Cerebrospinal fluid imvura inogeza zvimiro zvepakati tsinga system: uropi uye musana. Iine basa rekudzivirira uye kuvhunduka. Iyo cerebrospinal fluid iri mune yakajairika mamiriro, isina utachiona. Kuonekwa kwejemusi mukati maro kunogona kuve nemhosva yezvakakomba zvinotapukira pathologies.

tsananguro

Cerebrospinal fluid kana CSF imvura inoputira iyo yepakati tsinga system (uropi uye musana wemuzongoza). Inotenderera kuburikidza ne ventricular system (ventricles iri muuropi) uye nzvimbo ye subbarachnoid.

Sechiyeuchidzo, iyo yepakati tsinga system yakakomberedzwa nemahamvuropu anonzi mameninges, anoumbwa ne3 akaturikidzana:

• the dura, gobvu rekunze rekunze;
• the arachnoid, mutsetse mutete pakati pedura uye pia mater;
• iyo pia mater, yemukati pepa rakatetepa, rinonamira kune cerebral pamusoro.

Nzvimbo iri pakati pe arachnoid uye pia mater inoenderana nenzvimbo ye subbarachnoid, nzvimbo yekutenderera kwecerebrospinal fluid.

Features

Kugadzirwa kwezuva nezuva kweCSF kunofungidzirwa kunge kungangoita 500 ml.

Huwandu hwayo ndeye 150 - 180 ml, muvakuru, uye saka inovandudzwa kakawanda pazuva.

Kutsikirirwa kwayo kunopimwa pachishandiswa kuputika kwechiuno. Inofungidzirwa pakati pe10 ne15 mmHg muvakuru. (5 kusvika 7 mmHg muvacheche).

Kune ziso rakashama, CSF imvura yakajeka inonzi mvura yedombo.

Zvinoumba

Celphalo-spinal fluid inoumbwa ne:

• mvura;
• leukocytes (masero machena eropa) <5 / mm3;
• mapuroteni (anonzi proteinorrachia) pakati pe0,20 - 0,40 g / L;
• glucose (inozivikanwa se glycorrachia) inomiririra 60% yeglycemia (yero yeshuga yeropa), kana inenge 0,6 g / L;
• maion akawanda (sodium, chlorine, potassium, calcium, bicarbonate)

Iyo CSF ​​haina kubereka zvachose, kureva kuti haina pathogenic microorganisms (mavhairasi, mabhakitiriya, fungi).

Features

Cerebrospinal fluid imvura inogeza zvimiro zvepakati tsinga system. Iine basa rekudzivirira uye rinotyisa rekupedzisira, kunyanya panguva yekufamba uye kuchinja kwechinzvimbo. Cerebrospinal fluid yakajairika, isina utachiona (isina utachiona). Kuonekwa kwejemusi mukati maro kunogona kuve nemhosva kune zvakakomba zvinotapukira pathologies izvo zvinogona kutungamira kune neurological sequelae kana kunyange kufa kwemurwere.

Secretion uye kutenderera

Iyo cerebrospinal fluid inogadzirwa uye yakavanzwa nechoroid plexuses inoenderana nezvimiro zviri pamwero wemadziro eakasiyana ventricles (lateral ventricles, 3rd ventricle uye 4th ventricle) uye zvichiita kuti zvikwanisike kuita musanganiswa pakati peropa system nepakati. nervous system .

Kune kutenderera kunoenderera uye kwakasununguka kutenderera kweCSF pamwero we lateral ventricles, ipapo kune 3rd ventricle kuburikidza nemakomba eMonroe uyezve kune 4th ventricle kuburikidza neSylvius aqueduct. Iyo inobva yabatanidza nzvimbo ye subbarachnoid kuburikidza neforamina yeLuscka neMagendie.

Kudzokororwa kwayo kunoitika pamwero we arachnoid villi yePacchioni (yakashata kukura iri kunze kweiyo arachnoid), ichibvumira kuyerera kwayo kune venous sinus (kunyanya iyo yepamusoro longitudinal venous sinus) uye nekudaro kudzoka kwayo kune venous kutenderera. . .

Ongororo yeCSF inoita kuti zvikwanise kuona akawanda pathologies, mazhinji ayo anoda kukurumidza kutarisirwa. Kuongorora uku kunoitwa nekuputika kwechiuno, kunosanganisira kutora CSF, nekuisa tsono yakaonda pakati pemakumbo maviri emakumbo (zvizhinji zvezviitiko, pakati pe4th uye 5th lumbar vertebrae kuitira kuti udzivise chero njodzi yekukuvadzwa kwemutsipa wepelinha. . , kumira kwakatarisana ne2nd lumbar vertebra). Lumbar puncture chiito chinopinda, chinofanira kuitwa nachiremba, achishandisa asepsis.

