Zizindikiro, MRI, ndi Lumbar Nthawi Yodziwika PML
Mapulogalamu apamwamba a leukoencephalopathy (PML) ndi owopsa matenda a ubongo omwe amayamba chifukwa cha JC . Kachilombo kamene kamakhala kosawoneka ngati kamapatsira munthu, kenaka amatha kugona m'mimba mwawo. Koma pamene chitetezo cha mthupi chikufooka (monga matenda a Edzi, lupus, kapena khansa), kachilombo kamene kamatha kukhazikitsidwa, kuika maselo omwe amapanga myelin (zobvala zanu) -ndiwo biology kumbuyo kwa PML.
Kufunika kwa PML ku MS ndikuti ndizochepa zotsatira za mankhwala othandizira matenda , makamaka Tysabri (natalizumab).
Palinso mavoti awiri a PML omwe ali ndi anthu omwe ali ndi MS amene atenga Gilenya (fingolimod), Tecfidera (dimethyl fumarate), kapena Ocrevus (ocrelizumab).
Kuzindikira matendawa omwe amawopsyeza kumafunika kufufuza mozama ndi mofulumira ndi dokotala kuphatikizapo mbiri yakale ndi kuunika kwa thupi, MRI ya ubongo, ndi kupuma kwapadera .
Kuyesa kwa JC Virus mu Cerebrospinal Fluid
Pofuna kudziwa kuti ali ndi PML, dokotala amatha kupenda kuti awononge cerebrospinal fluid (CSF) chifukwa cha kukhalapo kwa JC. Izi zimachitika poyesa mapulogalamu a polymerase (PCR) ku CSF kuti awone ngati DNA ya JC imapezeka.
Zotsatira za mayeso a PCR kuti apeze kachilombo ka JC mu cerebrospinal fluid adzaphatikizidwa ndi zofufuza zachipatala (zizindikiro za PML) ndi zotsatira za MRI kuti zifike pozindikira.
MRI kuti izindikire PML
Ubongo wa magnetic resonance imaging (MRI) wa ubongo udzalamulidwa. Pa MRI, PML nthawi zambiri imakhala ndi tizilombo tating'ono t2 tambirimbiri . Pakutha pake amatha kujambula kupanga chotupa chachikulu.
Zisonyezo Zanu Zowunikira PML
Dokotala wanu akufuna kudziwa momwe mwakhala mukukumverera komanso pamene zizindikiro zanu zatsopano zinayamba.
Ndikofunika kufotokoza momveka bwino komanso mwatsatanetsatane m'mafotokozedwe anu. Zizindikiro za PML zimasiyana koma zimaphatikizapo kusintha kwa kuganiza ndi umunthu, kutayika kwa mgwirizano, mavuto a masomphenya, kufooketsa kwa mikono kapena miyendo, kupweteka mutu, kapena kugwa.
Nthawi zina zingakhale zovuta kusiyanitsa zizindikiro za kubwerera kwa MSL kuchokera ku PML. Malinga ndi kafukufuku wa 2009 mu Archives of Neurology, chidziwitso chimodzi ndi chakuti munthu amene ali ndi kachilombo ka MS kamakhala ndi chizindikiro chimodzi chachikulu, pamene anthu omwe ali ndi PML amakhala ndi zizindikiro zambiri.
Chidziwitso cha ubongo kuti azindikire PML
Ngati munthu ali pa Tysabri, mayesero amawoneka kuti ali ndi kachilombo ka JC ndi mayeso a PCR CSF, amasonyeza zizindikiro za PML, ndipo ali ndi MRI kusanthula ndi zomwe zikugwirizana ndi PML, mwinamwake dokotala angasamalire PML. Komabe, nthawi zina ubongo umagwiritsidwa ntchito.
Ubongo umaphatikizapo kuchotsedwa kwa tizigawo ting'onoting'ono ta ubongo kuti tigwiritse ntchito pa matenda a PML. Mitundu ya minofu imayang'aniridwa ndi kachilombo ka JC.
Ubongo wamaganizo ndi "ndondomeko ya golidi" ya mayesero opatsirana a PML. Komabe, ili ndi zoopsa, kuphatikizapo imfa. Kuonjezera apo, mankhwala a PML sangakhale ovuta kuti apeze zitsanzo za biopsy. Mosakayikira, izi sizomwe zimatchuka ndi odwala kapena madokotala, kapena omwe amagwiritsidwa ntchito kupatulapo zovuta kwambiri, kuti athetse matenda ena.
Pankhani ya munthu yemwe ali ndi MS yemwe ali pa Tysabri, izi sizingatheke kusiyana ndi munthu yemwe ali ndi kachilombo ka HIV / AIDS, chifukwa chiwerengero cha matenda omwe angayesedwe ndi PML (toxoplasmosis, cryptococcal meningitis, kapena matenda a AIDS) mwinamwake.
Mawu Ochokera
Ngati mukuyamba kukhala ndi zizindikiro zosavuta kapena zoopsa pamene Tysabri (kapena mankhwala ena opatsirana ndi matenda a MS) funsani dokotala mwamsanga. Musaganize kuti ndi "kubwezeretsa MS" kapena zizindikiro za paroxysmal. Pezani mwamsanga mwamsanga. Posakhalitsa chithandizo cha PML chayamba, bwino mwayi wanu wopulumuka.
> Zotsatira:
> Boster A et al. Mapulogalamu amphamvu kwambiri a leukoencephalopathy ndi kubwezeretsa m'mimba matenda ambiri a m'mimba. Arch Neurol. 2009 May; 66 (5): 593-9.
> Clifford DB et al. Matenda a Natalizumab omwe amachititsa kuti odwala ambiri azidwala matenda osiyanasiyana: maphunziro ochokera m'mabuku 28. Lancet Neurol . 2010 Apr; 9 (4): 438-46.
> National MS Society (2015). Nkhani ya PML Yotchulidwa Mwa Munthu Kulandira Gilenya: UPDATED. ndi > Mutu wa PML Wotchulidwa Mwa Munthu Kutenga Tecfidera.
> National MS Society (2017). Mlandu wa PML Wotchulidwa Mwa Munthu Wopeza Ocrevus kuti Achitire MS.
> PML Consortium. Odziwa zaumoyo: Kodi PML ndi chiyani?