Dambudziko rerufu rwehupi hwehupi, hunowanzobudiswa nekudengenyeka kweropa kutevera chikamu cheuropi. Zvinetso zvinowanzoitika zvevascular zvinogona kutungamirira pakurohwa zvinosanganisira kufungidzirwa (kuvhara) mitsipa yeropa muuropi, embolus (ropa rinoputira kuuropi uye rinogara imomo), nezvinetso zvemukati zvinosanganisira midzi yeropa muuropi, zvakadai seine ane chirwere kuputika.
Mushure mekunge mumwe munhu ave nechirwere, chiremba achaedza kutsvaga chikonzero chaicho, sezvo chikonzero chinokonzerwa nesitiroko kazhinji chinopa mishonga yakanakisisa. Mukusvika ku40 muzana yematambudziko, zvisinei, hapana chikonzero chaicho chinogona kuonekwa. Kurwadziwa kwechikonzero chisingazivikanwi kunonzi chirwere checryptogenic. (Izwi rokuti "cryptogenic" rinongoratidzira kuti chikonzero chacho chinopesana, kana chinokanganisika.)
Ndezvipi Zviro Zvinonzi Cryptogenic?
Mushure mekurohwa, dzimwe nguva zvinogona kuva zvakaoma kuziva kana kukanganiswa kweropa kunokonzera kushungurudzika kwakakonzerwa neropa rinenge rakaumbwa munzvimbo (thrombus), ropa rinopinda kuuropi kubva kune imwe nzvimbo ( embolus ), kana chimwe chinetso chemavhutu.
Kurwadza hakufaniri kunzi cryptogenic kusvikira kuongororwa kwakazara kwave kuchiitwa pasina kupa chikonzero chaicho. Nenzira yakawanda, kuongorora kwakadaro kunofanira kusanganisira uropi imaging (ine CT scan kana MRI scan ), kufungidzira kwemidziyo yeropa inopa huropi (carotid duplex kana kuti transcranial Doppler zvidzidzo), uye zvichida angiography .
Mukuwedzera, kuongorora kwakazara echocardiographic yemwoyo kunofanirwa kuitwa, kutarisa mhepo yemweya yezvinyorwa. Zvimwe zvinokonzerwa nemoyo yemweya zvinosanganisira ropa inopinza mukati memwoyo (kazhinji kuruboshwe rweatrium), patent foramen ovale (PFO) , aneurysm ye septrial atrial , fibrionic atrial , kana mitral valve prolapse (MVP) .
Kana pasina chikonzero chave chichionekwa mushure mekuongorora uku kwakakwana, kurohwa kunonzi kunonzi cryptogenic.
Zvimwe zvikonzero zvinokonzerwa nekrisptogenic stroke (kana zvingaonekwa) dzakawanda, uye vanhu vanonzi vane chirwere chekristptogenic iboka rakasiyana. Sezvo sayenzi yezvokurapa inovandudza kukwanisa kwayo kugona chikonzero chekurova mumarwere mumwe nomumwe, nhamba yevanhu vanoti kunonzi chirptogenic stroke ichawa.
Ndiani Anowana Cryptogenic Stroke?
Nhoroondo yevarwere vakambonzwa kurwadziwa kweprisptogenic inowanzofanana nevarwere vakambotambura nemarwadzo ezvikonzero zvinozivikanwa. Vanowanzova vanhu vakwegura vane zviitiko zvinokonzerwa nehutachiona hwehutano hwehutano.
Cryptogenic strokes inowanikwa zvakaenzana nevarume nevakadzi. Ingave yakave yakakurumbira muvatema uye Hispanics. Kunyange zvazvo chirptogenic shamroke muvanhu vaduku (pasi pezera remakore makumi mashanu) inowanikwa zvakanyanya kubva kuvanachiremba uye mumabhuku ekurapa, zvidzidzo zvinoratidza kuti kupararira kwezera kwemaitiro echicheptogenic kwakafanana neyekuti kwete-cryptogenic shamrokes. Izvi zvinoreva kuti, kukwanisa kuziva chikonzero chekurohwa muvanhu vaduku kunenge kwakangofanana neyevanhu vakwegura.
Mamiriro Api Pashure Che Cryptogenic Stroke?
Nenzira yakawanda, kufungidzira kwemurwere akacherwa chirwere che cryptogenic chinoratidzika kunge chiri nani pane zvisiri izvo zvinonzi cryptogenic strokes.
Kunyange zvakadaro, mutengo wemakore maviri wekudzoka kwechirwere kunowanikwa 15 - 20 muzana.
