Chirwere chinonzi cerebrovascular chikwata cheboka rakasarudzwa remamiriro ezvinhu anogona kutungamirira kumigumisiro yecherebrovascular / s, kureva Kurohwa. Izvi zviitiko zvinokanganisa kuwedzerwa kweropa nemidziyo kuuropi. Iine akuvhara, kukura, kana kupararaZvinoitika, izvi zvinodzivirira maseru ehuropi kubva pakuwana oxygen yakakwana, inogona kukonzera kukuvara kwehuropi. Zvirwere zveCerebrovascular zvinogona kukura nenzira dzakasiyana. Izvi zvinosanganisira yakadzika vein thrombosis (DVT) uye atherosclerosis.
Mhando dze chirwere cheperebrovascular: Stroke, kurwisa kwechikafu chinokanganisa, aneurysm, uye vascular malformations
MuAmerica cerebrovascular disease ndiyo yechishanu inowanzokonzera rufu.
Mukati
Cerebrovascular Disorders
The Brain
- Inoita ~ 2% yechipimo chemuviri
- Maakaunzi e ~ 10% yemuviri wekushandisa oxygen
- Maakaunzi e ~ 20% yemuviri wekushandisa glucose
- Inogamuchira ~ 20% yemutambo wemoyo
- Paminiti, inoda ~ 50-80cc yeropa pamusana pe100g ye grey nyaya yehuputi tissue uye ~ 17-40cc yeropa pa 100g yemuchena
- If ropa kuuropi iri <15cc pa100g yetishu, paminiti, kusagadzikana kweurourogic kunoitika
- Sezvo nemasukisi ose, iyo yakareba iine ischemia, zvinowanzove zviripo kuva sero rufu uye necrosis
- Uropi hunoenderana nehupenyu hunogara huchigadziriswa, husina kuvharwa we okisijeni uye glucose
- 3-8 maminitsi ekumanikidzwa kwemwoyo kunogona kukonzera kukanganisa kwepfungwa dzisingagoneki!
Autoregulation In The Brain
- Simba rinokonzera hutachiona hunokonzera kushanda kwehutachiona hwemhepo kuitira kuti ropa rakawanda riwedzere kuuropi
- Uropi hunogona kukonzera okisijeni yakakwana kubva muuropi kana systolic inokonzera 50 mmHg
- Atherosclerotic narrowing inogona kuita kuti vasedilation isashandise kuedza kuderedza kudzvinyirira zvakanyanya
- Kuwedzera kweropa rega kunogona kukonzera vasoconstriction, kuderedza mikana yekushaya ropa
- Kana systolic kumanikidza avhareji> 150 mmHg kwenguva yakareba, muripo uyu ungatadza
- Yakabatwa nehutachiona hwekudzivirira
Kupa Ropa KuMusoro
madeinkibera.com/lingual-arterie-anatomie
Collateral Circulation
- Mukufamba kwenguva pfupi kufambira mberi kwakadai seatrosclerotic thrombosis, kushambadzirwa kwezvikwata kune nguva yekukura
- Denderedzwa yaWotis inobatanidza hurongwa hwe carotid uye buslar
- Anterior uye posterior kutaurirana magetheni inopa kubhadhara
- Anastomoses pakati pehutachiona hukuru uye cerebellar arteri mune vamwe vanhu
- Yemukati neyekunze carotid arteri yekubatanidza kuburikidza neiyo ophthalmic & maxillary arteri
Circle Of Willis
- Inobatanidza vertebrobasilar system nechomukati carotid system
- Paunenge uchipa rubatsiro runobatsira runoshandiswa, ndiyo nzvimbo inonyanya kunetseka kuBerry Aneurysms iyo inogona kukonzera kuparara kwepakati
en.wikipedia.org/wiki/Circle_of_Willis
Kuwedzerwa kweRopa KuBongo
teachingmeanatomy.info/neuro/vessels/arterial-supply/
Maxillary & Ophthalmic aa.
Cerebrovascular Disorders
- ~ 700,000 vanhu vakuru muUnited States vane chirwere gore negore
- Chechitatu chinowanzokonzera rufu muUnited States
- ~ 2 mamiriyoni evanhu akaremara nekuda kwekurohwa
- Nezvinozivikanwa zvikuru kune vanhu vakura
- Occlusive / Ischemic Disease
- 80% yezvisungo zvose
- Nzvimbo yakawanda inowanzozivikanwa yekusvibiswa iri mukati memutambo wecarotid kumusoro kwepamusoro pezvakagadzirwa zvemahara carotid a.
