Cerebrospinal fluid ndi madzimadzi omwe amasambitsa mapangidwe apakati pa mitsempha: ubongo ndi msana. Lili ndi ntchito yoteteza komanso kusokoneza mantha. The cerebrospinal fluid ili mumkhalidwe wabwinobwino, wopanda majeremusi. Maonekedwe a majeremusi mmenemo akhoza kukhala ndi udindo waukulu matenda opatsirana.

Tanthauzo

Cerebrospinal fluid kapena CSF ndi madzi omwe amaphimba dongosolo lapakati la mitsempha (ubongo ndi msana). Amayenda kudzera mu ventricular system (ma ventricles omwe ali mu ubongo) ndi malo a subbarachnoid.

Monga chikumbutso, dongosolo lapakati la mitsempha lazunguliridwa ndi maenvulopu otchedwa meninges, opangidwa ndi zigawo zitatu:

• dura, wandiweyani wakunja wosanjikiza;
• arachnoid, wosanjikiza woonda pakati pa dura ndi limba;
• limba mater, mkati woonda pepala, kumamatira pamwamba pa ubongo.

Danga pakati pa arachnoid ndi limba mater limafanana ndi danga la subarachnoid, malo ozungulira cerebrospinal fluid.

Mawonekedwe

Kuchuluka kwa tsiku ndi tsiku kwa CSF kukuyembekezeka kukhala pafupifupi 500 ml.

Voliyumu yake ndi 150 - 180 ml, mwa akuluakulu, choncho imakonzedwanso kangapo patsiku.

Kuthamanga kwake kumayesedwa pogwiritsa ntchito puncture ya lumbar. Akuti pakati pa 10 ndi 15 mmHg mwa akuluakulu. (5 mpaka 7 mmHg mwa makanda).

M'maso, CSF ndi madzi omveka bwino omwe amati ndi madzi a rock.

zikuchokera

Celphalo-spinal fluid imapangidwa ndi:

• madzi;
• leukocytes (maselo oyera a magazi) <5 / mm3;
• mapuloteni (otchedwa proteinorrachia) pakati pa 0,20 - 0,40 g / L;
• shuga (yotchedwa glycorrachia) imayimira 60% ya glycemia (shuga wamagazi), kapena pafupifupi 0,6 g / L;
• ma ayoni ambiri (sodium, chlorine, potaziyamu, calcium, bicarbonate)

CSF ndi wosabala, ndiye kuti mulibe tizilombo toyambitsa matenda (ma virus, mabakiteriya, bowa).

Mawonekedwe

Cerebrospinal fluid ndi madzimadzi omwe amasambitsa mapangidwe a m'katikati mwa mitsempha. Iwo ali ndi udindo wa chitetezo ndi mantha absorber wa yotsirizira, makamaka pa kayendedwe ndi kusintha kwa udindo. Cerebrospinal fluid ndi yachibadwa, yopanda majeremusi (wosabala). Maonekedwe a majeremusi mmenemo akhoza kukhala ndi udindo waukulu matenda opatsirana amene angayambitse minyewa sequelae kapena imfa ya wodwalayo.

Kachinsinsi ndi kufalitsidwa

The cerebrospinal fluid imapangidwa ndikutulutsidwa ndi ma choroid plexuses omwe ali pamlingo wa makoma a ma ventricles osiyanasiyana (lateral ventricles, 3rd ventricle ndi 4th ventricle) ndikupangitsa kuti pakhale mphambano pakati pa dongosolo la magazi ndi chapakati. dongosolo lamanjenje .

Pali kuyendayenda kosalekeza komanso kwaulere kwa CSF pamlingo wa lateral ventricles, kenako kupita ku 3rd ventricle kupyolera mu mabowo a Monroe ndiyeno kupita ku 4th ventricle kupyolera mumtsinje wa Sylvius. Kenako imalumikizana ndi danga la subarachnoid kudzera pa foramina ya Luscka ndi Magendie.

