwelayo kanye ne-parasympathetic izobuya ngemva kwesikhashana, kodwa ngeke isakwazi ukulawulwa kwezakhiwo eziphakeme. Isibonelo, uma ukucindezeleka kwegazi kuwela, imithwalo yegazi yomzimba ngeke ikwazi ukulinganisa, ngoba lokhu kuxhomeke ekukhulumisaneni phakathi kwe-medulla ebuchosheni be-brainstem kanye nalo lonke umzimba ngomugogodla. Amanye ama-reflexes, noma kunjalo, azohlala ephelele. Uma isikhumba sikhonjiwe engalweni, isibonelo, imithwalo yegazi kuleso salo iyoba namandla, okuholela ekucindezeni okwenyuka kuleso sigaba.
Abantu abanesifo se-tetraplegic njengomphumela wokulimala komgogodla bangase bahlupheke kulokho okubizwa ngokuthi i-autyomic dysreflexia. Ukucindezelwa kwegazi kuphakama, izinga lezinhliziyo liyehla, kanti izingxenye ezingaphansi kwe-lesion zingase zithole futhi zifiputhe ngokweqile, ngaphezu kwemifucumfucu yomlenze nokuxoshwa kwesibindi. I-dysreflexia ye-autonomic ingasongela ukuphila uma ingelashwa ngokushesha.
Ukulimala okukhulu kwekhanda noma i- cerebral hemorrhages ingaphinde ikhulule ama-catecholamines adrenal futhi yandise ithoni ezwelayo. Ngezinye izikhathi izixuku zingagxila kwi-brainstem, eziholele ekushiseni okukhulu komfutho wegazi, ukuphefumula okungavamile, nokuncipha kwenhliziyo kulokho okuyaziwa ngokuthi impendulo yeCushing, isibonakaliso esibuhlungu sokucindezela okwenyuka kokungenelela.
I-Dysautonomia Ngenxa Yezidakamizwa Nezoxhuzo
Ukuphazamiseka komgogodla kufana nezinye izinkinga ezizimele ezibizwa ngokuthi "izivunguvungu ezizwelayo," okungenzeka kubangelwe ukusetshenziswa kwezidakamizwa, njenge-cocaine. Imithi eminingi enqunyiwe isebenze ngokusebenza ohlelweni lwezinzwa ezizimelayo, futhi ngokufanayo ngeshwa njengama-toxin amaningi. Izinambuzane ze-Organophosphate kanye ne-sarin, isibonelo, kubangele ukungasebenzi kahle kwe-parasympathetic.
Amanye ama-Dysautonomias
I-hyperhydrosis ingasongela impilo, kepha isengaba yidysautonomia engaba namahloni okuholela ekuphefumuleni okunzima okungafanele. Ngokuphambene nalokho, i-anhydrosis ibangela ukujuluka okuncane kakhulu, okungaba yingozi uma kuholela ekuqotheni.
Isimo sikaRaynaud senza ukwehla kwegazi kuya eminwe emakhazeni futhi kuvame ukuhlotshaniswa ne-peripheral neuropathy noma isifo sofuba esinjenge- scleroderma .
Ukukhubazeka kwesisindo kuvamile futhi kungabangela izinhlobo eziningi zezinkinga, kufaka phakathi ama-dysautonomias. Ukulondolozwa kwesibindi kuyinkimbinkimbi, futhi isenzo esibonakala sengathi esilula sokuvuthwa empeleni sincike ekubambiswaneni okusheshayo phakathi kwemisebenzi yenzalo yokuzithandela, ezwelayo, kanye ne-parasympathetic. Mhlawumbe ngoba umsebenzi wesibindi esifanele uxhomeke ezingxenyeni eziningi ezihlukene, akumangazi ukuthi izinkinga zivamile, futhi zingabandakanya ukungabi khona kwe-incontinence noma ukugcina umchamo.
Akunakwenzeka ukubhekana nazo zonke izici ze-dysautonomia kusihloko esisodwa. Ngaphezu kwalokho esikuhlanganisile, ngezinye izikhathi izingxenye zomzimba, njengezeso (njengase-Horner's syndrome) noma isilwane (njengokungathi ku-dlexstrophy ezwelayo). Lesi sihloko singase sisebenzise njengesingeniso esivamile, futhi sivuselele ukufunda okuqhubekayo kulabo abafuna ukwaziswa okwengeziwe.
Imithombo:
Adams kanye Nemigomo kaVictor ye-Neurology, 9th ed: The McGraw-Hill Companies, Inc., 2009
I-Blumenfeld H, i-Neuroanatomy ngokusebenzisa ama-Clinical Cases. I-Sunderland: Abakwa-Sinauer Associates Publishers 2002