IDysautonomia kunye neNgxaki nge-Autonomic yeNervous System
Inkqubo ye-neon autonomic ilawula imisebenzi ebalulekileyo yomzimba njengezinga lentliziyo kunye neengcinezelo zegazi ezigcina sisaphila ngaphandle kokuba sizicinge. Phantse nayiphi na ingxaki yonyango inokuchaphazela inkqubo ye-nervous autonomic ngendlela ethile, nangona izifo ezimbalwa zihlasela inkqubo ye-nervous autonomic kuphela. Ngezantsi ezinye zeendlela eziqhelekileyo zenkqubo ye-nervous disysomic disy function, okanye i- dysautonomia :
I-Autonomic Paralysis eyiyo
Ukukhubazeka okuzimele, okokuqala kuchazwe ngowe-1975, ihlala ingabonakali kakhulu kodwa isebenza njengomzekelo omhle wento eyenzekayo xa yonke imisebenzi ye-nervonic igxeka. Iimpawu ziza ngaphezu kweveki okanye iiveki ezimbalwa ngokulahlekelwa ngokupheleleyo kwemisebenzi emininzi yokuzimela kwaye zibandakanya amehlo aomileyo, i -hypotension orthostatic , ukungabi namandla kwe-salivation, ukungabi namandla, ukungasebenzi kakuhle kunye nesisu, kunye nesisu esiswini kunye nokuhlanza. Bobabini iifayili zengqondo kunye novelwano zichaphazelekayo, nangona ezinye iingxaki zisindiswa. Ukugqitywa kwe-lumbar kungabonakalisa iprotheni ephakamileyo kwi- CSF . Isizathu asifumaneki, nangona mhlawumbi isifo esifana nesisifo esifana ne- Guillain-Barre syndrome . Uphulo olungcono kakhulu alucacile, nangona abanye baye bacetyiswa ukuphucula emva kokutshintshwa kwe-plasma, okanye ukuphathwa kwe-IVIG.
Idiopathic Orthostatic Hypotension
Isifo esingaqhelekanga sokuguga, idiopathic orthostatic hypotension ifika phakathi kwexesha lobomi obude kwaye iquka izilonda kwi-neurons ebonisa ukuvalelwa kwintliziyo, ekhusela intliziyo ukuba ikwazi ukukhawuleza xa ifuneka.
Oku kunqabile kakhulu; i-dysautonomia ephezulu ye-preganglionic iquka ukungcola kwecandelo lomgcini womgudu apho iimbombo zogonyo ezizimelayo zihamba zijikeleza. Kwimeko apho, unyango luqala ngeenguqu ezingapheliyo zokuguquka kwendlela yokuphila, kuquka ukugqoka iimfosane zengcinezelo, kunye nokuguquka ngokukhawuleza ukusuka ekuhleli kwindawo yokuma.
Ukuba oku akunako, unyango olunjenge-midodrine okanye i-florinef lungafuneka.
Hypotension Secondary
Kulo hlobo oluqhelekileyo lwe-dysautonomia, i-peripheral neuropathy, efana neyokufumaneka kwisifo sikashukela , ichaphazela kwakhona inkqubo ye-nerveous autonomic system. Kukho iintlobo ezininzi zezinye izizathu, kubandakanywa nokusetyenziswa kotywala okunzima, ukungaphumeleli kokutya, okanye ukutshatyalaliswa kwezinto ezinobuthi.
I-dysautonomia ehamba ne-diabetes neuropathy ixhaphake ngokukhethekileyo kwaye ingabonisa ukungabi namandla, isifo sohudo kunye nokuqhawulwa, ngaphezu kwe-hypotension. Ezi zimpawu zinakho okanye zingenakuba nzima kangangoko ukutshintsha kweengqondo ezibangelwa yi-diabetes peripheral neuropathy. Kwakhona kubalulekile ukuba uqaphele ukuba le meypathies ye-peripheral periodically pre-date diagnostic diabetes, kwaye ezinye iimvavanyo zelabhoratri ezisetyenziselwa ukuxilonga isifo sikashukela, njengezinga le-hemoglobin A1c, linokuthi libe ngohlobo oluqhelekileyo. Ngamanye amazwi, iimbilini ze-peripher can be more sensitive than the tests of diagnostic used by doctors to diagnose diabetes.
Ezinye iindlela ze-peripheral neuropathy, ezinje ezibangelwa yi- amyloidosis , zinama-dysautonomi anamandla. I-neuropathy eyayizuzwa yi- Fabry ( isifo se- alpha-galactosidase) sinokudala i-dysautonomia.
I-Riley-Day Syndrome
Ngexesha elimalunga nekota yesithuba sabantu abangaphezu kweminyaka engama-65 banomnye uhlobo lwe-dysautonomia njengoko kuboniswe yi-orthostatic hypotension, i-dysautonomia ayifani kangangoko kakhulu kuncinci. Enye i-dysautonomia ezuze ilifa elibizwa ngokuba yi-Riley-Day syndrome.
I-Riley-Day Syndrome izuzwe ngefesimasi ye-autosomal, ebonisa ukuba abazali abanokuchaphazeleka nangona umntwana enesifo. Iimpawu ziquka i-post-hypotension, i- labile yexinzelelo yegazi , umgaqo-mpahla omsulwa, i-hyperhidrosis, ukuhlanza kwe-cyclic, ukunyameka kwengqondo kunye nokunciphisa ubuhlungu besifo. Ezi zibonakaliso zibangelwa ukungaphumeleli kokufuduka kwamaselula ngexesha lokuphuhliswa.
