Anisocoria rashin daidaituwa ne a diamita na ɗaliban biyu, wanda ya fi 0,3 millimeters: ɗaliban biyu suna da girma daban-daban. Ana iya danganta Anisocoria ko dai zuwa ga mydriasis unilateral, wato karuwa a girman daya daga cikin daliban biyu, ko kuma, akasin haka, zuwa miosis yana sanya almajiri karami fiye da ɗayan.

Abubuwan da ke haifar da anisocoria suna da yawa daban-daban, kama daga ƙananan aetiologies zuwa yiwuwar cututtuka masu tsanani, kamar lalacewar jijiya. Hanyoyi daban-daban suna ba da izinin ganewar asali, wanda dole ne a kafa shi cikin gaggawa don hana yiwuwar sakamako mai tsanani, irin su na bugun jini, wanda anisocoria ma alama ce.

Menene anisocoria

Mutum yana da anisocoria lokacin da almajiransa guda biyu suna da girma daban-daban: ko dai saboda mydriasis unilateral, saboda haka karuwar girman ɗayan ɗalibansa biyu, ko kuma saboda miosis unilateral, wato, ta kuntatawa. Anisocoria yana nuna bambanci a cikin diamita na yara fiye da 0,3 millimeters.

Almajiri shine budewa a tsakiyar iris, ta inda haske ke shiga cikin rami na baya na kwayar ido. Iris, bangaren kwan fitilar ido mai launi, ya kunshi sel wadanda suke ba shi launinsa (wanda ake kira melanocytes) da kuma filayen tsoka: babban aikinsa shi ne daidaita yawan hasken da ke shiga kwan fitilar ido. ido ta cikin almajiri.

A gaskiya ma, almajiri (wanda ke nufin, "ƙaramin mutum", saboda wannan shine inda kake ganin kanka lokacin da kake kallon mutum a cikin ido), wanda shine tsakiyar bude ido na iris, ya bayyana baƙar fata saboda lokacin da kake kallo Ta hanyar ruwan tabarau. , ita ce bangaren bayan ido ya bayyana (choroid da retina), wanda yake da launi sosai.

Reflexes suna tsara tantanin halitta, dangane da tsananin hasken: 

• lokacin da haske mai ƙarfi ya motsa ido, ƙananan zaruruwa na tsarin juyayi na ciyayi ne ke shiga cikin wasa. Don haka, jijiyar oculomotor na parasympathetic zaruruwa suna motsa ƙuƙuwar zaruruwan madauwari ko na shekara na iris (ko tsokoki na almajiri) suna haifar da raguwar ɗalibin, wato rage diamita na ɗalibi.
• Sabanin haka, idan hasken ya kasance mai rauni, wannan lokacin shine neurons masu tausayi na vegetative juyayi tsarin da aka kunna. Suna motsa radiary fibers ko dilator tsokoki na ɗalibin, haifar da haɓaka diamita na ɗalibin.

Duk wani anisocoria yana buƙatar kimar ophthalmological kuma, sau da yawa, neurological ko neuroradiological. Don haka ana iya danganta anisocoria da miosis na ɗaya daga cikin ɗaliban biyu, wanda ya haifar da kunna tsarin parasympathetic wanda ke haifar da na sphincter na iris, ko kuma mydriasis na ɗayan ɗaliban, wanda tsarin tausayi ke kunnawa. tsokar dilator na iris.

Akwai anisocoria physiological, wanda ke shafar kusan kashi 20% na yawan jama'a.

Yadda za a gane anisocoria?

Ana iya gane Anisocoria a gani ta wurin gaskiyar cewa ɗaliban biyu ba girmansu ɗaya ba ne. Yawancin likitocin ido suna ganin marasa lafiya da yawa tare da anisocoria yayin rana ta musamman ta shawarwari. Yawancin wadannan mutane ba su san shi ba, amma wasu sun zo musamman don a tantance shi.

Gwaje-gwajen da aka yi amfani da hasken wuta zai ba da damar tantancewa wanda shine ɗalibin ilimin cututtuka: don haka, anisocoria ya karu a cikin haske mai ƙarfi zai nuna cewa ɗalibin ilimin cututtuka shine mafi girma (ƙananan ƙanƙara na ɗabi'a), kuma akasin haka anisocoria ya karu a cikin ƙananan haske. nuna cewa dalibin ilimin cututtuka shine mafi ƙanƙanta (rashin shakatawa na ɗalibin ilimin cututtuka).

hadarin dalilai

Dangane da abubuwan iatrogenic (wanda aka danganta da kwayoyi), ma'aikatan kiwon lafiya, irin su ma'aikatan jinya da ke aiki a asibitoci, na iya fuskantar haɗarin haɓaka nau'ikan anisocoria na pharmacological, wanda ya zama mara kyau, bayan bayyanar wasu magunguna. samfurori, irin su scopolamine faci: waɗannan na iya haifar da anisocoria wanda zai ragu da kansa a cikin kwanaki.

