I-Cerebrospinal fluid iwuketshezi olugeza izakhiwo zesimiso sezinzwa esimaphakathi: ubuchopho nomgogodla. Inendima yokuvikela kanye ne-shock absorber. Uketshezi lwe-cerebrospinal lusesimweni esijwayelekile, alunawo amagciwane. Ukubonakala kwegciwane kuwo kungaba nesibopho sama-pathologies athathelwanayo angathi sína.

Incazelo

Uketshezi lwe-Cerebrospinal noma i-CSF uketshezi olumboza isimiso sezinzwa esimaphakathi (ubuchopho nomgogodla). Ijikeleza ngohlelo lwe-ventricular (ama-ventricles atholakala ebuchosheni) kanye nesikhala se-subarachnoid.

Njengesikhumbuzo, isimiso sezinzwa esimaphakathi sizungezwe izimvilophu ezibizwa ngokuthi ama-meninges, ezakhiwe ngezingqimba ezi-3:

• i-dura, ungqimba lwangaphandle olujiyile;
• i-arachnoid, ungqimba oluncane phakathi kwe-dura ne-pia mater;
• i-pia mater, ishidi elincanyana langaphakathi, elinamathela endaweni yobuchopho.

Isikhala esiphakathi kwe-arachnoid ne-pia mater sihambisana nesikhala se-subarachnoid, indawo yomjikelezo we-cerebrospinal fluid.

Izici

Isamba sokukhiqizwa kwansuku zonke kwe-CSF silinganiselwa ku-500 ml.

Umthamo wayo ngu-150 - 180 ml, kubantu abadala, ngakho-ke ivuselelwa kaningana ngosuku.

Umfutho wayo ulinganiswa kusetshenziswa i-lumbar puncture. Ilinganiselwa phakathi kuka-10 no-15 mmHg kubantu abadala. (5 kuya ku-7 mmHg ezinganeni).

Emehlweni enyama, i-CSF iwuketshezi olucacile okuthiwa amanzi e-rock.

Ukubunjwa

I-Celphalo-spinal fluid yenziwe:

• amanzi;
• ama-leukocyte (amangqamuzana egazi amhlophe) <5 / mm3;
• amaprotheni (abizwa nge-proteinorrachia) phakathi kuka-0,20 - 0,40 g / L;
• i-glucose (eyaziwa njenge-glycorrachia) imele ama-60% we-glycemia (izinga likashukela egazini), noma cishe u-0,6 g / L;
• ama-ion amaningi (i-sodium, i-chlorine, i-potassium, i-calcium, i-bicarbonate)

I-CSF ayinyumba ngokuphelele, okusho ukuthi ayiqukethe ama-microorganisms e-pathogenic (amagciwane, amagciwane, isikhunta).

Izici

I-Cerebrospinal fluid iwuketshezi olugeza izakhiwo zesimiso sezinzwa esimaphakathi. Inendima yokuvikela kanye ne-shock absorber yakamuva, ikakhulukazi phakathi nokunyakaza nokushintsha kwesimo. I-cerebrospinal fluid ijwayelekile, ayinamagciwane (ayinyumba). Ukubonakala kwegciwane kuwo kungaba nesibopho sezifo ezithathelwanayo ezingathí sina ezingaholela ku-sequelae yezinzwa noma ngisho nokufa kwesiguli.

Imfihlo kanye nokujikeleza

I-cerebrospinal fluid ikhiqizwa futhi ikhishwe yi-choroid plexuses ehambisana nezakhiwo ezisezingeni lezindonga zama-ventricles ahlukene (ama-lateral ventricles, 3rd ventricle kanye ne-4th ventricle) futhi okwenza kube nokwenzeka ukwenza ukuhlangana phakathi kwesistimu yegazi kanye nendawo ephakathi. isimiso sezinzwa .

Kukhona ukujikeleza okuqhubekayo nokukhululekile kwe-CSF ezingeni lama-ventricles angemuva, bese kuya ku-ventricle yesi-3 ngokusebenzisa izimbobo ze-Monroe bese kuya ku-4th ventricle ngokusebenzisa i-Sylvius aqueduct. Bese ijoyina isikhala se-subarachnoid ngokusebenzisa i-foramina ye-Luscka ne-Magendie.