Pane contraindications (yakanyanya coagulation disorder, zviratidzo intracranial hypertension, utachiona panzvimbo puncture) uye nemigumisiro inogona kuitika (post-lumbar puncture syndrome, utachiona, hematoma, kuderera shure marwadzo).

Kuongorora kweCSF kunosanganisira:

• kuongorora macroscopic (kuongororwa neziso rakashama rinobvumira kuonekwa uye ruvara rweCSF kuongororwa);
• kuongororwa kwebhakitiriya (kutsvaga mabhakitiriya nekuziva kwetsika);
• kuongorora kwe cytological (kutarisa nhamba yemasero machena uye matsvuku eropa);
• kuongorora biochemical (tsvaga nhamba yemapuroteni, glucose);
• kumwe kuongorora kunogona kuitwa kune chaiwo mavhairasi (Herpes virus, Cytomegalovirus, Enterovirus).

Zvirwere zvinotapukira

Meningitis

Inopindirana nekuputika kwemeninges iyo muzviitiko zvakawanda ndeyechipiri kune hutachiona nehutachiona hwehutachiona (hutachiona, hutachiona kana kunyange hutachiona kana fungi) nekuda kwekusvibiswa kwecerebrospinal fluid.

Zviratidzo zvikuru zve meningitis ndezvi:

• kupararira uye kurwadza kwemusoro nekusagadzikana kubva kune ruzha (phonophobia) uye chiedza (photophobia);
• fever;
• kusvotwa uye kurutsa.

Pakuongorora kwekiriniki, munhu anogona kuona kuoma kwemeningeal, kureva kupikisa kusingakundiki uye kunorwadza kana uchikotama mutsipa.

Izvi zvinotsanangurwa nekuputika kwepara-vertebral muscles maererano nekutsamwa kwemeninges.

Kana meningitis ichifungidzirwa, zvakakosha kupfekenura murwere zvachose, kuitira kuti utarise zviratidzo zvepurpura fulminans (ganda rinobuda ropa rakabatana nechirwere checoagulation, chisinganyangarike kana kumanikidzwa kuchiitwa). Purpura fulminans chiratidzo chetachiona chakanyanya, kazhinji chechipiri kune kutapukirwa nemeningococcus (bacteria). Injodzi yekutyisidzira hupenyu inoda jekiseni remuscular kana intravenous remishonga inorwisa mabhakitiriya nekukurumidza sezvinobvira.

Kuwedzera kuongororwa kunowanzodikanwa kuti kuve nechokwadi chekuongororwa:

• lumbar puncture (kunze kwezviitiko zve contraindication) zvichibvumira kuongorora kuti kuitwe;
• biological assessment (kuverengwa kweropa, hemostasis assessment, CRP, ropa ionogram, glycemia, serum creatinine, uye tsika dzeropa);
• kukurumidza kufungidzira kwehuropi muzviitiko zvinotevera zvinopesana nekuputika kwechiuno: kukanganisa kwekuziva, kushomeka kwetsinga uye / kana kubata.

Kuongororwa kweCSF kunoita kuti zvikwanise kunanga kune rudzi rwemeningitis uye kusimbisa kuvepo kweiyo pathogenic agent.

Kurapa kunoenderana nerudzi rweutachiona huri mu cerebrospinal fluid.

Meningoencephalitis

Inotsanangurwa nekubatana kwekuzvimba kwehuropi uye meningeal envelopes.

Inobva pakubatana kwe meningeal syndrome (musoro, kurutsa, kusvotwa uye kuoma kwemeningeal) uye kukanganisa kwehuropi kunotungamirirwa nekuvapo kwekusagadzikana kwekuziva, chikamu kana kuti kubatwa kwese kubatwa kana kunyange chiratidzo chekushaya simba kwetsinga (motor deficit). , aphasia).

Meningoencephalitis chirwere chakakomba chinogona kutungamira kurufu rwemurwere uye nekudaro inoda kurapwa nekukurumidza.

Kufungira meningoencephalitis kunoda kukurumidza kufungidzira kwehuropi, uye kunofanirwa kuitwa kusati kwabaya chiuno.

Dzimwe ongororo dzekuwedzera dzinosimbisa kuongororwa:

• kuongorora kwehupenyu (kuverengwa kweropa, CRP, ionogram yeropa, tsika dzeropa, kuongorora kwehemostasis, serum creatinine);
• EEG (electroencephalogram) inogona kuitwa, iyo inogona kuratidza zviratidzo zvinotsigira kukuvara kwehuropi.