- Atherothrombotic
- Embolic
- Muduku muduku
- Hemorrhagic Disease
Occlusive / Ischemic Stroke
- Inogona kunge yakakonzerwa netiyiti kana mishonga yemazuva
- Arteri occlusion yakawanda zvikuru
- Nekuda kwekushayikwa kweropa & oksijeni kupihwa kunosvika kune imwe nzvimbo yeuropi
- Kamwe kamwe-kamwe kunotanga kukanganisa kweurosi, kuwirirana nekugoverwa kweteri chaiyo
- Kukanganisa kuchasiyana zvinoenderana nekuti kugoverwa kwetsinga kwakakanganiswa
Venous Occlusion
- Hyperviscocity
- nemvura
- Thombocytosis
- Yakasvibirira tsvuku kana masero masero eropa anoverenga
- Polycythemia
- Hypercoagulability
- Elevated homocysteine
- Kuramba kwenguva refu kana kufamba ndege
- Genetic clotting factor disorders
- Kuberekwa
- kenza
- Hormone kutsiva & OCP kushandiswa
Atherothrombotic
- Kukanganisa kweeurologic kunogona kuva kwenguva pfupi kana kukura zvishoma nezvishoma kupfuura nguva
- Zvimwe zvinokonzera / marudzi:
- Dissection ye tunica intima uye tunica adventitia
- Zvinogona kuitika kune varwere vaduku vane zvirwere zvinogadzirisa zvirwere
- Zvekuzvimba zvinhu zvinochengeterwa & kuvaka mumidziyo masvingo
- Oxidized LDLs inopa mudziyo masvingo
Embolic
- Zvinokanganisa neurologic zvingangodaro zvichingoerekana zvaitika
- Akabvisa tissue kubva pakutsvaga kwe tunica intima uye tunica adventitia
- Chero chipi nechipi chinoputika chinyorwa chinogona kunge chichivhara / kupfiga chiedza chemidziyo miduku
Chikepe Chidiki
- Lipohyalinosis
- Vessel rusvingo micro-trauma & ballooning
- Amyloid Angiopathy
- Kuunganidza mapuroteni emamyloid mumadziro emadziro
- Zvimwe zvakajairika muvarwere> makore makumi matanhatu nemashanu ekuberekwa
- Zvinokonzera kuderedza (kutungamirira kune ischemia) asi kunogonawo kukonzera mhepo fragility (inotungamirira ku kuora ropa)
- Yakabatana nechirwere cheAlzheimer
- Kuvhiringidza
- Spasmotic
Zvinokonzerwa Nengozi Zvokuda Kuita Simba
- Hypertension
- Diabetes mellitus
- Cardiac kusakanganisika
- Kurudyi-kuruboshwe (Patent foramen ovale, VSD, tetralogy yenhema, etc)
- Atrial fibrillation
- Chirwere chevhavha / mapapiro emwoyo mavheti
- Nguva yakwegura
- kufutisa
- Hyperlipidemia
- Kunyanya high LDL uye pasi peHDL
- Sedentary lifestyle
- Sodya / Fodya fodya
- High oxidation status
- Elevated homocysteine
- Yakapihwa kune yakaderera folic acid, B6 & B12 mamiriro
- Inopindirana neLDL cholesterol
- Hyperviscocity uye hypercoagulability inotaura sezvinoratidzwa pane slide yapfuura
Chirwere cheIschemic Chidiki (TIA)
- Zvikamu zvakakwana zvekudzoka kwehutano hwehutano hwepfungwa nekuda kwekusagadzikana kwevasculasi zvinowanzogara pasina maminitsi e30 panguva imwechete
- Dzimwe nguva dzinogona kupedza maawa 24 kana kupfuura
- Hafu yevarwere avo vanotambura nechikwata chakazara chekare chakange chine nguva shoma ischemic attack (s)
- 20-40% yevarwere vane TIA vanoramba vaine chirwere chakakwana
- Mukati zvakakosha kuzivisa varwere vane TIAs kuti vangave vakakwanisa kunyatsogadziriswa uye kuchinjwa kwezvinhu zvinowedzera kuderedzwa
Nhoroondo Yeinononoka Neurologic Dhefisiti Mune Murwere> 45 y / o
- DDx
- TIA kazhinji dx
- Migraine
- Focal seizures
- BPPV
- Meniere s
- Kuderedza zvirwere
- Temporal arteritis
- Hypoglycemia
- Tumor
- Arteriovenous malformations
Carotid Artery Disease
- Yakazara yakasungwa systolic mheremhere inzwiwa pamusoro pecaritid arteri inogona kuratidza carotid stenosis
- Zvinoda duplex ultrasound kuongorora
- Maronda anoderedza lumen> 70% inogona kukonzera ischemia
- Zvakawanda zvekugadzirisa carotid hazvikonzeri ischemia nekuda kwekukurumidza kufambira mberi kunobvumira kushandiswa kwekuchengetedzwa kwekugadziriswa kuti ibudirire pamwe chete
- Kukurumidza kugadzira occlusions kana emboli kunogona kuburitsa matambudziko ne <70% stenosis
- Kupindira kwekuvhiya kunofanirwa kutariswa kune varwere vane> 70% stenosis uye zviratidzo zveTIA
