Ruwan Cerebrospinal wani ruwa ne wanda ke wanke tsarin tsarin juyayi na tsakiya: kwakwalwa da kashin baya. Yana da rawar kariya da abin sha. Ruwan cerebrospinal yana cikin yanayin al'ada, babu ƙwayoyin cuta. Bayyanar kwayar cuta a cikinta na iya zama alhakin cututtukan cututtuka masu tsanani.

definition

Ruwan Cerebrospinal ko CSF ​​wani ruwa ne mai lullube tsarin juyayi na tsakiya (kwakwalwa da kashin baya). Yana zagawa ta hanyar tsarin ventricular (ventricles dake cikin kwakwalwa) da kuma sararin subarachnoid.

A matsayin tunatarwa, tsarin juyayi na tsakiya yana kewaye da envelopes da ake kira meninges, wanda ya ƙunshi nau'i uku:

• da dura, mai kauri daga waje Layer;
• da arachnoid, wani bakin ciki Layer tsakanin dura da pia mater;
• da pia mater, ciki bakin ciki takardar, manne ga cerebral surface.

Wurin da ke tsakanin arachnoid da pia mater yayi daidai da sararin subarachnoid, wurin zagayawa na ruwan cerebrospinal.

Features

An kiyasta yawan samar da CSF na yau da kullun zuwa kusan 500 ml.

Adadinsa shine 150 - 180 ml, a cikin manya, don haka ana sabunta shi sau da yawa a rana.

Ana auna matsinsa ta amfani da huda lumbar. An kiyasta tsakanin 10 zuwa 15 mmHg a cikin manya. (5 zuwa 7 mmHg a jarirai).

A ido tsirara, CSF wani ruwa ne bayyananne da aka ce ruwan dutse ne.

Abun da ke ciki

Ruwan Celphalo-spinal ya ƙunshi:

• ruwa;
• leukocytes (farin jini Kwayoyin) <5 / mm3;
• na sunadarai (wanda ake kira proteinorrachia) tsakanin 0,20 - 0,40 g / L;
• glucose (wanda aka sani da glycorrachia) yana wakiltar 60% na glycemia (matakin sukari na jini), ko kusan 0,6 g / L;
• yawancin ions (sodium, chlorine, potassium, calcium, bicarbonate)

CSF gaba ɗaya bakararre ce, wato ba ya ƙunshi ƙwayoyin cuta na ƙwayoyin cuta ( ƙwayoyin cuta, ƙwayoyin cuta, fungi).

Features

Ruwan cerebrospinal wani ruwa ne wanda ke wanke tsarin tsarin juyayi na tsakiya. Yana da rawar kariya da abin girgiza na ƙarshe, musamman a lokacin motsi da canje-canjen matsayi. Ruwan cerebrospinal na al'ada ne, mara ƙwayoyin cuta (bakararre). Bayyanar kwayar cuta a cikinta na iya zama alhakin mummunan cututtukan cututtukan da ke haifar da cututtukan jijiyoyin jini ko ma mutuwar majiyyaci.

Sirri da zagayawa

Ana samar da ruwa na cerebrospinal da ɓoye ta hanyar ƙwayar choroid wanda ya dace da tsarin da ke a matakin ganuwar ventricles daban-daban ( ventricles na gefe, 3rd ventricle da 4th ventricle) kuma yana ba da damar yin haɗin tsakanin tsarin jini da tsakiya. tsarin juyayi .

Akwai ci gaba da zagayawa kyauta na CSF a matakin ventricles na gefe, sannan zuwa ventricle na 3rd ta cikin ramukan Monroe sannan zuwa ventricle na 4 ta hanyar Sylvius aqueduct. Sa'an nan kuma ya haɗu da sararin subarachnoid ta hanyar foramina na Luscka da Magendie.

Its reabsorption faruwa a matakin arachnoid villi na Pacchioni (mummunan growths located a kan waje surface na arachnoid), kyale ta kwarara zuwa venous sinus (mafi daidai babba a tsaye venous sinus) kuma ta haka ne ta dawo zuwa venous wurare dabam dabam. . .

Binciken CSF yana ba da damar gano cututtuka da yawa, mafi yawansu suna buƙatar kulawa da gaggawa. Ana yin wannan bincike ta hanyar lumbar lumbar, wanda ya ƙunshi ɗaukar CSF, ta hanyar shigar da allura na bakin ciki tsakanin nau'i biyu na lumbar (mafi yawan lokuta, tsakanin 4th da 5th lumbar vertebrae don kauce wa duk wani hadarin lalacewa ga kashin baya. ., tsayawa gaba da 2nd lumbar vertebra). Lumbar huda wani abu ne mai haɗari, wanda dole ne likita ya yi, ta amfani da asepsis.

