Dysautonomia uye Trouble neThe Autonomic Nervous System
Izwi rinotyisa remitemo rinodzora mabasa anokosha emumuviri akaita sekuda kwemoyo uye kuwedzerwa kweropa zvinoita kuti tirambe tiri vapenyu tisati tambofunga nezvazvo. Chinenge chinetso chekurapa chero chipi zvacho chinogona kukanganisa urongwa hwehutachiona hwehutongi mune imwe nzira, kunyange zvazvo zvishomanana zvirwere zvinokonzera urongwa hwehutongi huripo huga. Pasi pane mamwe maitiro akajairika ezvokudzivirira zvirwere zvinokanganisika, kana dysautonomia :
Acute Autonomic Paralysis
Acute autonomic paradysis, inotanga kurondedzerwa muna 1975, inoramba isingadikanwi asi inoshanda sechimiro chakanaka chezvinoitika apo mabasa ose emagetsi anokonzerwa. Zviratidzo zvinouya kwevhiki kana masvondo mashomanana nekurasikirwa kwakakwana kwemabasa akawanda ezvokudzivirira uye kunosanganisira maziso akaoma, orthostatic hypotension , kushayiwa simba, kusava nesimba, kusava nechirwere chechirwere uye chirwere chemuviri, uye kurwadziwa mumimba nekutuka. Vose parasympathetic uye nenyasha dzinoshungurudzika dzinokanganisa, kunyange dzimwe nharo dzisingabviri. Chirwere chechimbwa chinogona kuratidza protein yakakwirira muCSF . Chikonzero chacho hachiwanzowaniki, kunyange zvazvo zvichida chirwere chinotapukira semunhu chakafanana naGuillain-Barre syndrome . Iyo yakanakisisa kurapwa haina kunyatsojeka, kunyange vamwe vakaratidza kuvandudzwa mushure mokushandura plasma, kana kuti IVIG kutonga.
Idiopathic Orthostatic Hypotension
Chirwere chisingawanzwisisiki chinopera, idiopathic orthostatic hypotension inosvika pakati pehupenyu hwekupedzisira uye inosanganisira zvipembenene mumashure ekutsvaga kwemapurisa, anodzivirira mwoyo kuti irege kukurumidza kana ichidiwa.
Izvi hazviwanzoitiki; imwe inowanikwa pakati payo preganglionic dysautonomia inosanganisira kupera kwechikamu chemupopo wechipinara umo mazvigadziro emagetsi anowedzera muhembe rekupedzisira. Chero zvazvingaitika, kurapwa kunotanga nemararamiro evanhu vasina kuchinja, kusanganisira kupfeka zvinokonzerwa nemagetsi, uye zvishoma nezvishoma kuchinja kubva pakagara kusvika pakamira.
Kana izvi zvisingakwanisi, mishonga yakadai semidodrine kana florinef inogona kudiwa.
Secondary Orthostatic Hypotension
Mune chimiro chakawanda kwazvo che dysautonomia, chirwere chepfungwa chinokonzerwa neuropathy, chakadai chinowanikwa mune chirwere cheshuga , chinobatsirawo purogiramu yakakwana yehutachiona hwehutano. Kune zvikonzero zvakasiyana-siyana zvakasiyana-siyana, kusanganisira doro rinodhaka, kusakwana kwezvokudya, kana kusvibisa.
Dysautonomia inobatana nechirwere cheshuga neuropathy inonyanya kuwanzana uye inogona kuve nokushaya simba, chirwere, uye kubvongodza, kuwedzera kune maonero ehutano. Zviratidzo izvi zvinogona kana kuti hazvingave zvakaoma sezvinoenderana nekushanduka kwemashoko kunokonzerwa nechirwere cheshuga chinorwara neuropathy. Zvakakoshawo kuziva kuti izvi zvinokonzerwa neuropathies dzimwe nguva zvisati zvaratidza kuti chirwere cheshuga chinotanga kuitika, uye mamwe maongorori ekurapa anoshandiswa kutsvaga chirwere cheshuga, zvakadai se hemoglobin A1c level, angangodaro ari mumamiriro ezvinhu akaenzana. Mune mamwe mazwi, mishonga inoputika inogona kuva yakanyanyisa kupfuura zvirwere zvekuongorora zvinoshandiswa navanachiremba kuti vaone chirwere cheshuga.
Mamwe maitiro europheral neuropathy, akadai seakakonzerwa neamyloidosis , ane dysautonomias yakasimba. Nhaka yakagadzirirwa neuropathy inokonzerwa nechirwere cheT Fabry (alpha-galactosidase inoshaya) inogona kukonzera a pronounced dysautonomia.
Riley-Day Syndrome
Nepo inenge chikamu chevanhu vanhu vanopfuura makore makumi matanhatu nemashanu vane rimwe dysautonomia sezvinoratidzwa nehutano hypotension, dysautonomia haina kunyanya kufanana mudiki zvikuru. Imwe yega ndiyo dysautonomia inotora nhaka inonzi Riley-Day syndrome.
Riley-Day Syndrome inotora nhaka muzvinyorwa zvekutsvaga, zvichireva kuti vabereki vangave vasina kugadziriswa kunyange mwana wacho ane chirwere chacho. Zviratidzo zvinosanganisira hyperension postural, zvinokonzerwa neropa zvakashata, mitemo yekutonhora yakawanda, hyperhidrosis, kushambidzika kwepabhesi, kushanda mupfungwa, uye kuderera kunzwisa tsitsi. Zviratidzo izvi zvichida zvinokonzerwa nokukundikana kwemazuva ose kushandiswa kwemashure panguva yekuvandudza.
