Mliriwu ndi imfa ya minofu ya ubongo, yomwe imapangidwa ndi kusokonezeka kwa magazi kupita ku ubongo. Matenda omwe amachititsa kuti matendawa asokonezeke ndi monga thrombosis (clotting) ya mitsempha ya m'mitsempha mu ubongo, kukumbidwa (magazi omwe amatha kupita ku ubongo ndikugona pamenepo), ndi mavuto am'deralo omwe amakhudza mitsempha ya m'mitsempha, monga anirysm kapena kutupa.
Pambuyo pake, munthu adakali ndi matenda osokoneza bongo, adokotala adzayesa kudziwa chifukwa chake, chifukwa chimene chimayambitsa matenda a stroke nthawi zambiri chimapanga chithandizo chabwino koposa. Komabe, mpaka 40 peresenti ya milandu, palibe chifukwa chenicheni chomwe chingadziwike. Mliri wa zifukwa zosadziwika umatchedwa stroke cryptogenic. (Liwu lakuti "cryptogenic" limangosonyeza kuti chifukwa chake ndi chodabwitsa, kapena chosokoneza.)
Kodi Stroke Imatchedwa Cryptogenic?
Pambuyo pa kupwetekedwa, nthawi zina zimakhala zovuta kudziwa ngati kusokonezeka kwa magazi komwe kunabweretsa kupweteka kunayambitsidwa ndi magazi omwe amapangidwa m'malo (thrombus), magazi omwe amapita ku ubongo kuchokera kwina ( embolus ), kapena vuto lina lalikulu.
Sitiroko sayenera kutchedwa cryptogenic mpaka kuyezetsa kwathunthu kwachitidwa popanda kupereka chifukwa china. Kawirikawiri, kufufuza koteroko kumaphatikizapo kuganizira za ubongo (pogwiritsa ntchito CT scan kapena MRI scan ), malingaliro a mitsempha ya magazi yomwe imapereka ubongo (duplex ya carotid kapena maphunziro a Doppler ), komanso mwina angiography .
Kuphatikiza apo, kufufuza kwathunthu kwa mafilimu a mtima kuyenera kuchitidwa, kuyang'ana magwero a mtima a chiwalo. Zomwe zimayambitsa matenda zimaphatikizapo magazi m'mitima (kawirikawiri pamtundu wa atrium), patent foramen ovale (PFO) , matenda osokoneza bongo , matenda opatsirana pogonana , kapena mitsempha yotchedwa metral valve prolapse (MVP) .
Ngati palibe chifukwa chomwe chadziwitsidwa pambuyo pofufuza bwinobwino, mliriwu umakhala ngati cryptogenic.
Zomwe zimayambitsa mikwingwirima ya cryptogenic (ngati zikhoza kudziwika) ndizochuluka, ndipo anthu omwe amadziwika kuti ali ndi zilonda za cryptogenic ndi gulu losagwirizana. Monga sayansi ya zachipatala imakulitsa mphamvu yake yodziwira chifukwa cha zikwapu mwa odwala pawokha, chiŵerengero cha anthu omwe amanenedwa kuti ali ndi zilonda za cryptogenic adzagwa.
Ndani Amapeza Stroke Cryptogenic?
Mbiri ya odwala omwe anavutika ndi zilonda za cryptogenic ndizofanana ndi odwala omwe adamva zowawa zodziwika. Amakonda kukhala anthu achikulire omwe ali ndi zifukwa zoopsa za matenda a mtima.
Sitiroko za Cryptogenic zikuwoneka chimodzimodzi kwa amuna ndi akazi. Zingakhale zofala kwambiri kwa anthu akuda ndi Hispanics. Ngakhale kukwapulika kwa cryptogenic kwa achinyamata (osakwana zaka 50) kumamvetsera kwambiri madokotala komanso m'mabuku a zachipatala, kafukufuku akusonyeza kuti kufalitsa kwa msinkhu wa kukwapulika kwa cryptogenic kukufanana ndi mikwingwirima yopanda cryptogenic. Izi zikutanthauza kuti, kudziwa zomwe zimachititsa kuti achinyamata azivutika ndi matendawa ndi zofanana ndi zomwe zikuchitikira anthu achikulire.
Kodi Malingaliro Atachitika Pambuyo pa Kulimbana ndi Cryptogenic Stroke N'chiyani?
Kawirikawiri, chifuwa cha wodwala amene walumidwa ndi cryptogenic sitiroko amawoneka kuti ndi abwino kwambiri kusiyana ndi zikwapu zomwe sizinaphatikizidwe.
Komabe, chiwerengero cha zaka 2 za kupweteka kwapakati pa 15 - 20 peresenti.