Bugu da ƙari, a cikin abubuwan injiniya, akwai, a cikin yara, haɗarin anisocoria da ke haifar da wahalar haihuwa, musamman lokacin da ake amfani da karfi.

Abubuwan da ke tattare da anisocoria sun bambanta sosai: alama ce ta cututtukan cututtukan da za su iya bambanta daga abubuwan da ba su da kyau zuwa ƙwayoyin cuta ko ma mahimmancin gaggawa.

Physiological anisocoria

Wannan lamari na anisocoria physiological, wanda ke nan ba tare da akwai wata cuta mai alaƙa ba, yana shafar tsakanin 15 zuwa 30% na yawan jama'a. Ya daɗe yana nan, kuma bambancin girman da ke tsakanin ɗaliban biyu bai wuce milimita 1 ba.

Idoji na ido kawai

Abubuwan da ke haifar da anisocoria kawai ana iya gano su cikin sauƙi yayin gwajin ido:

• tashin hankali;
• ruwa;
• m glaucoma.

Anisocoria na injiniya

Akwai dalilai na inji na anisocoria, wanda za'a iya danganta shi da tarihin rauni (ciki har da tiyata), zuwa kumburin cikin ido wanda zai iya haifar da haɗuwa tsakanin iris da ruwan tabarau, ko ma ga cututtuka na haihuwa. .

Adie's tonic almajiri

Almajiri Adie ko Ciwon Adie cuta ce da ba kasafai ba, wacce yawanci ke shafar ido daya kawai: wannan ido yana da babban almajiri, mai fadi da karfi, mai rauni ko rashin amsawa a yayin da haske ya tashi. Ana ganin shi sau da yawa a cikin 'yan mata, kuma ba a san asalinsa ba. Bugu da ƙari, yana iya ko ba zai iya nuna alamun gani ba, kamar rashin jin daɗi a wasu lokuta lokacin karatu.

Dalibai masu fa'ida da magunguna

Ɗaliban da suka faɗu saboda wani abu na harhada magunguna suna wanzuwa a yanayi biyu: fallasa na bazata ga wakili wanda ke shafar aikin ɗalibi-motar, ko fallasa da gangan.

Wasu daga cikin wakilai da aka sani suna faɗaɗa ɗalibin sune:

• scopolamine faci;
• inhaled ipratopium (maganin asma);
• vasoconstrictor na hanci;
• glycopyrrolate (maganin da ke rage ayyukan ciki da hanji);
• da ganye, irin su ciyawa Jimson, ƙaho na Mala'ika ko dare.

Ana ganin ƴan ƴan ƴan ƙunƙun yayin bayyanar da:

• pilocarpine;
• prostaglandins;
• opioids;
• clonidine (magungunan antihypertensive);
• organophosphate kwari.

Rashin yin kwangilar pilocarpine alama ce ta iatrogenic dilation na ɗalibin.

Horner Syndrome

Claude-Bernard Horner ciwo cuta ce da ta haɗu da ptosis (faɗuwar fatar ido na sama), miosis da jin enophthalmos (ƙancewar ido a cikin orbit). Ganewarsa yana da mahimmanci, saboda ana iya haɗa shi da rauni a kan hanyar jin daɗin ido, sannan yana iya zama alamar, a tsakanin sauran abubuwa, na:

• huhu ko ciwon daji na tsakiya;
• neuroblastoma (mafi kowa a cikin yara);
• dissections na carotid arteries;
• lalacewar thyroid;
• trigemino-dysautomatic ciwon kai da autoimmune ganglionopathies (duba ƙasa).

Shanyewar jijiya

Ciwon jijiya na Oculomotor kuma na iya shiga cikin anisocoria.

Hanyoyin cututtuka na neurovascular 

• Shanyewar jiki: wannan dalili ne da dole ne a gano shi da sauri domin a samu damar amsawa cikin sa'o'i shida na bugun jini;
• Aneurysm artery (ko kumburi).

Pourfour du Petit Syndrome

Pourfour du Petit ciwo, wani excitation ciwo na tsarin juyayi, ya gabatar musamman mydriasis da ja da baya na fatar ido: shi ne wani rare ciwo sau da yawa saboda m ƙari.

Trigemino-dysautomic ciwon kai

Wadannan ciwon kai suna da zafi a kai da kuma mafi yawan lokuta suna fitowa daga hancin hanci da zubar da hawaye. Suna da alaƙa da miosis na ɗalibi a cikin 16 zuwa 84% na lokuta. Ana iya siffanta su ta hanyar hoto. An ba da shawarar yin shawarwari tare da likitan jijiyoyi ko neuro-ophthalmologist don jagorantar jiyya da tabbatar da ganewar asali a wasu lokuta masu kama.