Ukubuyiselwa kwayo kabusha kwenzeka ezingeni le-arachnoid villi yePacchioni (ukukhula okuyisimanga okukhona ebusweni bangaphandle be-arachnoid), okuvumela ukugeleza kwayo kuye esonweni esinemithambo yegazi (ikakhulukazi isonus venous venous venous) futhi ngaleyo ndlela ibuyele ekuhambeni kwegazi . .

Ukuhlaziywa kwe-CSF kwenza kube nokwenzeka ukuthola izifo eziningi, eziningi zazo ezidinga ukunakekelwa okuphuthumayo. Lokhu kuhlaziya kwenziwa ngokubhoboza i-lumbar, okuhlanganisa ukuthatha i-CSF, ngokufaka inaliti encane phakathi kwama-vertebrae amabili e-lumbar (iningi lamacala, phakathi kwe-4th kanye ne-5th vertebrae ye-lumbar ukuze ugweme noma iyiphi ingozi yokulimala kwentambo yomgogodla. . , ukuma ngokuphambene ne-2nd lumbar vertebra). I-Lumbar puncture iyisenzo esihlaselayo, okumele senziwe udokotela, esebenzisa i-asepsis.

Kukhona ukuphikisana (ukuphazamiseka okukhulu kwe-coagulation, izimpawu ze-hypertension ye-intracranial, ukutheleleka endaweni yokubhoboza) kanye nemiphumela emibi ingase yenzeke (i-post-lumbar puncture syndrome, ukutheleleka, i-hematoma, ubuhlungu obuphansi emuva).

Ukuhlaziywa kwe-CSF kuhlanganisa:

• ukuhlolwa kwe-macroscopic (ukuhlolwa ngeso lenyama okuvumela ukubukeka nombala we-CSF ukuba kuhlaziywe);
• ukuhlolwa kwe-bacteriological (sesha amagciwane ngokuqaphela amasiko);
• ukuhlolwa kwe-cytological (kubheka inani lamangqamuzana egazi amhlophe nabomvu);
• ukuhlolwa kwe-biochemical (sesha inani lamaprotheni, i-glucose);
• ukuhlaziya okwengeziwe kungenziwa kumagciwane athile (Herpes virus, Cytomegalovirus, Enterovirus).

Izifo ezithathelwanayo

I-meningitis

Ihambisana nokuvuvukala kwama-meninges okuyinto ezimweni eziningi okwesibili ekuthelelekeni yi-ejenti ye-pathogenic (ibhaktheriya, igciwane noma i-parasite noma isikhunta) ngenxa yokungcoliswa koketshezi lwe-cerebrospinal.

Izimpawu eziyinhloko ze-meningitis yilezi:

• amakhanda asakaza futhi anamandla ngokuphatheka kabi ngomsindo (phonophobia) nokukhanya (photophobia);
• umkhuhlane;
• isicanucanu nokuhlanza.

Ekuhlolweni komtholampilo, umuntu angakwazi ukubona ukuqina kwe-meningeal, okungukuthi ukumelana okungenakunqotshwa nokubuhlungu lapho egoba intamo.

Lokhu kuchazwa ukufinyela kwemisipha ye-para-vertebral mayelana nokucasuka kwama-meninges.

Uma kusolwa i-meningitis, kubalulekile ukukhumula isiguli ngokuphelele, ukuze kubhekwe izimpawu ze-purpura fulminans (indawo yokopha esikhumbeni exhunywe nenkinga yokuhlangana, engashabalali lapho kucindezela). I-Purpura fulminans iwuphawu lokutheleleka okunzima kakhulu, okuvame ukwedlula ukutheleleka nge-meningococcus (bacteria). Kuyisimo esiphuthumayo esisongela impilo esidinga umjovo we-intramuscular or intravenous of the antibiotic therapy ngokushesha okukhulu.