Sezvo kurapwa kunodzivirira kuparadzaniswa kunowanzoitika kunobva pachikonzero chekurohwa (anticoagulation ne warfarin mushure mekurohwa kwemaitiro, antiplatelet therapy ne aspirin kana clopidogrel mushure mekurwadziwa kwetachiona), kurapa kwakanakisisa mushure mekushaya chirwere checryptogenic hachisi pachena. Kubvumirana pakati pezvenyanzvi panguva ino, zvisinei, kunoshandisa kushandisa antiplatelet therapy.
The PFO Controversy
Chimwe chezvinhu zvinopesana zvakanyanya zvekuchema kweprisptogenic ndiyo mubvunzo wekuti vanowanzonzerwa sei nePatent Foramen Ovale (PFOs), zvichida inozivikanwa segomba mumoyo.
Hapana mubvunzo kuti mamwe maitiro echireptogenic anokonzerwa neropa rekuvhara ropa rinoputika PFO, kupinda muparidzi, uye kuenda kuuropi. Zvisinei, izvi zvinoshamisa hazviwanzoitiki, asi PFOs dzakawanda kwazvo. (PFOs inogona kuonekwa kusvika ku25% yevanhu vose nekunyorwa kwemashoko echocardiography.)
Zvichida, nokuda kwechikonzero ichi, zvidzidzo zvakaongororeza zvingabatsira kuburikidza nekushandisa mafaira ekuvhara PFO kune varwere vane chirwere chekristptogenic chave chichiodza mwoyo - hapana kuderedzwa kwekurohwa kwechikwata kwave kuchionekwa. Panguva imwecheteyo, nzira dzinoshandiswa kupfigira PFOs dzinoratidzira varwere kune zvingava nemigumisiro yakakomba.
Icho chichiri kuitika kuti kune vamwe varwere, kupfigira PFOs zvingangobatsira. Asi panguva ino, hapano nzira yakaratidza yekuziva kuti ndeupi varwere vane cryptogenic stroke uye PFO vaizobatsirwa nekuvhara PFO.
Zvisinei, kuongorora kwemazuva ano kwakaratidza kuti kuburikidza nekushanda kwechirongwa chekudzidzira Doppler , pamwe chete nehutukudzidzira kudzidza, vanachiremba vanogona kutanga kuona avo vakanyanya varwere vane maitiro e cryptogenic angave akonzerwa ne PFO. Zvimwe zvidzidzo zvichadikanwa kuti zvione kana kupedza PFO kunoderedza kudengenyeka kwekupedzisira mune iyi sarudzo yevarwere.
Chinhu chakakosha, kunyange zvakadaro, ndechokuti kugadziriswa kwePOO muzvigaro zvevarwere vane cryptogenic stroke hazvikwanisi kururamiswa nhasi. IAmerican Academy of Neurology muna 2016 yakanyevera pamusoro pekugara ichipa PFO kuvharwa kune vanhu vakambotambura kurwadziwa kweprisptogenic.
Atrial Fibrillation uye Cryptogenic Stroke
Atrial fibrillation inonyanyozivikanwa chinokonzera chirwere chepamuro, uye varwere vane fibrillation yeAririal vanowanzofanira kuvezwa.
Uchapupu huchangobva kuratidza hunoratidza kuti vashoma vevarwere vane chirwere che cryptogenic vanogona kuva ne "subclinical" yechirungu chekushaya ropa - izvo, zvikamu zvehutachiona hwehutachiona husingaiti zviratidzo zvikuru, uye naizvozvo hazvizivikanwi. Uyezve, kune deta inofunga kuti iyo nguva refu yekuvhara mwoyo kwekutsvaga kwemuviri inogona kubatsira pakutsanangura kugadziriswa kwetrial fibrillation kune varwere vane chirwere checryptogenic. Mune ava varwere, zvichida, sevamwe varwere vane hutachiona hwetrial, anticoagulation ingangoderedza dambudziko rekurohwa.
Sources:
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> Lansberg MG, O'Donnell MJ, Khatri P, et al. Antithrombotic uye Thrombolytic Therapy yeIschemic Stroke: Antithrombotic Therapy uye Prevention of Thrombosis, 9th ed: American College of Chest Physicians Zviratidzo-Based Clinical Practice Guidelines. Chest 2012; 141: e601S.
> Messe SR, Gronseth G, Kent DM, Et al. Gadzirisa mazano: Kuramba kwechirwere chekare nePentent Foramen Ovale (Kuvandudzwa kweGadziriro yeParamende) Gwaro reMutungamiri Wekutsvaga, Kuparidzirwa, uye Kushandisa Komiti Yepamusoro yeAmerican Academy of Neurology.Neurology Yakabudiswa paIndaneti July 27, 2016. 10.1212 / WNL.0000000000002961
Mohr, JP, Choi, WC, Grotta, JC, et al. Stroke: Pathophysiology, Kuziva, uye Management, 4th Edition, Churchill Livingstone, New York 2004.