Kubwezeretsedwa kwake kumachitika pamlingo wa arachnoid villi wa Pacchioni (zophuka zoyipa zomwe zili pamtunda wakunja kwa arachnoid), zomwe zimalola kutuluka kwake kupita ku nkusani ya venous (zambiri ndendende kumtunda kwakutali kwa venous sinus) motero kubwereranso kumayendedwe a venous. . .

Kusanthula kwa CSF kumapangitsa kuti athe kuzindikira ma pathologies ambiri, omwe ambiri amafunikira chisamaliro chofulumira. Kusanthula uku kumachitidwa ndi lumbar puncture, yomwe imakhala ndi kutenga CSF, poyika singano yopyapyala pakati pa ma vertebrae awiri a lumbar (nthawi zambiri, pakati pa 4th ndi 5th lumbar vertebrae pofuna kupewa chiopsezo cha kuwonongeka kwa msana. ., kuyima moyang'anizana ndi vertebra yachiwiri ya m'chiuno). Kuphulika kwa lumbar ndi ntchito yowonongeka, yomwe iyenera kuchitidwa ndi dokotala, pogwiritsa ntchito asepsis.

Pali zotsutsana (zovuta kwambiri za coagulation, zizindikiro za matenda oopsa a intracranial, matenda pa malo opunthwa) ndi zotsatirapo zake ( post-lumbar puncture syndrome, matenda, hematoma, kupweteka kwa msana).

Kusanthula kwa CSF kumaphatikizapo:

• kufufuza kwa macroscopic (kuwunika ndi maso amaliseche kulola maonekedwe ndi mtundu wa CSF kusanthula);
• bacteriological kufufuza (fufuzani mabakiteriya ndi kuzindikira zikhalidwe);
• kufufuza kwa cytological (kuyang'ana chiwerengero cha maselo oyera ndi ofiira a magazi);
• kuyesa kwa biochemical (fufuzani kuchuluka kwa mapuloteni, shuga);
• kuwunika kowonjezera kungathe kuchitidwa kwa ma virus enieni (Herpes virus, Cytomegalovirus, Enterovirus).

Matenda opatsirana

meninjaitisi

Zimafanana ndi kutupa kwa meninges yomwe nthawi zambiri imakhala yachiwiri ku matenda ndi tizilombo toyambitsa matenda (mabakiteriya, tizilombo toyambitsa matenda kapena tizilombo toyambitsa matenda kapena bowa) chifukwa cha kuipitsidwa kwa cerebrospinal fluid.

Zizindikiro zazikulu za meningitis ndi:

• kufalikira ndi kupweteka kwa mutu kwambiri ndi kusapeza phokoso (phonophobia) ndi kuwala (photophobia);
• malungo;
• nseru ndi kusanza.

Pakuwunika kwachipatala, munthu amatha kuzindikira kuuma kwa meningeal, ndiko kuti kukana kosagonjetseka komanso kowawa popinda khosi.

Izi zikufotokozedwa ndi kutsika kwa minofu ya para-vertebral pokhudzana ndi kukwiya kwa meninges.

Ngati akuganiziridwa kuti meningitis, ndikofunikira kuvula wodwalayo kwathunthu, kuti ayang'ane zizindikiro za purpura fulminans (mawanga otuluka pakhungu omwe amalumikizidwa ndi vuto la coagulation, lomwe silizimiririka akakakamizidwa). Purpura fulminans ndi chizindikiro cha matenda oopsa kwambiri, omwe nthawi zambiri amayamba chifukwa cha matenda a meningococcus (mabakiteriya). Ndi ngozi yowopsa yomwe imafuna kubayidwa mumtsempha kapena kudzera m'mitsempha ya maantibayotiki mwachangu momwe mungathere.