I-Trauma kunye ne-Autonomic yeNervous System
Iimvungu zenceba zihamba ngentshontsho yomgca kwizinto ezibizwa ngokuba yi-intermediolateral cell columns. Ukuba ezi kholamni ziphazamisekile ngenxa yentlekele kunye ne-hypotension, ukulahleka kwesifungo, ukukhubazeka kwesisu, kunye nesisu somzimba singabangela; oku kwaziwa ngokuba ngumthunzi wesisu. Ukunika i-naloxone kubonakala kunciphisa ezinye zeempawu: imisebenzi enovelwano kunye ne-parasympathetic iya kubuya emva kwexesha, kodwa abayi kuba ngaphantsi kolawulo lwezakhiwo eziphezulu. Ngokomzekelo, ukuba uxinzelelo lwegazi luwa, imithambo yegazi ye-peripheral ayiyi kunqanda, kuba oku kuxhomekeke ekunxibelelaneni phakathi kwe-medulla kwi-brainstor kunye nomzimba wonke ngomgca wesipelini. Ezinye i-reflexes, nangona kunjalo, ziya kuhlala zihambelana. Ukuba ulusu lufakwe kwiengalo, umzekelo, imithwalo yegazi kwalo ngalo iya kunqongophala, okubangele ukunyuka kwengcinezelo kweso salo.
Abantu abanesifo se-tetraplegic ngenxa yengozi yomgogodla bangaphinda bahlupheke kwizinto ezibizwa ngokuba yi-autonomic dysreflexia. Uxinzelelo lwegazi luphuma, inqanaba lentliziyo linciphisa, kwaye iinxalenye ezingaphantsi kwesilonda zinokuphefumula kwaye zithuthuke ngokweqile, ngaphezu kwentsholongwane yomlenze kunye nokungabikho kokungabikho kokuzikhupha. I-dysreflexia ye-autonomic ingasongela ubomi xa ingaphathwa ngokukhawuleza.
Ukulimala kweentloko ezinzulu okanye i- cerebral hemorrhages inokukhupha i-adrenal catecholamines kunye nokwanda kwetoni. Ngamanye amaxesha amaninzi angacinezela kwi-brainstem, ekhokelela ekubeni nomfutho ophezulu wexinzelelo, ukuphefumula okungaqhelekanga, kunye nentliziyo ephosakeleyo kwizinto ezibizwa ngokuba yi-Cushing response, isibonakaliso esinzima sokunyuka kwengcinezelo.
I-Dysautonomia Ngenxa yeeDrugs kunye neTyxin
Ukutshitshiswa komlwelana kufana nezinye iintlungu ezizimelayo ezibizwa ngokuba "izivunguvane zentlungu," ezinokubangela ukusetyenziswa kwamachiza, njenge cocaine. Imisebenzi emininzi enikwe imithi ngokusebenza kwinkqubo ye-nervous autonomic, kwaye ngokunjalo ngenye inyaniso yeexinxi. I-insecticides ye-Organophosphate kunye ne-sarin, umzekelo, kubangela ukuba i-parasympathetic overactivity.
Ezinye iiDysautonomias
I-Hyperhydrosis yingozi yokuphila esichengeni, kodwa isenokuba yi-dysautonomia enokuhlazisa inobangela obuthathaka. Ngokwahlukileyo, i-anhydrosis ibangela ukukhupha okuncinci kakhulu, okuya kuba yingozi xa kukhokelela ekugqithiseni.
Ingqungquthela kaRaynaud ibangela ukunciphisa ukuhamba kwegazi kwiminwe ebanda kwaye ihlala ihambelana ne-peripheral neuropathy okanye isifo esixhamlayo sesifo njenge- scleroderma .
Ukungasebenzi kakubi kwaye kuya kubangelwa kwiintlobo ezininzi zeengxaki, kuquka i-dysautonomias. Ukugcinwa kobungqina be-bladder kuyinkimbinkimbi, kwaye isenzo esibonakala ngathi esilula sokuvuthwa ngokuqinisekileyo sithembele ekusebenzisaneni ngokuthe ngqo phakathi kokuzithandela, uvelwano kunye nemisebenzi yentsholongwane. Mhlawumbi kuba umsebenzi ochanekileyo we-bladder uxhomekeka kwiinkalo ezininzi ezahlukeneyo, akumangalisi ukuba iingxaki ziqhelekileyo kwaye zingabandakanya ukungahambisi okanye ukugcina umchamo.
Akunakwenzeka ukulungisa zonke iinkalo ze-dysautonomia kwinqaku enye. Ukongeza kwizinto esizigubungileyo, maxa wambi nje amalungu omzimba, afana neliso (njengase-Horner's syndrome) okanye isalathisi (njengokwimeko ebonisa ukunyameka kwe-dystrophy). Eli nqaku linokuthi lisebenzise njengesingeniso esivakalayo, kwaye lukhuthaze ukufunda ngakumbi kwabo bafuna ulwazi oluninzi.
Imithombo:
I-Adams kunye neMigaqo yeVictor ye-Neurology, 9th: I-McGraw-Hill Companies, Inc., 2009
I-Blumenfeld H, i-Neuroanatomy ngokusebenzisa iiKliniki zeeKliniki. I-Sunderland: Abapapashi be-Sinauer Associates 2002