I-Triad yeMpawu, i-MRI, ne-Lumbar Ukukhawulela ukujonga i-NPH
Uxinzelelo oluqhelekileyo i-hydrocephalus yindlela yokwandiswa kwezikhala kwindawo yengqondo, ebizwa ngokuba yi- ventricle , equkethe i- cerebrospinal fluid-isicacisi esicacileyo esihlamba ubuchopho nentambo yomgudu kwaye idla ngokuba yi-CSF.
Uxinzelelo oluqhelekileyo i-hydrocephalus kubangela ubunzima bokuhamba, ukucinga, nokulawula i-bladder. Iimpawu ziyakwazi ukuphucula xa i-neurosurgeon ibeka i-drain ebizwa ngokuba yi-shunt kwi-ventricles ukuze i-CSF igele kwisisu kunokusiwela phantsi kwekholam yomgcini.
Naliphi na inkqubo ye-neurosurgical inomngcipheko, nangona kunjalo, kunye neenzuzo zokubeka i-stent enjalo ye-NPH ayisoloko iqinisekile-ngoko i-NPH ebalulekileyo ifunyaniswe kakuhle. Ngaphandle kweli nyathelo, ezinye izigulane zinokuphucula ngaphezulu kunye nokufakwa kwesigxina kunabanye.
Abaxakeli beengcinezelo eziqhelekileyo Hydrocephalus
Ngaba unokucinga ukuba uphethwe ngengozi yobuchopho, kwaye ungaphuculanga ngenxa yokuba iimpawu zibangelwa zizifo ezahlukeneyo ngokubanzi? Le ngxaki elula kwi-NPH kuba iimpawu ziqhelekileyo kubantu abadala ngenxa yezizathu ezahlukeneyo.
Ukunzima ukuhamba, umzekelo, kunokusukela ngenxa yesisu somgulane , iingxaki ze-vestibular, iingxaki zembono, okanye i-peripheral neuropathy. Ukungahambi kakuhle kwe-Urinary kuqheleke kakhulu kwibudala ngenxa yezizathu ezahlukeneyo. Ukuphazamiseka kwengqondo kungabangelwa zizifo eziqhelekileyo ezifana nesifo se-Alzheimer. Olunye u-dementias lunokunyusa ingozi yokuhamba iingxaki, ezifana ne-Lewy yokugula komzimba, isifo sengqondo sika-Parkinson okanye isifo sengqondo se-vascular dementia.
Abaninzi balaba baxelisayo bangabandakanywa ngokucokisekileyo ngophando lwezempilo. Umzekelo, i- Lewy yokugula komzimba okanye isifo sika-Parkinson sinokubangela iingxaki ezifanayo ezihambahambayo, kodwa zithatha ukuba nomthwalo ogqithiseleyo kune-NPH, kwaye zihlala zikhona ezinye iimpawu ezifana ne- hallucinations ebonakalayo.
Enye ingxaki kukuba ukuba ne-NPH ayithinteli abantu ukuba banesifo sengqondo somnxeba, ngakumbi i- Alzheimer's disease .
Kuphakathi kwama-20 ukuya kuma-60 ekhulwini labantu ababenengqondo ye-brain biop ngexesha lokutsalwa kweentengo baye bafumanisa ukuba bane-pathology ye-Alzheimer's disease. Abo banethemba lokubona ingxaki yokumelana neengqondo ngokukhawulelana nokuxhoma kungadana ngenxa yokuba i-Alzheimer ayiphuculanga neyourosurgery.
Uvavanyo lweeuropsychological and Laboratory
Amanyathelo okuqala ekuxilongweni kwe-NPH ngokuqinisekileyo aya kugxila kwiimpawu ezinjenge-dementia. Ukukhutshwa komgangatho oza kubandakanya ukuhlolwa kweelabhoratri ngegazi ngenxa yezizathu ezinokuthi ziguquke, ezifana nokusilela kwe-vitamin B12 okanye isifo se-thyroid.