Mayeso owonjezera nthawi zambiri amafunikira kuti atsimikizire za matendawa:

• lumbar puncture (kupatula ngati contraindication) kulola kusanthula kuchitidwa;
• kuwunika kwachilengedwe (kuwerengera magazi, kuwunika kwa hemostasis, CRP, ionogram yamagazi, glycemia, serum creatinine, zikhalidwe zamagazi);
• Kulingalira mwachangu kwaubongo muzochitika zotsatirazi zomwe zimatsutsana ndi kupunthwa kwa lumbar: kusokonezeka kwa chidziwitso, kuchepa kwa minyewa ndi / kapena kukomoka.

Kusanthula kwa CSF kumapangitsa kuti ziwongolere ku mtundu wa meningitis ndikutsimikizira kukhalapo kwa tizilombo toyambitsa matenda.

Chithandizo chidzadalira mtundu wa tizilombo tomwe timapezeka mu cerebrospinal fluid.

Matenda a meningoencephalitis

Zimatanthauzidwa ndi mgwirizano wa kutupa kwa ubongo ndi ma envulopu a meningeal.

Zimachokera ku mgwirizano wa matenda a meningeal (mutu, kusanza, nseru ndi kuuma kwa meningeal) ndi kuwonongeka kwa ubongo komwe kumayendetsedwa ndi kukhalapo kwa kusokonezeka kwa chidziwitso, kugwidwa pang'ono kapena kugwedezeka kwathunthu kapena chizindikiro cha kuchepa kwa ubongo (kuchepa kwa galimoto). , apasia).

Meningoencephalitis ndi matenda aakulu omwe angayambitse imfa ya wodwala ndipo motero amafunikira chithandizo chamankhwala mwamsanga.

Kukayikira kwa meningoencephalitis kumafuna kujambulidwa mwachangu kwaubongo, ndipo kuyenera kuchitidwa musanapume m'chiuno.

Mayeso ena owonjezera amatsimikizira matendawa:

• kuwunika kwachilengedwe (kuwerengera magazi, CRP, ionogram yamagazi, zikhalidwe zamagazi, kuwunika kwa hemostasis, serum creatinine);
• EEG (electroencephalogram) ikhoza kuchitidwa, yomwe ingasonyeze zizindikiro zokomera ubongo kuwonongeka.

Kusamalira mwachithandizo chamankhwala kuyenera kuchitika mwachangu ndipo kenako kusinthidwa ndi majeremusi owululidwa.

Carcinomatous meningitis

Carcinomatous meningitis ndi kutupa kwa meninges chifukwa cha kupezeka kwa maselo a khansa omwe amapezeka mu CSF. Zowonjezereka, ndi funso la metastases, ndiko kunena kuti kufalikira kwachiwiri chifukwa cha khansa yoyamba (makamaka khansa ya m'mapapo, khansa ya melanoma ndi khansa ya m'mawere).

Zizindikiro zake ndi polymorphic, zomwe zimaphatikizapo:

• meningeal syndrome (mutu, nseru, kusanza, kuuma khosi);
• kusokonezeka kwa chidziwitso;
• kusintha kwa khalidwe (kutayika kwa kukumbukira);
• khunyu;
• kusowa kwaubongo.

Mayeso owonjezera ndi ofunikira kuti atsimikizire matenda:

• kupanga zojambula zaubongo (MRI) zomwe zimatha kuwonetsa zizindikiro zomwe zimathandizira kuzindikira;
• kuphulika kwa lumbar kuyang'ana kukhalapo kwa maselo a khansa mu CSF ndipo motero kutsimikizira matenda.

Kuneneratu za carcinomatous meningitis kukadali kodetsa nkhawa lerolino ndi njira zochepa zochizira.

Hydrocephalus

Hydrocephalus ndi kudzikundikira kwamadzi ochulukirapo a muubongo mkati mwa cerebral ventricular system. Zimawonetsedwa popanga chithunzi chaubongo chomwe chimapeza kufalikira kwa ma ventricles aubongo.

