ʻO ka wai cerebrospinal kahi wai e ʻauʻau ai i nā hale o ka ʻōnaehana nerve waena: ka lolo a me ke kuamoʻo. Loaʻa iā ia kahi kuleana o ka pale a me ka haʻalulu. Aia ka wai cerebrospinal i kahi kūlana maʻamau, ʻaʻohe germs. ʻO ke ʻano o kahi germ i loko ona hiki ke kuleana no nā pathologies infectious koʻikoʻi.

Definition

ʻO ka wai cerebrospinal a i ʻole CSF he wai e hoʻopuni ana i ka ʻōnaehana nerve waena (lolo a me ke kuamoʻo). Kaapuni ia ma ka ʻōnaehana ventricular (ventricles aia i loko o ka lolo) a me ka lewa subarachnoid.

I mea e hoʻomanaʻo ai, ua hoʻopuni ʻia ke kikowaena kikowaena e nā envelopes i kapa ʻia nā meninges, i hana ʻia me 3 mau papa:

• ka dura, he papa mānoanoa o waho;
• ʻo ka arachnoid, kahi ʻāpana lahilahi ma waena o ka dura a me ka pia mater;
• ka pia mater, ka pepa lahilahi o loko, e pili ana i ka ili o ka lolo.

ʻO ka hakahaka ma waena o ka arachnoid a me ka pia mater e pili ana i ka subarachnoid space, kahi o ke kaʻa ʻana o ka wai cerebrospinal.

hiʻona

ʻO ka nui o ka hana ʻana o CSF ​​i kēlā me kēia lā ma kahi o 500 ml.

ʻO kona nui he 150 - 180 ml, i nā pākeke, a no laila e hoʻololi hou ʻia i nā manawa he nui i ka lā.

Hoʻohana ʻia kona puʻe me ka lumbar puncture. Kuhi ʻia ma waena o 10 a me 15 mmHg i nā pākeke. (5 a 7 mmHg i nā kamaliʻi).

I ka maka maka, he wai maʻemaʻe ka CSF i ʻōlelo ʻia he wai pōhaku.

haku mele

ʻO ka wai Celphalo-spinal i hana ʻia me:

• wai;
• nā leukocytes (ke koko keʻokeʻo) <5 / mm3;
• o nā protein (i kapa ʻia ʻo proteinorrachia) ma waena o 0,20 – 0,40 g / L;
• ʻO ka glucose (ʻike ʻia ʻo glycorrachia) he 60% o ka glycemia (ka pae koko koko), a i ʻole 0,6 g / L;
• nui nā ion (sodium, chlorine, potassium, calcium, bicarbonate)

ʻO ka CSF he sterile loa, ʻo ia hoʻi ʻaʻole i loko o nā microorganism pathogenic (viruses, bacteria, fungi).

hiʻona

ʻO ka wai cerebrospinal kahi wai e ʻauʻau ai i nā hale o ke kikowaena pūnaʻi. He kuleana ko ia o ka pale a me ka haʻalulu o ka hope, i ka wā o ka neʻe ʻana a me nā loli o ke kūlana. He mea maʻamau ka wai cerebrospinal, ʻaʻohe germ (sterile). ʻO ke ʻano o kahi germ i loko o ia mea ke kuleana no nā pathologies infectious koʻikoʻi e hiki ke alakaʻi i ka sequelae neurological a i ʻole ka make ʻana o ka mea maʻi.

Ka huna a me ke kaa ana

Hana ʻia ka wai cerebrospinal a hūnā ʻia e nā plexuses choroid e pili ana i nā hale i loaʻa ma ka pae o nā paia o nā ventricle like ʻole (lateral ventricles, 3rd ventricle a me 4th ventricle) a hiki ke hana i kahi hui ma waena o ke koko a me ke kikowaena. nenoaiu .

Loaʻa ka holo ʻana a me ka manuahi o ka CSF ma ke kiʻekiʻe o nā ventricle lateral, a laila i ka ventricle 3 ma o nā lua Monroe a laila i ka ventricle 4 ma o ka aqueduct Sylvius. A laila e hui pū me ka lewa subarachnoid ma o ka foramina o Luscka a me Magendie.

