kefalaio 23 (meros 4) Flashcards
triti sixnotita thanatou ston ditiko kosmo
aee(kardiagkeiaka ,ca)
aee sixnotera..
stous andres ,anw 55
i endokrania piesi pia piesi avksanei
tin fleviki
aee
80% isxaimika, 20% aimoragika(12%endoegkefaliki aimoragia,8% eksagkeiwsi ston ip xoro epomenos iparaxnoeidi aimoragia)
se vlavi prosthias egkefalikis exoume(aimatwnei esw epifaneia egk imisfairiou ews parakentro lovio elegxei katw akro kai akrateies):
paralisi kai diataraxi en to vathei aisthitikotitas tou antiplevrou katw akrou,akrateia ourwn(paralisi periferikou tmimatos katw akrou,provlima sto paxi entero ,alla kai piramidiki sindromi )
mesi egkefaliki,anion kladoi(einai floiwdeis,metwpiaio kai vregmatiko) :
perioxi broca kai+ kinitikotita kai aisthitikotita twn antiplevrwn :prosopou kai anw akrou
mesi egkefaliki kation kladoi(floiwdeis ,
perioxi wernicke + agnwsies kai apraksies,optiki aktinovolia(omoplevri katw tetartokikliki anopsia)
mesi egkefaliki ,diatitrainontes kladoi (vasika gagglia kai esw kapsa epomenws den exoume imianopsia afasia kai aisthitikes diataraxes)
antiplevri imipligia(katw meros prosopou,omotimi prosvoli anw kai katw akrou(arxika xalari paralisi kai argotera spastiki)
se monoplevri okseia stenwsi esw karotidas exoume
apofraksi ofthalmikis aririas omoplevra(thamvos orasis-amavrosis fugax) kai inteplevri adinamia kai aimwdia logo isxaimias mesis kai prosthias egkefalikis=> xiasti optikopiramidiki sindromi
pote exoume locked in syndrome
se isxaimia vasikis artirias ,giati afti nevrwnei tin gefira ,pio panw leitourgei to kino kinitiko
vlavi sto stelexos exoume… sindromi
epalasousa (vlavi egkefalikwn sizigiwn omoplevra kai kinitikwn i aisthitikwn diataraxwn antiplevra)
isxaimia mesegkefalou
prosvoli koinou kinitikou,apoklinwn stravismos
isxaimia opisthias katw paregkefalidikis–>isxaimia promiki(sindromo wallenberg pou einai epalasousa)
kai isxaimia aithousiaou =>peristrofikos iligkos naytia emetoi,dislitourgeia 9 10 c.n
isxaimia paregkefalidas
zali nautia emetos nistagmos ,paregkefalidiki ataksia ,kai apo oidima tis piesi sti gefira
ct gia isxaimiko aee poso xrono thelei na fanei
48 h(ipopikni perioxi me safi oria)
likofotiki perioxi
i perioxi pou ardevete apo dio artiries ,afti tou isxaimikou kai apo kapoia alli giafto ta kittara tis ipoleitourgoun
mri isxaimikou aee
se liges wres t2 avksimeni entasi ,t1 meiwmeni
antimetwpisi okseias egkefalikis isxaimias
anapnevstiki leitourgeia ,kardiaki leitourgeia ,artiriaki piesi (oxi apotomi meiwsi),amesi antimetwpisi piretou ,isizigio igrwn(xorigisi isotonwn dialeimatwn) ,oxi dialimata glykozis giati avksnoun to galaktiko kai zwtika
epiplokes okseos isxaimikou ee
piretos ,limwkseis (pnevmonon kai ouropoitikou) , katakliseis ,iperglykaimia(apo ekrisi kortizolis kai katexolamines) ,en to vathei flevothromvwsi,miokardiopatheia
nevrikos kindinos okseos isxaimikou ee
na egkoleasei logo avksimenou egkefalikou oidimatos(diaskinidiaka),epipedo sinidisis,metaptwsi isaimikou kai aimoragiko
defterogeni prolipsi (isxaimikou aee) (dld aftoi pou to pathan na min ksanapathoun deftero)
antiaimopetaliaka opws aspirini klopidogreli tiklopidini
pws onomazontai oi perioxes pou aimatwnountai apo telikous kladous artiriwn
methories zwnes
epiplokes aimoragikou aee apo riksi anevrismatos
idrokefalos logo flegmonodou antidrasis,agkeiosispasmos(4-12d) , epanemfanisi riksis
antimetwpisi agkeiosispasmou aimoragikou aee