Akwai contraindications (cututtuka mai tsanani, alamun hauhawar jini na intracranial, kamuwa da cuta a wurin huda) da sakamako masu illa na iya faruwa (cututtukan bayan lumbar puncture, kamuwa da cuta, hematoma, ciwon baya).

Binciken CSF ya haɗa da:

• jarrabawar macroscopic (bincike tare da ido tsirara yana ba da damar bayyanar da launi na CSF don nazarin);
• nazarin kwayoyin halitta (bincike kwayoyin cuta tare da fahimtar al'adu);
• gwajin cytological (neman adadin fararen jini da jajayen jini);
• gwajin kwayoyin halitta (bincika adadin sunadarai, glucose);
• Ana iya yin ƙarin bincike don takamaiman ƙwayoyin cuta (cutar Herpes, Cytomegalovirus, Enterovirus).

Cutar cututtuka

Meningitis

Ya yi daidai da kumburin meninges wanda a mafi yawan lokuta shi ne na biyu zuwa kamuwa da cuta ta kwayoyin cuta (kwayoyin cuta, ƙwayoyin cuta ko ma parasites ko fungi) saboda gurɓataccen ruwa na cerebrospinal.

Babban alamun cutar sankarau sune:

• yaduwa da matsanancin ciwon kai tare da rashin jin daɗi daga amo (phonophobia) da haske (photophobia);
• zazzabi;
• tashin zuciya da amai.

A kan jarrabawar asibiti, mutum zai iya gano taurin meningeal, wato juriya mai raɗaɗi da raɗaɗi lokacin lanƙwasa wuyansa.

An bayyana wannan ta hanyar raguwar tsokoki na para-vertebral dangane da haushi na meninges.

Idan ana zargin cutar sankarau, yana da mahimmanci a cire rigar majiyyaci gabaɗaya, don neman alamun purpura fulminans (tabon jini na fatar jiki da ke da alaƙa da matsalar coagulation, wanda ba ya ɓacewa lokacin da aka matsa lamba). Purpura fulminans alama ce ta kamuwa da cuta mai tsanani, mafi yawan lokuta na biyu zuwa kamuwa da cuta tare da meningococcus (kwayoyin cuta). Gaggawa ce mai barazanar rai da ke buƙatar allurar maganin rigakafi na cikin jiki ko ta jijiya da sauri.

Ƙarin gwaje-gwaje sau da yawa suna buƙata don tabbatar da ganewar asali:

• lumbar huda (sai dai a lokuta na contraindications) ba da damar yin nazari;
• nazarin halittu (ƙididdigar jini, ƙimar hemostasis, CRP, ionogram na jini, glycemia, serum creatinine, da al'adun jini);
• Hoto na gaggawa na kwakwalwa a cikin lokuta masu zuwa wanda ke haifar da huda lumbar: damuwa na sani, raunin neurological da / ko kama.

Binciken CSF yana ba da damar kai tsaye zuwa nau'in cutar sankarau kuma don tabbatar da kasancewar wakili mai cutarwa.

Jiyya zai dogara ne akan nau'in kwayar cutar da ke cikin ruwan cerebrospinal.

Meningoencephalitis

An bayyana shi ta hanyar haɗin kumburin kwakwalwa da envelopes na meningeal.

Yana dogara ne akan haɗuwa da ciwon sankarau (ciwon kai, amai, tashin zuciya da ƙumburi na meningeal) da kuma nakasar kwakwalwa wanda ke jagorantar kasancewar rashin fahimta, ɓarna ko ɓarna gaba ɗaya ko ma alamar rashin lafiyar jijiya (rashin mota , aphasia).

Meningoencephalitis cuta ce mai tsanani wanda zai iya haifar da mutuwar majiyyaci don haka yana buƙatar kulawar gaggawa na likita.

Zato na meningoencephalitis yana buƙatar hoton kwakwalwa na gaggawa, kuma dole ne a yi shi kafin huda lumbar.

Wasu ƙarin gwaje-gwaje sun tabbatar da ganewar asali:

• nazarin halittu (ƙididdigar jini, CRP, ionogram na jini, al'adun jini, ƙimar hemostasis, serum creatinine);
• Ana iya yin EEG (electroencephalogram), wanda zai iya nuna alamun da ke goyon bayan lalacewar kwakwalwa.

Gudanarwa ta hanyar magani dole ne ya kasance cikin sauri sannan kuma za'a daidaita shi da kwayar cutar da aka bayyana.

Cutar sankarau

Cutar sankarau cuta ce kumburin maniyyi saboda kasancewar ƙwayoyin kansar da aka samu a cikin CSF. Fiye da gaske, tambaya ce ta metastases, wato yaduwa ta biyu sakamakon ciwon daji na farko (musamman daga ciwon huhu, melanoma da kansar nono).