Hana ʻia kona reabsorption ma ke kiʻekiʻe o ka villi arachnoid o Pacchioni (nā ulu ulu ʻana ma ka ʻaoʻao o waho o ka arachnoid), e ʻae ana i kona kahe ʻana i ka venous sinus (ʻoi aku ka pololei o ka venous sinus longitudinal luna) a pēlā kona hoʻi ʻana i ka venous circulation. . .

ʻO ka nānā ʻana o ka CSF e hiki ai ke ʻike i nā pathologies he nui, ʻo ka hapa nui o ia mea e koi i ka mālama wikiwiki. Hana ʻia kēia hoʻopaʻa ʻana e ka lumbar puncture, ʻo ia hoʻi ka lawe ʻana i ka CSF, ma ka hoʻokomo ʻana i kahi nila lahilahi ma waena o ʻelua lumbar vertebrae (ka hapa nui o nā hihia, ma waena o ka 4th a me ka 5th lumbar vertebrae i mea e pale ai i ka pōʻino o ke kuamoʻo. ., e ku ana ma ke alo o ka vertebra lumbar 2). ʻO ka lumbar puncture kahi hana invasive, pono e hana ʻia e ke kauka, me ka hoʻohana ʻana i ka asepsis.

Loaʻa nā contraindications (ka maʻi coagulation koʻikoʻi, nā hōʻailona o ke kiʻekiʻe intracranial hypertension, ka maʻi ma ka wahi puncture) a hiki ke loaʻa nā hopena ʻaoʻao (post-lumbar puncture syndrome, maʻi, hematoma, ʻeha kua hope).

Aia ka CSF analysis:

• kahi hoʻokolokolo macroscopic (ka nānā ʻana me ka maka ʻōlohelohe e ʻae i ka nānā ʻana i ke ʻano a me ke kala o ka CSF);
• kahi hoʻokolohua bacteriological (ʻimi no ka bacteria me ka ʻike o nā moʻomeheu);
• kahi hoʻokolohua cytological (e ʻimi ana i ka helu o nā keʻokeʻo keʻokeʻo a me ka ʻulaʻula);
• kahi hoʻokolohua biochemical (ʻimi i ka helu o nā protein, glucose);
• Hiki ke hana ʻia nā loiloi hou no nā maʻi maʻi kūikawā (Herpes virus, Cytomegalovirus, Enterovirus).

Nā maʻi maʻi maʻi

ʻO ke kāne

Ua like ia me ka mumū o ka maninges a ma ka hapanui o nā hihia he lua ia i ka maʻi e ka pathogenic agent (bacterial, virus a i ʻole parasite a fungi paha) ma muli o ka haumia o ka wai cerebrospinal.

ʻO nā hōʻailona nui o ka maningitis:

• ʻO ke poʻo poʻo ākea me ka ʻehaʻeha mai ka walaʻau (phonophobia) a me ka māmā (photophobia);
• he kuni;
• nausea a me ka luaʻi.

Ma ka hoʻokolohua lapaʻau, hiki i kekahi ke ʻike i ka ʻoʻoleʻa maningeal, ʻo ia hoʻi ke kūʻē hiki ʻole a ʻeha ke kūlou i ka ʻāʻī.

Ua wehewehe ʻia kēia e ka ʻoki ʻana o nā ʻiʻo para-vertebral e pili ana i ka huhū o nā maninges.

Inā manaʻo ʻia ka maʻi maʻi, pono e wehe loa i ke kapa o ka mea maʻi, i mea e ʻimi ai i nā hōʻailona o ka purpura fulminans (kahi hemorrhagic ʻili pili i kahi maʻi coagulation, ʻaʻole e nalowale ke hoʻoikaika ʻia ke kaomi). ʻO ka Purpura fulminans kahi hōʻailona o kahi maʻi koʻikoʻi loa, ʻoi aku ka lua o ka maʻi meningococcus (bacteria). He pilikia ia e hoʻoweliweli i ke ola e koi ana i ka hoʻokō intramuscular a i ʻole intravenous o ka lāʻau antibiotic i ka wikiwiki.