nimodipini(ca channel blocker)
antimetwpisi egkefalikou anevrismatos
xeirourgeio kai klinostatismos gia 4w
prognwsi iparaxnoeidous aimoragias
30% paithanoun prwto 24 kai 40% paithanoun tin prwti evdomada
aimatwsi egkefalou apo poious kladous
2/3 karotidiko kai 1/3 spondilavasiko (15% tis kardiakis p)
thromvwsi kai emvoli pou na kanei estiaki egkefaliki isxaimia kanei i _
athirwmatiki nosos twn megalwn agkeiwn (koini kai esw karotida)
tipoi isxaimikwn aee
parodiko(24H prili apokatastasi),anastrepsimo(>24h pliri apokatastasi) ,ekselissomeno (epidinwsi kata tis prwtes meres),egkatestimeno( monimo nevrologiko eleimma)
pathogenesi isxaimikwn
meiwnete to o2 kai i glikozi ,epomenos meiwnete to atp ,exoume anaerovia glikolisi kai paragwgi galaktikou oksews (metavoliki oksewsi) ,diataraxi isoropias stin antalagi iontwn (mpainei na ca) apeleftherwsi litikwn enzimwn kai eleftherwn rizwn me kittariko thanato
isxaimia opisthias egkefalikis(aimatwnei iniako lovo,mesegkefalo,optiko thalamo kai ipothalamo)
se apofraksi stelexous exoume omonimi imianopsia,antiplevri imiparesi imipesthisia
isxaimia epipolis kladwn opisthias egkefalikis
omonimi imianopsia ,diatirisi kentrikis orasis,optiki agnwsia
isxaimia diatitrainwnwn kladwn opisthias egkefalikis
omoplevri pparalisi kinou kinitikou kai anteplevri imiparesi kai imi ipaisthisia
isxaimia vasikis artirias(aimatwnei gefira paregkefalida)
tetrapligia vathi kwma ,kores se misis alla antanakloun se fws , mporei na kanei locked in syndrome
se isxaimia egkefalikou stelexous pou einai oi vlaves
apo egkefalikes sizigies omopelvra pros tin valvi kai kinitikes kai aisthitikes antiplevra(epalasousa)
dd okseia egkefalikis isxaimias
ipoglikaimiki krisi ,lipothimiko epeisodio , orthostatiki ipotasi , sigkoptiki krisi ,epilipsia ,lavirinthika sindroma ,skp
xronia mikroaggeiopatheia tou egkefalou
exoume prosvoli artiriwn mirkou evrous (apo ipertasi)
vlavi kanei paxinsi kai lipoialinwsi tou toixwmatos twn diatitrainontwn artiridiwn ,isxaimoun vasika gagglia eesw ksapsa gefira levki ousia ,,dimiourgountai kenoxoria(lacunes) ,gloiwsi kai atrofia lefkis ->leukoaraiwsi (nossos binswanger),disarthria diskataposia sinaisthimatiki asthatheia vadisi me mikra vimata mexri kai anoia agkeiakis aitiologias
logoi endoefkefalikis aimoragias(aimoragiko aee)
ipertasi,amiloeidiki aggeiopatheia,aggeiakes displasies ,neoplasies ,antipitiki agwgi,aggeiitides ,kokaini
simptwmata endoegkefalikis aimoragias
kefalalgias emetos diataraxi epipedou sinidisis, aimoragia ston fakoeidi vlepei tin vlavi tou me imiparesi kai imipaisthisia,thalamos :siglisi kai pros ta katw oi ofthalmoi,gefira :tetrapligia kai koma ,kores me entoni misi antidroun sto fos, paregkefalida:zali emetos diataraxi isoropias
ct sto aimoragiko aee
iperpikrni tis prwtes wres
therapeia aimoragikou aee
elexos zwtikwn,elexos ap oxi epithetiki meiwsi,diakopi antipiktikis,xorigisi vit k ,apoidimatika
pote tha xeirourgisoume se aimoragiko aee
otan einai prospelasimo to simeio,otan den statheropoite i katastasi ,avksaete end piesi,iparxei ca i agkeiodisplasia
aitia iparaxnoeidous aimoragias
kak ,riksi anevrismatos,af displasia,artir ipertasi,ca ,aggitida
simptwmata iparaxnoeidous aimoragias
kefalalgia diplwpia thamvos orasis,aifnidia kefalalgia ,diataraxi sinidisis,epilipsia naftia emetos ,diskampsia
se poio anevrisma exoume ofthalmokinitikes diataraxes
esw karotidas