Occlusive Stroke
- Kana paine kutanga kwechikonzero chakasimba chechirwere chepfungwa, murwere anofanirwa kuva neCCT kuti atonge kunze kwehutachiona
- Kana kuora ropa kuchibviswa kunze, mishonga inonzi plasminogen activator inofanira kupiwa mukati mekutanga kwemaawa 4.5
- Hazvifanirwi kupiwa mushure meizvi nokuti inogona kuwedzera njodzi yekubuda ropa panguva yekushandurwa kwehuputi tissue
- Mushure mekutanga kwekutanga, tarongedzo yekrombolysis kana kushandiswa kwema mechanical ye embolus
Intracranial Hemorrhage
- Inenge 20% yemakumbo emakumbo
- Ha HA yakajeka kana kurutsa zvinoratidza kuora kwemvura pamusoro pekushandiswa
- Mhando mbiri
- Kunokonzera kusagadzikana kwekushaya ropa
- Hypertension
- Arterial aneurysms
- Arteriovenous malformations
- Kusvibisa zvinetso
- Chikepe chinopera simba nekuda kwekunyengedzera kwemajozi
- Kutambudzika
Aneurysm Sites
- Intraparenchymal hemorrhage
- 50% - Matavi anonzi Lenticulostriate emutambo wepakati cerebral artery
- Unoshushikana ne-putamen nekunze capsule
- 10% - Matavi anoputika anonzi posterior cerebral artery
- Inobata thalamus
- 10% - Matavi anoputika e-cerebellar artery yakakwirira
- Inobata cerebellum
- 10% - Paramedian mapazi e-buslar artery
- Inokanganisa buslar pons
- 20% - Mitambo yakasiyana inobata nzvimbo dzemavara machena
- Subarachnoid homorrhage
- Bherry aneurysms pakukurukura arteri masangano
Kuderedza kuora Kwemhepo
- Thrombocytopenia
- Leukemia
- Kunyanya anticoagulant therapies
Zvinokonzerwa Nengozi NeHemorrhagic Stroke
- Hypertension
- Arterial aneurysms
- Arteriovenous malformations
- Kusvibisa zvinetso
- Chikepe chinopera simba nekuda kwekunyengedzera kwemajozi
- Head trauma
Zviratidzo zveSproke: Dzidzisa Vatano FAST
chrcsf.org/expert-tips-to-help-with-detecting-the-early-signs-of-stroke/
Zviratidzo Zvenguva Zvose
- Vertigo
- Kushamwaridzana kana kurasikirwa kwemaonero
- Ataxia
- Diplopia
- Kubatanidzwa kana kusagadzikana kwekunamatira uye kushaya motokari
- Syncope
- Kushaya simba mukuparadzirwa kwemhepo inokonzera mutsara imwe rutivi rwemusoro nemutambo unonzi hemiparesis (utachiona hunokanganisa brainstem)
- Kukuvadzwa kune sensory cranial nerve & Horner's syndrome kune rimwe divi remusoro uye kurasikirwa kwe contralateral. marwadzo uye kutonhora kunzwa mumuviri (lateral brainstem kukuvara)
Zviratidzo Zvenguva refu Ichitenderera Kunzvimbo Yakatarisana
- Monocular visual obscuration (amaurosis fugax) inokonzera retinal ischemia
- Contralateral hemiparesis
- Kukanganisa kweHemisensory
- Mavara ekuona mashoma
- Dysphasia
- Inogamuchira aphasia (Wernicke s nharaunda lesion)
- Anotsanangura aphasia (Broca s nzvimbo lesion)
- Contralateral kukanganwa (pane-pineetal parietal lobe lesion)
- Matambudzikowithinitiationofmovement (Supplementarymotorcortex lesion)
- Dambudziko nekutarisa nokuzvidira kumativi akasiyana (Frontal eye field lesions)
- Mhedziso yenguva pfupi yekuyeuka
Ubongo-Stem Syndromes
roho.4senses.co/stroke- syndromes / zvakajairika-sitiroko- syndromes-chitsauko-9-bhuku-rekurohwa-sitiroko.html
Stroke Recovery
- Rehab inoda kutarisana nenharaunda yehupi hutachiona hwakashungurudzwa nemuroyo
- Kutaura kwekutaura
- Chiremera chekushanda kwemakumbo
- Kuenzanisa uye gadziriro maitiro
- Inokurudzira neuroplastic restructuring
- Zviratidzo zvinogona kuvandudzwa mukati mezuva rekutanga re5 nekuda kwekuderedza edema
- Edema inogona kukonzera herniation kuburikidza ne foramen magnum iyo inogona kukonzeresa kukanganiswa kwehuropi uye kufa - varwere vane dambudziko iri vangangoda craniectomy (yekupedzisira kushandiswa)
Sources
Alexander G. Reeves, A. & Swenson, R. Kukanganiswa kweNervous System. Dartmouth, 2004.
Swenson, R. Cerebrovascular Disorders. 2010
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