Pono pinepine nā hoʻokolohua hou no ka maopopo o ka maʻi:

• lumbar puncture (koe naʻe nā hihia o ka contraindication) e ʻae ana e hana ʻia kahi loiloi;
• ka loiloi olaola (helu koko, loiloi hemostasis, CRP, ionogram koko, glycemia, serum creatinine, a me nā moʻomeheu koko);
• ʻO ke kiʻi wikiwiki o ka lolo i kēia mau hihia e kūʻē i ka lumbar puncture: haunaele o ka ʻike, neurological deficit a / a hopu paha.

ʻO ka loiloi o ka CSF e hiki ai ke kuhikuhi i kahi ʻano maningitis a hōʻoia i ka hele ʻana o kahi mea pathogenic.

Ma muli o ke ʻano o ka germ i loko o ka wai cerebrospinal.

ʻO ka maʻi maʻi maʻi

Ua wehewehe ʻia e ka hui ʻana o kahi mumū o ka lolo a me nā envelopes maningeal.

Hoʻokumu ʻia ia ma ka hui ʻana o kahi maʻi meningeal (ʻeha poʻo, luaʻi, nausea a me ka maningeal stiffness) a me kahi hōʻino o ka lolo i alakaʻi ʻia e ka hele ʻana o nā maʻi o ka noʻonoʻo, ʻāpana a i ʻole ka hoʻopaʻapaʻa holoʻokoʻa a i ʻole ka hōʻailona o kahi deficit neurological (deficit motor. , aphasia).

ʻO ka Meningoencephalitis kahi maʻi maʻi koʻikoʻi e hiki ke alakaʻi i ka make o ka mea maʻi a no laila pono ke mālama olakino wikiwiki.

ʻO ka manaʻo kānalua o ka maningoencephalitis pono ke kiʻi wikiwiki i ka lolo, a pono e hana ʻia ma mua o ka ʻoki ʻana i ka lumbar.

ʻO nā hoʻokolohua ʻē aʻe e hōʻoia i ka maʻi:

• kahi loiloi olaola (helu koko, CRP, ionogram koko, moʻomeheu koko, loiloi hemostasis, serum creatinine);
• Hiki ke hana ʻia kahi EEG (electroencephalogram), e hōʻike ana i nā hōʻailona no ka pōʻino o ka lolo.

Pono e wikiwiki ka mālama ʻana i ka lāʻau lapaʻau a laila e hoʻololi ʻia i ka germ i hōʻike ʻia.

ʻO ka maʻi maʻi maʻi maʻi

ʻO ka maningitis carcinomatous ka mumū o nā maninges ma muli o ka loaʻa ʻana o nā maʻi kanesa i loaʻa i ka CSF. ʻO ka ʻoi aku ka pololei, he nīnau ia no nā metastases, ʻo ia hoʻi ka hoʻolaha lua ʻana ma muli o ka maʻi maʻi maʻi mua (ma ke ʻano o ka maʻi maʻi ʻāʻī, melanoma a me ka maʻi maʻi umauma).

He polymorphic nā hōʻailona, ​​ʻo ia hoʻi:

• meningeal syndrome (ʻeha poʻo, nausea, luaʻi, ʻāʻī ʻoʻoleʻa);
• nā haunaele o ka ʻike;
• hoʻololi hoʻololi (hoʻomanaʻo nalowale);
• ka hopu ʻana;
• hemahema neurological.

Pono nā hoʻokolohua hou e hōʻoia i ka maʻi:

• ka hana ʻana i ka lolo (brain MRI) hiki ke hōʻike i nā hōʻailona e pili ana i ka ʻike;
• kahi lumbar puncture e nānā ai i ka loaʻa ʻana o nā maʻi maʻi maʻi i loko o ka CSF a pēlā e hōʻoia ai i ka ʻike.

ʻO ka wānana o ka maʻi maʻi maʻi carcinomatous he pōʻeleʻele i kēia lā me ka liʻiliʻi o nā mea lapaʻau maikaʻi.

ʻO ke kamepiula

ʻO ka Hydrocephalus kahi hōʻiliʻili o ka nui o ka wai cerebrospinal i loko o ka ʻōnaehana ventricular cerebral. Hōʻike ʻia ia ma ka hana ʻana i kahi kiʻi lolo e ʻike ai i ka dilation o ka cerebral ventricles.

Hiki i kēia keu ka hopena i ka piʻi ʻana o ke kaomi intracranial. ʻOiaʻiʻo, e hilinaʻi ka intracranial pressure i kekahi mau ʻāpana:

• ka lolo parenchyma;
• ka wai cerebrospinal;
• ka nui o ka cerebrovascular.