Kuchuluka kumeneku kungapangitse kuwonjezeka kwa kuthamanga kwa intracranial. Zowonadi, kuthamanga kwa intracranial kudzadalira magawo angapo omwe ndi awa:

• parenchyma ya ubongo;
• cerebrospinal fluid;
• kuchuluka kwa cerebrovascular.

Chifukwa chake chimodzi kapena zingapo mwazigawozi zikasinthidwa, zidzakhudza kukakamizidwa kwa intracranial. Intracranial hypertension (HTIC) imatanthauzidwa ngati mtengo> 20 mmHg mwa akuluakulu.

Pali mitundu yosiyanasiyana ya hydrocephalus:

• non-communicating hydrocephalus (obstructive): imafanana ndi kuchulukirachulukira kwa cerebrospinal fluid mu ventricular system yachiwiri ndi chopinga chomwe chimakhudza kufalikira kwa CSF ndipo motero kuyambiranso. Nthawi zambiri, ndi chifukwa cha kukhalapo kwa chotupa compressing ya yamitsempha yamagazi dongosolo, komanso akhoza kukhala yachiwiri malformations alipo kuyambira kubadwa. Zimabweretsa kuwonjezeka kwa intracranial pressure yomwe imafuna chithandizo chachangu. N'zotheka kuchita kunja kwa ventricular bypass ya CSF (yosakhalitsa yankho) kapena posachedwapa, kukwaniritsidwa kwa endoscopic ventriculocisternostomy (kulengedwa kwa kulankhulana pakati pa ubongo wa ubongo ndi zitsime zomwe zimagwirizana ndi kukulitsa kwa subbarachnoid. space) motero kulola kudutsa chopingacho ndikupeza kuyenda kokwanira kwa CSF;
• Kulankhulana ndi hydrocephalus (yosaletsa): imafanana ndi kuchulukana kwamadzimadzi a muubongo pokhudzana ndi jini pakuyamwanso kwa CSF. Nthawi zambiri zimakhala zachiwiri kwa subbarachnoid hemorrhage, kuvulala mutu, meningitis kapena mwina idiopathic. Imafunika kuwongolera ndi CSF shunt yamkati yotchedwa ventriculoperitoneal shunt (ngati madziwa akupita ku peritoneal cavity) kapena ventriculo-atrial shunt (ngati madziwa akupita kumtima);
• matenda a hydrocephalus pa kuthamanga kwabwinobwino: amafanana ndi kuchuluka kwamadzimadzi muubongo muubongo wamitsempha yamagazi koma popanda kuwonjezereka kwa intracranial pressure. Nthawi zambiri amakhudza akuluakulu, pambuyo pa zaka 60 ndi predominance amuna. Njira ya pathophysiological sichidziwika bwino. Zitha kupezeka mwa anthu omwe ali ndi mbiri ya subarachnoid hemorrhage, kupwetekedwa mutu kapena kuchitidwa opaleshoni ya intracranial.

Amatanthauzidwa nthawi zambiri ndi zizindikiro zitatu, zotchedwa Adams ndi Hakim triad:

• kuwonongeka kwa kukumbukira;
• matenda a sphincter (kulephera kwa mkodzo);
• zovuta kuyenda ndi kuyenda pang'onopang'ono.

Kujambula kwaubongo kumatha kuwonetsa kutukuka kwa ma ventricles aubongo.

Kuwongolera kumakhazikitsidwa makamaka pakukhazikitsa njira yodutsa mkati mwa ventricular, mwina ventriculo-peritoneal kapena ventriculo-atial.

Matenda ena

Kuwunika kwa cerebrospinal fluid kumatha kuwulula ma pathologies ena ambiri:

• subbarachnoid hemorrhage ndi umboni wa magazi ozungulira mu CSF;
• matenda otupa omwe amakhudza chapakati mantha dongosolo (multiple sclerosis, sarcoidosis, etc.);
• matenda a neurodegenerative (matenda a Alzheimer's);
• matenda a neuropathies (Guillain-Barré syndrome).