Ukuphazamiseka kukufa kweengcambu zengqondo, eziqhelekileyo eziveliswa kukuphazamiseka kwegazi ukuza kube yingxenye yengqondo. Iingxaki eziqhelekileyo zengxubevange ezinokubangela ukuphazamiseka zibandakanya i-thrombosis (i-clotting) yemithwalo yegazi kwingqondo, i- embolus (i-blood clot ehamba kwiingqondo kwaye ilala khona), kunye neengxaki zengingqi ezibandakanya imivenge yegazi kwingqondo, njenge- aneurysm okanye ukuvuvukala.
Emva kokuba umntu sele enesifo, ugqirha uya kuzama ukucacisa isizathu esithile, ekubeni isisifo esiqhekezayo sihlala siqulunqa unyango olungcono. Nangona kunjalo, kuma-40 ekhulwini lamatyala, nangona kunjalo, akukho nto ebangela ukuba ichongwe. Ukubetha kwesibanga esingaziwayo kuthiwa yi-cryptogenic stroke. (Igama elithi "cryptogenic" libonisa nje ukuba imbangela i-cryptic, okanye iphazamisekile.)
Xa Izibetho Zibizwa ngokuba yi-Cryptogenic?
Emva kwesifo, ngamanye amaxesha kunokuba kunzima ukufumanisa ukuba ukuphazamiseka kokuphuma kwegazi okwakubangele ukuphazamiseka kubangelwa i- clot yegazi eyenziwe endaweni (thrombus), i-clot yegazi eya kwiingqondo ukusuka kwenye indawo (i- embolus ), okanye enye ingxaki yesisulu.
I-stroke ayifanele ibizwa ngokuba yi-cryptogenic de ukuvavanywa ngokupheleleyo ngaphandle kokunikezela isizathu esithile. Ngokubanzi, ukuhlolwa okunjalo kufanele kubandakanye ukucinga ngengqondo (kunye ne- CT scan okanye i- MRI scan ), ukucinga ngemida yegazi ehambisa ingqondo (i-carotid duplex okanye i- transcranial Doppler studies), kwaye mhlawumbi i- angiography .
Ukongezelela, isifundo esipheleleyo se- echocardiographic yentliziyo sifanele senziwe, sifuna imithombo yenyama ye-embolus. Imithombo yezinto ezinentliziyo ifaka i-blood clots entliziyweni (ngokuqhelekileyo kwi-atrium yekhohlo), i- patent foramen ovale (PFO) , i- aneurysm ye-annum ye-atrial , i-fibrillation ye-atrial , okanye i- valve mitral prolapse (MVP) .
Ukuba akukho nto ibonakalisiwe emva kokuvavanya ngokucokisekileyo, ukubetha kuthathwa njenge-cryptogenic.
Iimbangela zangempela zezibetho ze-cryptogenic (ukuba ziyakwazi ukuchongwa) zininzi, kwaye abantu ababizwa ngokuba ne-stroke ye-cryptogenic yiqela eliphambili. Njengoko isayensi yezogqirha iphucula amandla ayo okuchonga imbangela yezibetho kwizigulane ngabanye, inani labantu abathi banesifo sokulila i-cryptogenic liya kuwela.
Ngubani Ofumana I-Cryptogenic Stroke?
Iiprofayili zezigulane eziye zabuhlungu iintlobo ze-cryptogenic ngokufanayo zifana nezigulane eziye zahlushwa izibetho zezizathu ezibonakalayo. Bajwayele ukuba ngabantu abadala kakhulu abanezinto ezinobungozi zesifo senhliziyo.
Izibetho ze-Cryptogenic zibonwa ngokulinganayo kumadoda nabasetyhini. Zingaba zixhaphake kubantu abamnyama nase-Hispanics. Nangona ukubetha kwe-cryptogenic kubantu abancinci (abangaphantsi kweminyaka engama-50) bafumana ingqalelo eninzi kuogqirha nakwiincwadi zonyango, uphando lubonisa ukuba ukusabalalisa ngokwexesha eliqhelekileyo imivimbo ye-cryptogenic kufana nokushaywa kwe-cryptogenic. Oko kukuthi, ukukwazi ukubona imbangela yokubetha kwabantu abancinci kufana nokufana nabantu abadala.
Yiyiphi iMbono emva kweCroptogenic Stroke?
Ngokuqhelekileyo, ukugxekwa kwesigulane esinezibetho ze-cryptogenic kubonakala kulunge ngakumbi kunemibala engenzi-cryptogenic.
Sekunjalo, umyinge we-2 weminyaka yesilinganiso esiphathekayo sesigidi se-15 ukuya kuma-20 ekhulwini.
Ekubeni unyango lokuthintela uhlangothi oluqhubekayo luxhomekeke kwimbangela yokubetha (i-antiticoagulation kunye ne-warfarin emva kokuphazamiseka kwe-embolic, i-antiplatelet yonyango kunye ne-aspirin okanye i-clopidogrel emva kokuphazamiseka kwe-thrombotic), unyango olungcono emva kwesifo sokukrakra singacacile. Ukuvumelana phakathi kweengcali kule nkalo, nangona kunjalo, kuxhomekeke ekusebenziseni unyango lwe-antiplatelet.