No laila ke hoʻololi ʻia kekahi a ʻoi aku paha o kēia mau ʻāpana, e loaʻa ka hopena i ke kaomi intracranial. ʻO ke kiʻekiʻe o ka intracranial hypertension (HTIC) i wehewehe ʻia ma ke ʻano he waiwai> 20 mmHg i nā pākeke.

Aia nā ʻano like ʻole o ka hydrocephalus:

• non-communicating hydrocephalus (obstructive): pili ia i ka hoʻonui nui ʻana o ka wai cerebrospinal i loko o ka ʻōnaehana ventricular lua i kahi obstacle e pili ana i ke kahe o ka CSF a pēlā i kona reabsorption. ʻO ka pinepine, ma muli o ka loaʻa ʻana o kahi tumo e hoʻopiʻi ana i ka ʻōnaehana ventricular, akā hiki nō ke kiʻekiʻe i nā malformations mai ka hānau ʻana. ʻO ia ka hopena i ka piʻi ʻana o ke kaomi intracranial e koi ana i ka mālama wikiwiki. Hiki ke hoʻokō i kahi bypass ventricular waho o ka CSF (temporary solution) a i ʻole i hoʻomohala hou ʻia, ka ʻike ʻana i kahi ventriculocisternostomy endoscopic (hana i kahi kamaʻilio ma waena o ka cerebral ventricular system a me nā luawai e pili ana i ka hoʻonui ʻana o ka subarachnoid. space) no laila e ʻae ai e kāʻalo i ka mea keakea a loaʻa kahi kahe kūpono o ka CSF;
• hydrocephalus kamaʻilio (non-obstructive): pili ia i ka hoʻonui ʻana o ka wai cerebrospinal e pili ana me kahi gene i ka reabsorption o CSF. ʻO ia ka mea maʻamau i ka lua o ka hemorrhage subarachnoid, trauma poʻo, maningitis a i ʻole idiopathic paha. Pono ia e hoʻoponopono ʻia e kahi shunt CSF kūloko i kapa ʻia ʻo ventriculoperitoneal shunt (inā e kuhikuhi ʻia ka wai i ka peritoneal cavity) a i ʻole ventriculo-atrial shunt (inā kuhikuhi ka wai i ka puʻuwai);
• ʻO ka hydrocephalus maʻamau i ke kaomi maʻamau: pili ia i ka nui o ka wai cerebrospinal i loko o ka cerebral ventricular system akā me ka piʻi ʻole o ke kaomi intracranial. Hoʻopili pinepine ia i nā pākeke, ma hope o 60 mau makahiki me ka nui o nā kāne. Hoʻomaopopo maikaʻi ʻole ʻia ka hana pathophysiological. Hiki ke loaʻa i ka poʻe me ka mōʻaukala o ka subarachnoid hemorrhage, ka ʻeha poʻo a i ʻole ka loaʻa ʻana o ka ʻoki intracranial.

Ua wehewehe ʻia i ka hapa nui o ka manawa e kahi triad o nā hōʻailona, ​​i kapa ʻia ʻo Adams a me Hakim triad:

• hoʻohaʻahaʻa manaʻo hoʻomanaʻo;
• nā maʻi sphincter (ka hoʻomau ʻole ʻana o ka mimi);
• pilikia ka hele ʻana me ka hele mālie.

Hiki i ke kiʻi lolo ke hōʻike i ka dilation o ka cerebral ventricles.

Hoʻokumu ʻia ka hoʻokele ma ka hoʻokumu ʻana i kahi bypass ventricular kūloko, ʻo ventriculo-peritoneal a i ʻole ventriculo-atial.

Nā pathology ʻē aʻe

ʻO ka nānā ʻana i ka wai cerebrospinal hiki ke hōʻike i nā pathologies ʻē aʻe:

• ka hemorrhage subarachnoid me nā hōʻike o ke koko e kahe ana i ka CSF;
• nā maʻi inflammatory e pili ana i ke kikowaena o ke kikowaena (multiple sclerosis, sarcoidosis, etc.);
• nā maʻi neurodegenerative (ka maʻi o Alzheimer);
• nā neuropathies (Guillain-Barré syndrome).