Ukuhlolwa okwengeziwe ngokuvamile kuyadingeka ukuze kuqinisekiswe ukuxilongwa:

• ukubhoboza i-lumbar (ngaphandle kwezimo zokuphikisana) okuvumela ukuhlaziywa ukuthi kwenziwe;
• ukuhlolwa kwezinto eziphilayo (isibalo segazi, ukuhlolwa kwe-hemostasis, i-CRP, i-ionogram yegazi, i-glycemia, i-serum creatinine, namasiko egazi);
• ukucabanga okuphuthumayo kobuchopho kulezi zimo ezilandelayo eziphikisana nokubhoboza i-lumbar: ukuphazamiseka kokuqaphela, ukushoda kwezinzwa kanye / noma ukuquleka.

Ukuhlaziywa kwe-CSF kwenza kube nokwenzeka ukuqondisa ohlotsheni lwe-meningitis nokuqinisekisa ukuba khona kwe-ejenti ye-pathogenic.

Ukwelashwa kuzoncika ohlotsheni lwegciwane elikhona ku-cerebrospinal fluid.

I-Meningoencephalitis

Kuchazwa ngokuhlangana kokuvuvukala kobuchopho kanye nezimvilophu ze-meningeal.

Kusekelwe ekuhlotshaneni kwe-meningeal syndrome (ubuhlungu bekhanda, ukuhlanza, isicanucanu nokuqina kobuchopho) kanye nokukhubazeka kobuchopho okuqondiswa ukuba khona kokuphazamiseka kokuqaphela, ukuquleka okuyingxenye noma okuphelele noma ngisho nophawu lokushoda kwemizwa (ukushoda kwemoto). , aphasia).

I-Meningoencephalitis i-pathology eyingozi kakhulu engaholela ekufeni kwesiguli ngakho-ke idinga ukunakekelwa okuphuthumayo kwezokwelapha.

Ukusolwa kwe-meningoencephalitis kudinga ukuthwebula isithombe esiphuthumayo sobuchopho, futhi kufanele kwenziwe ngaphambi kokubhoboza i-lumbar.

Ezinye izivivinyo ezengeziwe ziqinisekisa ukuxilongwa:

• ukuhlolwa kwezinto eziphilayo (isibalo segazi, i-CRP, i-ionogram yegazi, amasiko egazi, ukuhlolwa kwe-hemostasis, i-serum creatinine);
• i-EEG (electroencephalogram) ingase yenziwe, engabonisa izimpawu ezivuna ukulimala kobuchopho.

Ukuphathwa ngokwelashwa kufanele kusheshe futhi kuzofanelana negciwane eliveziwe.

I-Carcinomatous meningitis

I-Carcinomatous meningitis ukuvuvukala kwe-meninges ngenxa yokuba khona kwamangqamuzana omdlavuza atholakala ku-CSF. Ngokuqondile, umbuzo wama-metastases, okusho ukuthi ukusabalalisa kwesibili okuvela kumdlavuza oyinhloko (ikakhulukazi umdlavuza wamaphaphu, i-melanoma kanye nomdlavuza webele).

Izimpawu ziyi-polymorphic, ehlanganisa:

• meningeal syndrome (ikhanda elibuhlungu, isicanucanu, ukuhlanza, ukuqina kwentamo);
• ukuphazamiseka kwengqondo;
• ukushintsha kokuziphatha (ukulahlekelwa inkumbulo);
• ukuquleka;
• ukushoda kwezinzwa.

Ukuhlolwa okwengeziwe kuyadingeka ukuze kuqinisekiswe ukuxilongwa:

• ukwenza isithombe sobuchopho (i-MRI yobuchopho) engabonisa izimpawu ezihambisana nokuxilongwa;
• i-lumbar puncture ukuze ubheke ukuba khona kwamangqamuzana omdlavuza ku-CSF futhi ngaleyo ndlela uqinisekise ukuxilongwa.

Ukubikezelwa kwe-carcinomatous meningitis kusemnyama nanamuhla njengoba kunezindlela ezimbalwa zokwelapha ezisebenzayo.

Hydrocephalus

IHydrocephalus ukunqwabelana kwenani eleqile loketshezi lwe-cerebrospinal ngaphakathi kwesistimu ye-cerebral ventricular. Kuboniswa ngokwenza isithombe sobuchopho esithola ukuvuleka kwama-ventricles obuchopho.