Alamomin cutar polymorphic ne, sun ƙunshi:

• ciwo na meningeal (ciwon kai, tashin zuciya, amai, taurin wuya);
• rikicewar sani;
• canjin hali (asarar ƙwaƙwalwar ajiya);
• ciwon kai;
• raunin jijiyoyin jiki.

Ana buƙatar ƙarin gwaje-gwaje don tabbatar da ganewar asali:

• yin hoto na kwakwalwa (kwakwalwa MRI) wanda zai iya nuna alamun da ke goyon bayan ganewar asali;
• wani nau'i na lumbar don neman kasancewar ƙwayoyin ciwon daji a cikin CSF kuma don haka tabbatar da ganewar asali.

Hasashen ciwon sankarau har yanzu yana cikin duhu a yau tare da ƴan hanyoyin warkewa kaɗan.

Hydrocephalus

Hydrocephalus shine tarin yawan adadin ruwa mai yawa na cerebrospinal a cikin tsarin ventricular na kwakwalwa. Ana nunawa ta hanyar yin hoton kwakwalwa wanda ke gano dilation na ventricles na cerebral.

Wannan wuce haddi na iya haifar da karuwa a matsa lamba na intracranial. Tabbas, matsa lamba na intracranial zai dogara da sigogi da yawa waɗanda sune:

• kwakwalwa parenchyma;
• ruwan cerebrospinal;
• karfin cerebrovascular.

Don haka lokacin da aka gyara ɗaya ko fiye na waɗannan sigogi, zai yi tasiri akan matsa lamba na ciki. Hawan jini na intracranial (HTIC) an bayyana shi azaman ƙimar> 20 mmHg a cikin manya.

Akwai nau'ikan hydrocephalus daban-daban:

• hydrocephalus ba mai sadarwa ba (mai hana): ya dace da yawan tarin ruwa na cerebrospinal a cikin tsarin ventricular na biyu zuwa wani cikas da ke shafar kewayawar CSF kuma don haka zuwa sake dawowa. Mafi sau da yawa, shi ne saboda kasancewar ciwon daji yana matsawa tsarin ventricular, amma kuma yana iya zama na biyu ga rashin daidaituwa da ke faruwa tun daga haihuwa. Yana haifar da karuwa a cikin matsa lamba na intracranial na buƙatar magani na gaggawa. Yana yiwuwa a gudanar da wani waje ventricular kewaye na CSF (maganin wucin gadi) ko ma kwanan nan da aka haɓaka, fahimtar wani endoscopic ventriculocisternostomy (halittar sadarwa tsakanin tsarin ventricular na cerebral da rijiyoyin da suka dace da haɓakar subarachnoid). sarari) don haka ba da damar ƙetare shingen da samun isasshen kwararar CSF;
• sadarwar hydrocephalus (marasa hana): ya dace da yawan tarin ruwa na cerebrospinal dangane da kwayar halitta a cikin reabsorption na CSF. Mafi sau da yawa yana na biyu zuwa zubar jini na subarachnoid, ciwon kai, ciwon sankarau ko yiwuwar idiopathic. Yana buƙatar kulawa ta hanyar shunt CSF na ciki da ake kira ventriculoperitoneal shunt (idan an kai ruwa zuwa ga kogin peritoneal) ko ventriculo-atrial shunt (idan ruwan yana nufin zuciya);
• hydrocephalus na yau da kullun a matsa lamba na al'ada: ya dace da wuce haddi na ruwa na cerebrospinal a cikin tsarin ventricular cerebral amma ba tare da karuwa a cikin matsa lamba na intracranial ba. Mafi sau da yawa yana rinjayar manya, bayan shekaru 60 tare da rinjaye na maza. Har yanzu ba a fahimci tsarin ilimin halittar jiki ba. Ana iya samun shi a cikin mutanen da ke da tarihin zubar jini na subarachnoid, ciwon kai ko kuma sun yi tiyata a ciki.

An bayyana shi a mafi yawan lokuta ta hanyar triad na alamomi, wanda ake kira Adams da Hakim triad:

• rashin ƙwaƙwalwar ajiya;
• cututtuka na sphincter (rashin fitsari);
• matsala tafiya tare da jinkirin tafiya.

Hoton kwakwalwa na iya nuna faɗuwar ventricles na cerebral.

Gudanarwa ya dogara ne akan kafa hanyar wucewa ta ciki, ko dai ventriculo-peritoneal ko ventriculo-atial.

Sauran cututtuka

Binciken ruwa na cerebrospinal na iya bayyana wasu cututtuka masu yawa:

• subarachnoid hemorrhage tare da shaidar jini yawo a cikin CSF;
• cututtuka masu kumburi da ke shafar tsarin kulawa na tsakiya (magungunan sclerosis, sarcoidosis, da dai sauransu);
• cututtukan neurodegenerative (cututtukan Alzheimer);
• neuropathy (Guillain-Barré ciwo).