Ingqondo isingqinelana ngokulinganayo phakathi kwe-hemispheres ekhohlo kunye nelungelo. Kwi-scan computed tomography (CT) ejongene neengqondo ezivela phezulu entloko, kukho i-groove egijima phakathi kwamacala omabini engqondo ephakathi komzimba. Intambo yomthambo ivela kwi-middle-base of brain kwaye iqhubeka iphantsi kwinqanaba lomva.
Ukutshintsha kwe-midline kwenzeka xa kukho nto iqhubelela esi sikhungo sendawo yengqondo engxondeni okanye ngakwesobunxele. Ingumqondiso emva kweentlungu zentloko.
Midline Shift kunye ne-Intracranial Pressure
Ingqondo igcina inqanaba loxinzelelo lwendalo ngexesha lonke. Uxinzelelo oluqhelekileyo ngaphakathi kwekhayi li-5-15 mm / hg. Olu xinzelelo olusisiseko luyilwe ngamanzi, izicubu kunye nokujikeleza kwegazi ngaphakathi kwegrey bony.
Intlungu yongxowankulu inganyusa ngokukhawuleza uxinzelelo lwe-intracranial (ICP). Ukuba kukho ukuvuthela okunamandla entloko, imithwalo yegazi iphuma kwaye iphuma ngaphakathi kwaye ijikeleze ingqondo. Ekubeni intliziyo iqhubela phambili ukupompa igazi elitsha kwingqondo, igazi elongezelelweyo elikhupha emifuleni yegazi ephukile liqala ukuqokelela. Oku kuphakamisa uxinzelelo lweengqondo kunye nokuqokelela kwegazi, okubizwa ngokuba yi-hematoma , kuqala ukuxhoxhela kwiisisu zomzimba.
Ezinye izizathu zokunyuka kwe-ICP emva kokusasazeka kwentloko kubandakanya ukukhukhumeza kwengqondo kwiindawo zokulimala, imeko ebizwa ngokuba yi-hydrocephalus eqokelelwa ngamanzi e-ventricles yengqondo kunye nokusuleleka.
Ukutshintsha kwe-midline kwenzeka xa uxinzelelo oluqhutywe ngunxungu lwegazi kunye nokuvuvukala malunga neengcambu zeengqondo ezinobungozi zinamandla ngokwaneleyo ukuba zitshintshe ingqondo yonke. Oku kubonwa njengongxamiseko lwezonyango kwaye kuyisimboli esichukumisayo.
Ukuxilongwa
Uvavanyo oluqhelekileyo ukuchonga ukutshintsha kwe-midline yi- CT scan .
Nangona kunjalo, kwezinye iimeko, i-CT scan ayinakwenzeka ngenxa yokuba isiguli asizinzile, okanye ngenxa yokuba imilinganiselo rhoqo ifuna ukulandelela inkqubela yegazi. Kule meko, iingcamango zengqengqelo zingasetyenziselwa ukuxilonga nokulandelela ukuphuhliswa kwe-shiftline.
Kukho izinto ezintathu ezibalulekileyo ezivandlakanywayo xa kuqikelelwe ubukho be-shift line: i-septum pellucidum, i-ventricle yesithathu, kunye ne-pineal gland.
- I-septum pellucidum : i-membrane elincinci ehamba ngokukhawuleza phakathi kwendawo yengqondo
- I-ventricle yesithathu : indawo egcwele i-cerebrospinal fluid elala phakathi kweengqondo
- I-pineal gland : intsimbi encinci elele emva kwe-ventricle yesithathu
Iindawo zezi zakhiwo zengqondo ezi-3 zikhonza njengeengqinisiso ze-radiologic scan. Ukuba kukho nawuphi na ongekho ukulungelelaniswa, oku kubonisa ukuba uxinzelelo kwicala elinye lobuchopho luchukumisa ubuchopho kwindawo.
Unyango
Olona unyango olubaluleke kakhulu xa ukutshintsha kwe-midline kukhoyo kukunciphisa uxinzelelo oluchukumisa ingqondo kwindawo. Ukuba iqoqo legazi liyimbangela, njenge-hematoma yangaphantsi, kuza kufuneka utyando ukuba ususe i-clot yegazi kwaye umise ukuphuma kwegazi.
I-antibiotics isetyenziselwa ukunyanga i-infection kunye ne-steroids ingasetyenziselwa ukunciphisa ukuvutha.
Prognosis
Izifundo ezininzi zihlolisise imiphumo yokutshintsha kwexesha elide kwiziphumo ezide. Ekubeni ukutshintshwa kwimizuzu emininzi kwenzeka ngenxa yokuphuma kwegazi kunye noxinzelelo, umlinganiselo wokuphuma kwamanzi, indawo yokulimala, kunye nezinga elipheleleyo loxinzelelo olubangelwa yingqondo yonke into ebalulekileyo.
Xa ubuchopho buhamba, oku kubangele ukukhathazeka kwezinye izakhiwo njengoko zithathwa kwaye zikhuphe ngaphandle kwendawo yazo yendalo. Eyona ndlela iphezulu yokutshintsha kwe-midline, ingakumbi ingxaki enkulu kunye nomngcipheko wokufa.
Imithombo:
Bartels, RH, & Meijer, FJ (2015). Ukutshintsha kwe-Midline ngokumalunga nobukhulu be-hematoma engummangaliso wecala lokumbulala. 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). Ukufumanisa ngokuzenzekelayo kunye nekanti yokwenza ingqondo ye-middleline ngokusebenzisa umzekelo wempawu zobunzima. I-Computing Medical Imaging and Graphics , 38 1-14. i-doi: 10.1016 / j.compmedimag.2013.11.001