Lokhu okweqile kungabangela ukwanda kwengcindezi ye-intracranial. Ngempela, ingcindezi ye-intracranial izoncika kumapharamitha amaningana okuyilawa:

• i-parenchyma yobuchopho;
• uketshezi lwe-cerebrospinal;
• umthamo we-cerebrovascular.

Ngakho-ke uma ipharamitha eyodwa noma ngaphezulu ilungiswa, izoba nomthelela kungcindezi ye-intracranial. I-Intracranial hypertension (HTIC) ichazwa njengenani> 20 mmHg kubantu abadala.

Kunezinhlobo ezahlukene ze-hydrocephalus:

• i-hydrocephalus engaxhumani (obstructive): ihambisana nokunqwabelana okweqile koketshezi lwe-cerebrospinal ohlelweni lwe-ventricular yesibili kuya kusithiyo esithinta ukujikeleza kwe-CSF futhi ngaleyo ndlela ekumunceni kabusha kwayo. Imvamisa, kungenxa yokuba khona kwesimila esicindezela uhlelo lwe-ventricular, kodwa futhi kungaba okwesibili kokungalungi kahle okukhona kusukela ekuzalweni. Kuphumela ekwenyukeni komfutho we-intracranial odinga ukwelashwa okuphuthumayo. Kungenzeka ukwenza i-ventricular bypass yangaphandle ye-CSF (isixazululo sesikhashana) noma ngisho nakamuva nje ukuthuthukiswa, ukugcwaliseka kwe-endoscopic ventriculocisternostomy (ukwakhiwa kokuxhumana phakathi kwesistimu ye-cerebral ventricular kanye nemigodi ehambisana nokwandiswa kwe-subarachnoid. isikhala) ngaleyo ndlela evumela ukudlula isithiyo futhi athole ukugeleza okwanele kwe-CSF;
• ukuxhumana ne-hydrocephalus (okungavimbeli): kuhambisana nokunqwabelana ngokweqile koketshezi lwe-cerebrospinal ngokuhlobene nesakhi sofuzo ekumunceni kabusha kwe-CSF. Imvamisa ilandela ukopha kwe-subarachnoid, ukuhlukumezeka kwekhanda, i-meningitis noma i-idiopathic. Kudinga ukuphathwa yi-CSF shunt yangaphakathi ebizwa nge-ventriculoperitoneal shunt (uma uketshezi luqondiswe embotsheni ye-peritoneal) noma i-ventriculo-atrial shunt (uma uketshezi luqondiswe enhliziyweni);
• i-hydrocephalus engapheli ekucindezelweni okuvamile: ihambisana nokudlulela koketshezi lwe-cerebrospinal ohlelweni lwe-cerebral ventricular kodwa ngaphandle kokwanda kwengcindezi ye-intracranial. Ivamise ukuthinta abantu abadala, ngemuva kweminyaka engama-60 ngokugcwala kwabesilisa. Indlela ye-pathophysiological ayikaqondwa kahle. Ingatholakala kubantu abanomlando we-subarachnoid hemorrhage, ukuhlukumezeka kwekhanda noma ukuhlinzwa kwe-intracranial.

Ichazwa isikhathi esiningi ngezimpawu ezithathu, ezibizwa nge-Adams ne-Hakim triad:

• ukukhubazeka kwememori;
• ukuphazamiseka kwe-sphincter (i-urinary incontinence);
• inkinga yokuhamba ngokuhamba kancane.

I-imaging yobuchopho ingabonisa ukuvuleka kwama-ventricles obuchopho.

Ukuphatha kusekelwe ikakhulukazi ekumisweni kwe-ventricular bypass yangaphakathi, kungaba i-ventriculo-peritoneal noma i-ventriculo-atial.

Ezinye izifo

Ukuhlaziywa kwe-cerebrospinal fluid kungaveza amanye ama-pathologies amaningi:

• i-subarachnoid hemorrhage enobufakazi begazi elijikelezayo ku-CSF;
• izifo ezivuthayo ezithinta isimiso sezinzwa esiphakathi (i-multiple sclerosis, i-sarcoidosis, njll.);
• izifo ze-neurodeergenerative (isifo i-Alzheimer's);
• I-neuropathies (i-Guillain-Barré syndrome).