Popeza chithandizo choletsa kupweteka kamodzi kokha chimadalira chifukwa cha stroke (antiticoagulation ndi warfarin pambuyo pa kupweteka kwa embolic, antiplatelet mankhwala ndi aspirin kapena clopidogrel pambuyo pa kupweteka kwa thrombotic), njira yabwino kwambiri yothandizira kupweteka kwa cryptogenic sikudziwikiratu. Chigwirizano pakati pa akatswiri pa mfundoyi, komabe, chimadalira kugwiritsa ntchito mankhwala oletsa antiplatelet.
Pulezidenti wa PFO
Chimodzi mwa zovuta kwambiri pa zikwapu za cryptogenic ndi funso la momwe zimayambira kawirikawiri ndi Patent Foramen Ovale (PFOs), zomwe zimadziwika kuti dzenje mu mtima.
Sitikukayikanso kuti zilonda za cryptogenic zimatuluka ndi magazi omwe amatha kuwoloka PFO, kulowetsa, ndikupita ku ubongo. Komabe, chodabwitsa ichi sichipezeka, koma PFOs ndizofala. (PFOs amatha kupezeka pofika 25 peresenti ya anthu onse mwa kujambula zithunzi.)
Mwinamwake, chifukwa cha ichi, kafukufuku omwe awonetsa phindu lopindulitsa pogwiritsira ntchito zipangizo zotsekemera za PFO kwa odwala omwe ali ndi zikopa za cryptogenic akhala akukhumudwitsa - kuchepetsa kuchepa kwa ziwalo pambuyo pake kwatulukira. Pa nthawi yomweyi, njira zomwe zimagwiritsidwa ntchito kutsegula PFOs zimapereka odwala kuti zikhale zoopsa.
Zili choncho kuti odwala ena, kutseka PFOs kungakhale kopindulitsa. Koma pakadali pano, palibe njira yovomerezeka yodziwitsa omwe ali ndi cryptogenic stroke ndi PFO angapindule ndi PFO kutseka.
Komabe, kafukufuku waposachedwapa amasonyeza kuti pogwiritsa ntchito njira yophunzirira Doppler , pogwirizana ndi kuphunzira kovuta, madokotala angayambe kuzindikira odwala omwe amamva kupweteka kwa cryptogenic chifukwa cha PFO. Maphunziro ena adzafunikanso kuti aone ngati kutseka PFO kungachepetse chigamulo cha odwala.
Chofunika kwambiri, ndikuti kusungidwa kwa PFOs kwa odwala omwe ali ndi vuto la cryptogenic sikungakhale wolungama lero. The American Academy of Neurology mu 2016 anachenjeza kuti nthawi zonse amapereka PFO kutsekedwa kwa anthu amene anavutika ndi matenda a cryptogenic.
Kuthamanga kwa Atrial ndi Cryptogenic Stroke
Matenda a atrial ndi omwe amadziwika bwino chifukwa cha kupweteka kwapadera, ndipo odwala okhala ndi mafinyrous atrial amafunika kudziwika.
Umboni waposachedwapa umasonyeza kuti odwala ochepa omwe ali ndi vuto la cryptogenic akhoza kukhala ndi "matenda oopsa" omwe amachititsa kuti thupi lisagwiritsidwe ntchito. Kuwonjezera apo, pali deta yomwe ikusonyeza kuti kufufuza kwa mtima kwa nthawi yaitali kungakhale kothandiza pozindikira kugwiritsira ntchito mankhwala opatsirana pogonana kwa odwala omwe ali ndi vuto la cryptogenic. Odwalawa, mwachidziwikire, monga odwala ena omwe ali ndi matenda oopsa a atrial, antiticoagulation angachepetse chiopsezo cha kupwetekedwa kobwerezabwereza.
Zotsatira:
> Cujec B, Polasek P, Voll C, Shuaib A. Mapulogalamu Otsatira Mapulogalamu Odziwika pa Kuzindikira Komwe Mungapangire Mtundu wa Mtima wa Kugonjetsa Pakati pa Odwala. Stroke 1991; 22: 727.
> Lansberg MG, O'Donnell MJ, Khatri P, et al. Chithandizo cha Antithrombotic ndi Thrombolytic for Ischemic Stroke: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Malangizo Othandizira Malangizo Othandizira Odwala. Chifuwa cha 2012; 141: e601S.
> Messe SR, Gronseth G, Kent DM, Et al. Gwiritsani Ntchito Malangizidwe: Stroke Yachizolowezi ndi Patent Foramen Ovale (Zopangira Zolemba Zomwe Zimapangidwira.) Report of the Guideline Development, Dissemination, and Implementation Komiti Yachigawo ya American Academy of Neurology.
Mohr, JP, Choi, WC, Grotta, JC, et al. Kukwapulidwa: Kutengera Pathophysiology, Kusanthula, ndi Kulamulira, 4 Edition, Churchill Livingstone, New York 2004.