Trauma uye Autonomic Nervous System
Tsitsi dzinonzwira tsitsi dzinomhanya nomumutsipa wepelinha mune izvo zvinonzi intermediolateral cell columns. Kana aya mazamu akavhiringidzika nekuda kwekushungurudzika ne hypotension, kurasikirwa kwekutuka, chirwere chekufa kwechirwere, uye kushaya muviri kwemimba kunogona kuguma; izvi zvinozivikanwa sekushungurudzwa kwepelinha. Kupa naroxone kunoratidzika kuderedza zvimwe zvezviratidzo: kunzwira tsitsi uye kuita mabasa ehurumende kuchadzoka mushure mechinguva, asi havachazovi pasi pekutonga kwezvivako zvakakwirira. Semuenzaniso, kana kuwedzerwa kweropa kuchiwa, mitsipa yeropa yega inenge isingagadziri, sezvo izvi zvinovimba nekukurukurirana pakati pe medulla mu brain brain uye yose yomuviri kuburikidza nemutsara wemugunha. Zvimwe mafungiro, zvisinei, zvicharamba zvakasimba. Kana ganda racho rakanamirwa paruoko, somuenzaniso, mishonga yeropa iri muruoko rwayo inogumira, zvichiita kuti kuwedzerwa kunetseka muchikamu ichocho.
Vanhu vane tetraplegic semagumisiro emusana wegorosi inogonawo kutambura kubva kune zvinonzi autonomic dysreflexia. Dambudziko reRopa rinomuka, mwoyo unoterera zvishoma, uye zvikamu zvasi pasi pechironda zvinogona kuputika uye kufema zvakanyanyisa, kuwedzera kumakumbo emakumbo uye kusabvumira kudzvinyirira kwechirwere. Autonomic dysreflexia inogona kutyisa upenyu kana isingatarisirwi pakarepo.
Kukuvara kwepamusoro kwemawere kana kuora mwoyo kunogonawo kusunungura adrenal catecholamines uye kuwedzera inzwi rekunzwira tsitsi. Dzimwe nguva mashesi anokwanisa kupfurikidza neuropiyo, zvichiita kuti awedzere kuwedzera kwehutano, kushaya kufema, uye mwoyo kunonoka pane izvo zvinozivikanwa seCushing response, chiratidzo chinotyisa chekuwedzera kusagadzikana kwechisimba.
Dysautonomia Pamusana pezvinodhaka uye chepfu
Kushungurudza kwepamuviri kwakafanana nemamwe matambudziko okuzvidzivirira anonzi "tsitsi dzinonzwika," izvo zvingave zvichikonzerwa nekushandiswa kweimwe mishonga, yakadai secocaine. Vakawanda vanorayirira mishonga inoshanda kuburikidza nehutachiona hwehutachiona hwehutongi, uye zvakafananawo zvinosuruvarisa zvechokwadi zvehuwandu hwehupfu. Organophosphate insecticides uye sarin, somuenzaniso, zvinokonzera kuperesika kwekushaya simba.
Zvimwe Dysautonomias
Hyperhydrosis isingatauri upenyu huri pangozi, asi ichiri kunganganisa dysautonomia inonyadzisa iyo inokonzera kufema kusina kunaka. Kusiyana neizvi, anhydrosis inokonzera kuputika kuduku, izvo zvinogona kuva nengozi kana zvinotungamirira pakupisa.
Raynaud's phenomenon inokonzera kuderera kweropa kunopera kuminwe mumvura inotonhora uye inowanzobatanidzwa nehutachiona hwehutachiona kana chirwere chinogadzirisa chinonzi scleroderma .
Chirwere chisina kunaka chinowanzoitika uye chingaguma kubva mumarudzi akawanda ematambudziko, kusanganisira dysautonomias. Iyo kusachengetwa kwechirwere ichi chiri chakaoma, uye chiito chinoratidzika sechiri nyore chokudhonza chinonyatsovimba nekubatana kwepedyo pakati pekuzvidira, kunzwira tsitsi, uye kushaya mishonga inoshanda. Zvichida nokuti chirongwa chakakosha chebhanhire chinoenderana nenyaya dzakawanda dzakasiyana, hazvishamisi kuti matambudziko akajairika, uye anogona kusanganisira kana incontinence kana kuchengetedza urine.
Hazvibviri kutarisa zvinhu zvose zve dysautonomia mune imwe nyaya. Mukuwedzera kune zvataifukidza, pane dzimwe nguva zvikamu zvemuviri, zvakadai seziso (sezvinonzi Horner's syndrome) kana chikwata (sezvinenge chichiratidza kunzwira tsitsi dystrophy) chinogona kuchinjwa. Ichi chinyorwa chinogona kushanda sechinhu chinowanzonzi, uye kukurudzira kuverenga kune avo vanoda mamwe mashoko.
Sources:
Adams naVictor's Principles of Neurology, 9th ed: The McGraw-Hill Companies, Inc., 2009
Blumenfeld H, Neuroanatomy kuburikidza neCliniki Cases. Sunderland: Sinauer Associates Publishers 2002