Iimvavanyo ze-neuropsychological ziya kwenziwa ukwenzela ukuba ziqinisekise ukuba kukho iingxaki zengqondo, nangona kungekho vavanyo olulodwa luyakwazi ukuqinisekisa i-NPH. Iipateni eziqhelekileyo ezihambelanayo ne-NPH zibandakanya ukukhawuleza kwimisebenzi echanekileyo kunye nokusebenza kakubi kwimisebenzi yokuqwalasela kunye nomsebenzi olawulayo. Olunye u-dementias, nangona kunjalo, njengengqondo ye-vascular or Deyy dementia yomzimba, kunokubangela ukuba utshintsho olufanayo kuvavanyo.
Ukufanekisa Ukuhlaziywa Kwemagnetic Ukufumana I-NPH
Ngenkcazo, izigulane ezineempembelelo eziqhelekileyo ze-hydrocephalus ziza kuba ne-ventricles ezinkulu kwi-neuroimaging study ezifana ne -imagination magontic resonance (MRI) okanye i-computed tomography (CT) . I-Ventricles isoloko ikhudlwana njengoko ubuchopho buyekezela ekugugeni okuqhelekileyo okanye kwenye i-dementias, kodwa kwi-NPH ukwandiswa kwezonyamakazi akukhathalanga neyo yonke ingqondo.
Oku kunjalo ke, into ethile yomgwebo wecingo kwinxalenye ye-neuroradiologist kunye nokunyanga ugqirha, kwaye izimvo ziyahlukahluka kule ngongoma. Ezinye zipapashwe ngamanqanaba e-ventriculomegaly kwaye ziyakwazi ukukhokela iziphakamiso zogqirha kwezinye iimeko, kodwa ezi zikhokelo azivunyelwanga ngokubanzi.
Ezinye i-MRIs kwizigulane ezine-NPH show zinciphisa isignali apho i-CSF igeleza igxina elincinci elibizwa ngokuba yi-Sylvia aqueduct ngokusebenzisa i-brainstem. Oku kucatshangelwa ukuba umele ukuhamba kwezinga eliphezulu. Nangona oku kuthethwa ngolu hlobo, uphando oluninzi alubonisi ukulungelelanisa okucacileyo phakathi kokufunyanwa nokuphuculwa emva kwe-neurosurgery.
I-MRI iyakunceda ekuhloleni izilonda ezimhlophe ezinokuthi zibangelwa zizifo zesifo. Ngakolunye uhlangothi, utshintshi lwezibonakaliso kwi-MRI kufuphi neepricrics zingabonisa isifo se-vascular okanye ukuvuza kwamanzi ngenxa ye-NPH ngokwayo. Uninzi lwezifundo zibonisile ukuba akukho ncitshiseko yokuba sibe nemiphumo emihle ngokuzikhupha ukuba kukho ezininzi izilonda ezimhlophe, nangona iimpapasho ziyahluke kule nto. Impendulo eyanciphayo ekugxineni kwizigulane ezinemizimba emhlophe ingabakho ngenxa yokuba umqondiso wombala omhlophe ubonisa isigaba esiphambili se-NPH, okanye inkqubo yesifo eyahlukileyo, njengengqondo ye-vascular dementia.
Ukususa i-CSF ukuchonga uxinzelelo oluqhelekileyo lwe-Hydrocephalus
"Imilinganiselo yegolide" yokuxilongwa kwe-NPH kukuphucula iimpawu nge-ventricular shunting. Lo mgangatho awunamsebenzi, nangona kunjalo, ukuze ucebise inqubo enobungozi njengokuba ugxilwe ugqirha kufuneka ukuba sele eqinisekile kakhulu ukuba isiguli sinempilo ye-NPH. Akukho sikhokelo santoni esichazela ukuphucuka okukhulu kweempawu, okanye ixesha elide lokulinda emva kokumiswa ngaphambi kokuba ezo ziphuculo zibonwe. Ngaphezu koko, impendulo engapheliyo yokukhupha ingabangelwa ngenxa yeengxaki ezingaphaya kwe-diagnosis diagnostic - umzekelo, isigulane sinokuba nengqondo engakumbi.