Autoimmune ganglionopathy na autonomic tsarin

Wannan cuta da ba kasafai ake gabatar da ita tare da autoantibodies da ke niyya ga ganglia na tsarin juyayi mai sarrafa kansa. Dukansu tsarin, mai tausayi da kuma parasympathetic, ana iya shafa su; Dangane da matsalar rashin lafiyar ɗalibi, ganglia ce ta parasympathetic ganglia wacce aka fi shafa. Don haka, kashi 40 cikin XNUMX na marasa lafiya suna fama da rashin lafiyar yara, gami da anisocoria. Wannan Pathology yana wanzu a kowane zamani, kuma yana iya nuna alamun bayyanar cututtuka irin su na encephalitis. Ana iya warkar da shi ba tare da bata lokaci ba, amma lalacewar jijiyoyi na iya kasancewa, don haka yawan nuni ga immunotherapy.

Babu ainihin haɗarin rikitarwa a cikin kansa na anisocoria, haɗarin rikice-rikice shine na cututtukan cututtukan da ke tattare da shi. Idan anisocoria wani lokaci yana da dalili mara kyau, yana iya zama alamar cututtuka waɗanda zasu iya zama mai tsanani, musamman lokacin da suke da ciwon jijiya. Don haka waɗannan abubuwa ne na gaggawa, waɗanda dole ne a gano su da wuri-wuri, ta hanyar gwaje-gwaje daban-daban:

• Gwaje-gwajen hoto irin su MRI na kwakwalwa na iya buƙatar amfani da su da sauri, musamman idan ana zargin bugun jini, da kuma wani lokacin angiography na kai da wuya (wanda ke nuna alamun jini).

Duk waɗannan gwaje-gwajen dole ne su ba da damar daidaita cutar da sauri da sauri don guje wa matsaloli masu mahimmanci, kamar waɗanda ke biyo bayan bugun jini, tunda idan an kula da shi cikin sa'o'i shida, sakamakon zai zama ƙasa da mahimmanci. Bugu da ƙari, don guje wa gwaje-gwajen hoto marasa mahimmanci, gwaje-gwaje ta amfani da zubar da ido yana da tasiri:

• Don haka, anisocoria pharmacological, saboda wani magani, za a iya bambanta daga pupillary dilation na neurological asalin ta amfani da ido saukad da gwajin da 1% pilocarpine: idan dilated almajiri ba ya raguwa bayan minti talatin, shi ne shaida na pharmacological blockade. tsoka iris.
• Gwaje-gwaje ta amfani da digon ido kuma na iya jagorantar gano cutar ta Horner: idan akwai shakka, ya kamata a sanya digo na 5 ko 10% na ruwan hodar ido a kowane ido, kuma a lura da canje-canjen diamita na yara: hodar iblis yana haifar da mydriasis na almajiri na al'ada, yayin da yake da ɗan tasiri ko rashin tasiri a cikin ciwon Horner. Ruwan ido na Apraclodine shima yana da amfani wajen tabbatar da ciwon Horner, yanzu ya fi dacewa da gwajin hodar iblis. A ƙarshe, yin hoto a yanzu yana ba da damar ganin duk hanyar tausayi don gano ciwon Horner: yau shine gwaji mai mahimmanci.

Ƙimar mydriasis unilateral ko miosis na iya zama ƙalubalen ganowa kuma ana ɗaukar gaggawar jijiya. Ta hanyar tarihin majiyyaci, jin daɗin jikin sa da bincike daban-daban, ana iya kafa alamun cutar kuma kai tsaye zuwa hanyar da ta dace.

A zamanin magungunan zamani, idan akwai bugun jini, ƙwayar plasminogen activator magani ne wanda ya ba da damar ci gaba mai girma a cikin jiyya. Gudanarwa yakamata ya kasance da wuri - a cikin sa'o'i 3 zuwa 4,5 na farkon bayyanar cututtuka. Dole ne a jaddada mahimmancin ganewar asali a nan: saboda gudanar da wannan nama na plasminogen activator zai sami, a cikin marasa lafiya marasa cancanta, sakamakon da zai iya zama bala'i, kamar ƙara yawan haɗarin zubar jini.

A gaskiya ma, jiyya za su kasance musamman ga kowane nau'i na ilimin cututtuka wanda ke nuna alamar anisocoria. A dukkan lokuta, likita Dole a shawarci a taron na anisocoria, sa'an nan kwararru, kamar neurologists da neuro-ophthalmologists, ko ophthalmologists, wanda zai iya kafa musamman kula ga kowane cuta. Ya kamata a tuna cewa wannan alama ce da dole ne a yi gaggawar magance ta, domin yayin da yake iya bayyana cututtuka marasa kyau, ana iya danganta shi da gaggawar rayuwa.