I-PFO Controversy
Enye yeengxaki ezinokuphikisana kwezibetho ze-cryptogenic ngumbuzo wokuba zingaphi zibangelwa yi-Patent Foramen Ovale (PFOs), mhlawumbi eyaziwa njengegodi entliziyweni.
Akungabazeki ukuba ezinye izibetho ze-cryptogenic ziveliswa ngamacenge egazi awela i-PFO, angene ukujikeleza, kwaye ahambe ekhompini. Nangona kunjalo, le ngxaki ayifumanekanga, ngelixa i-PFO ziqhelekileyo. (Ii-PFOs zinokufunyanwa kwi-25% yazo zonke abantu ngo-echocardiography.)
Mhlawumbi, ngenxa yoko, izifundo eziye zavavanya iingenelo zokusebenzisa izixhobo zokuvalwa kwe-PFO kwizigulane ezibethekile zididekile - akukho ncitshiseko ekuye kwafunyanwa. Ngexesha elifanayo, iinkqubo ezisetyenziselwa ukuvala ii-PFO ziveza izigulane ukuba zibe neziphumo ezibi kakhulu.
Kusenokwenzeka ukuba kwezinye izigulane, ukuvala i-PFOs kuya kuba luncedo. Kodwa ngelo xesha, akukho ndlela eqinisekisiweyo yokukhetha ukuba iziphi izigulane ezine-cryptogenic stroke kunye ne-PFO ziya kuzuza kwi-PFO ukuvalwa.
Nangona kunjalo, uphando olutshanje lubonisa ukuba ngokusebenzisa i- Drumpleral Doppler study , ngokubambisana ne-bubble study, oogqirha bangaqala ukufumana ezo zigulane ezibethelwa yi-PFO. Kuya kufuneka ukuba kwenziwe uphando olongezelelweyo ukuvavanya ukuba ukuvala i-PFO kuya kunciphisa izibetha ezilandelayo kule gulane yezigulane.
Umgca, nangona kunjalo, kukuba ukuvalwa kweziganeko ze-PFOs kwizigulane ezine-stroke ze-cryptogenic akunakulungiswa namhlanje. I-American Academy ye-Neurology ngo-2016 yaxwayisa ngokusondeza ngokuvakalayo ukuvalwa kwe-PFO kubantu abaye bavalelwa yi-cryptogenic strokes.
I-Fibrillation ye-Atrial kunye ne-Cryptogenic Stroke
I-fibrillation ye-Atrial yiyona nto eyaziwayo ngenxa yesifo esiyingozi, kwaye izigulane ezine-fibrillation ye-atrial zifuna ukuba zichazwe.
Ubungqina bwanamhlanje bubonisa ukuba incinci yezigulane ezine-stroke ze-cryptogenic zinokuthi zibe "ne-subclinical" i-fibrillation ye-atrial - oko kukuthi, iziqulatho ze-fibrillation ye-atrial ezingabangeli iimpawu ezibalulekileyo, ngoko ke zingabonakali. Ukongezelela, kukho idatha ebonisa ukuba ukubeka iliso kwimizimba yexesha elide kunokuba luncedo ekufumaneni i-subclinical frillment friction kwizigulane eziye zine-cryptogenic stroke. Kulezi zi gulane, mhlawumbi, njengakwamanye izigulane ezinefayili ye-agrification, i-anticoagulation inokunciphisa umngcipheko wesifo esivamile.
Imithombo:
> Cujec B, i-Polasek P, i-Voll C, i-Shuaib A. i-Transesophageal Echocardiography kwi-Detection of Potential Cardiac Source of Embolism in Stroke Patients. Stroke 1991; 22: 727.
> Lansberg MG, O'Donnell MJ, Khatri P, et al. I-Antithrombotic neThrombolytic Therapy ye-Iskrochem Stroke: I-Antithrombotic Therapy kunye nokukhuselwa kweThsissi, 9th: Ikholeji yaseMerika yase-Chest Physicians Izikhokelo zoBuchule boLwazi lweeNkcubeko. Ngomhla ka-2012; 141: e601S.
> Messe SR, Gronseth G, Kent DM, Et al. I-Practice Advisory: I-Stroke ephindaphindiweyo kunye ne-Patent Foramen Ovale (Ukuhlaziywa kweParameter ye-Practice.) Ingxelo yesiKhokelo soPhuhliso, ukuSasazwa kunye nokuPhunyezwa kweKomiti ye-American Academy ye-Neurology. I- Neurology iphetshwe nge-intanethi ngo-Julayi 27, 2016. 10.1212 / WNL.0000000000002961
Mohr, JP, Choi, WC, Grotta, JC, et al. Isisu: I-Pathophysiology, i-Diagnosis, ne-Management, 4 Edition, uChurchill Livingstone, eNew York 2004.