Ngenxa yokuba ukufakwa kwe-shunt kungenasiphelo, iindlela ezingaphantsi kobudlova bokususwa kwe-CSF zivame ukuzama ukuqala ukuqinisekisa ukuphucula kwesigulane ngokuphucula. Ezi zixhobo ziquka ukugqitywa kwe - lumbar okanye i-lumbar drain. Kwakhona, nangona kunjalo, akukho mgangatho wento echaza ukuphucuka okukhulu, ukushiya amagqirha ukuba athembele kwisigwebo sabo kunye "nemithetho embalwa yesohlwayo."
Ukugqitywa kwe-lumbar kungenziwa kwiofisi yonyango kwaye kubandakanye ukususwa kwexabiso elikhulu le-CSF (phakathi kwama-30 ukuya ku-50 ububanzi bentimitha). Uphuculo oluqhelekileyo luhamba ekuhambeni kwezigulane, ngokukhawuleza ukukhawuleza nokukhawuleza. Iimvavanyo zengqondo ziyakwenziwa, kuquka iimvavanyo zengqalelo kunye nememori. Ukuphuculwa kule mizuzu engama-30 ukuya kwisiqingatha seyure emva kokuba inqubo ibonise inzuzo yokuyeka.
Indlela eyahlukileyo ibandakanya ukubeka isikhephe esikhatywayo kwisithuba se-lumbar, apho i-CSF ingahlalisa malunga ne-5 ukuya kwi-10 milliliters ngeyure. Ucwaningo luye lwabonisa ukuba le nto ingaba yindlela ebalaseleyo yokumakisha abo baza kuphendula xa bezama ukukhwaza, nangona ezinye iingcaphephe zibonisa ukuba izigulane ezininzi ezingaphuculanga ngokucoca zinokuthi ziphuculwe ngokukhupha.
Iindlela eziqhelekileyo ezisetyenziswayo zokuxilongwa kwe-NPH ziquka ukunyanzeliswa kokunyanzeliswa koxinzelelo okanye ukuhlolwa kwe-CSF, kodwa ukungaphumeleli kwezi nkqubo kunciphisa ukusetyenziswa kwazo. I-Csternography, esebenzisa ii-radiosotopes ukuphanda ukugeleza kwe-CSF, ayizange iboniswe iziphumo zokubeka ngokubeka i-shunt placement. Ezinye iindlela zobugcisa ezifana neendlela zeMRI ezitsha okanye ukuchithwa kwesinye se-photon CT (SPECT) zifuna uphando olongezelelweyo ukuseka ukuba luncedo kwi-NPH.
Okukwintsusa
Ukuxilongwa kwe-NPH kuxhomekeke kwimbali echanekileyo kunye nokuhlolwa komzimba ukuqala ukukhupha ezinye iziphazamiso ezingabangela enye intlupheko yesifo sengqondo, ukungazinzi kakuhle kunye nokungahambisani nomzimba. I-MRI iya kubonisa iipriricric ezinkulu ezibonwe ngokulinganayo nenye ingqondo yengqondo, kwaye ingaphinda ikhuphe ezinye iinguqu zonyango. Ukugqitywa kwesibhakabhaka okanye ukugqithisa okukukhokelela ekuphuculeni izibonakaliso kukubonisa ukunyaniseka kwe-NPH yangempela enokufumana inzuzo kwi-shunt ukubekwa yi-neurosurgeon.
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INKCAZELO: Ulwazi olukule ndawo lusezinjongo zemfundo kuphela. Akufanele isetyenziswe njengendawo yokunyamekelwa ngumntu ogqirha. Nceda ubone ugqirha wakho ukuze ufumane unyango kunye nonyango malunga nayiphi na impawu okanye imeko yonyango .