Kutarisira nekurapa kunofanirwa kukurumidza uye kunozochinjirwa kune hutachiona hwakaburitswa.

Carcinomatous meningitis

Carcinomatous meningitis kuzvimba kwemeninges nekuda kwekuvapo kwekenza maseru anowanikwa muCSF. Zvikuru chaizvo, inyaya yemametastases, ndiko kuti kuparadzirwa kwechipiri kunobva kugomarara rekutanga (kunyanya kubva kukenza yemapapu, melanoma uye kenza yemazamu).

Zviratidzo zvepolymorphic, zvinosanganisira:

• meningeal syndrome (musoro, kusvotwa, kurutsa, kuoma kwemutsipa);
• kukanganisa kwekuziva;
• kuchinja kwemaitiro (kurasikirwa kwendangariro);
• pfari;
• Neurological deficit.

Kuwedzera kuongororwa kunodiwa kuti usimbise chirwere ichi:

• kuita imaging yeuropi (brain MRI) iyo inogona kuratidza zviratidzo mukufarira kuongororwa;
• a lumbar puncture kutarisa kuvapo kwekenza masero muCSF uye nokudaro kusimbisa kuongororwa.

Kufungidzira kwecarcinomatous meningitis kuchiri kusuruvara nhasi kune nzira shoma dzekurapa dzinoshanda.

Hydrocephalus

Hydrocephalus kuunganidzwa kwehuwandu hwakawandisa hwecerebrospinal fluid mukati mecerebral ventricular system. Inoratidzwa nekuita kufungidzira kwehuropi iyo inowana kuwedzera kwecerebral ventricles.

Kuwedzera uku kunogona kukonzera kuwedzera kwe intracranial pressure. Chokwadi, intracranial pressure inotsamira pane akati wandei ma parameter ayo ari:

• uropi parenchyma;
• cerebrospinal fluid;
• cerebrovascular volume.

Saka kana imwe kana yakawanda yeiyi paramita yakagadziridzwa, inova nekukanganisa intracranial pressure. Intracranial hypertension (HTIC) inotsanangurwa seukoshi> 20 mmHg muvakuru.

Kune marudzi akasiyana ehydrocephalus:

• isiri-ikurukurirana hydrocephalus (inodzivisa): inopindirana nekuwanda kwekuunganidza kwecerebrospinal fluid mu ventricular system yechipiri kune chipingamupinyi chinokanganisa kutenderera kweCSF uye nekudaro pakudzorerwa kwayo. Kazhinji kazhinji, imhaka yekuvapo kwebundu rinomanikidza ventricular system, asi zvakare rinogona kuve rechipiri kune malformations aripo kubva pakuzvarwa. Zvinokonzera kuwedzera kwe intracranial pressure inoda kurapwa nekukurumidza. Zvinokwanisika kuita kunze kwe ventricular bypass ye CSF (yenguva mhinduro) kana kunyange ichangobva kugadzirwa, kuitika kwe endoscopic ventriculocisternostomy (kusikwa kwekutaurirana pakati pecerebral ventricular system uye matangi anoenderana nekuwedzera kwe subarachnoid. space) zvichibvumira kudarika chipingamupinyi uye kuwana kuyerera kwakakwana kweCSF;
• kutaurirana hydrocephalus (isina-obstructive): inoenderana nekuwanda kuunganidzwa kwecerebrospinal fluid yakabatana nejini mukudzoreredzwa kweCSF. Iyo inowanzova yechipiri kune subarachnoid hemorrhage, kushungurudza musoro, meningitis kana pamwe idiopathic. Inoda kutungamirirwa nemukati weCSF shunt inonzi ventriculoperitoneal shunt (kana iyo mvura inotungamirirwa kune peritoneal cavity) kana ventriculo-atrial shunt (kana mvura yakananga kumwoyo);
• chronic hydrocephalus at normal pressure: inoenderana nekuwanda kwecerebrospinal fluid mucerebral ventricular system asi pasina kuwedzera intracranial pressure. Kazhinji kazhinji inobata vanhu vakuru, mushure memakore makumi matanhatu nekuwanda kwevarume. Iyo pathophysiological mechanism ichiri kunzwisiswa zvisina kunaka. Inogona kuwanikwa kune vanhu vane nhoroondo ye subbarachnoid hemorrhage, kushungurudza musoro kana kuve nekuvhiyiwa kwemukati.

Inotsanangurwa kazhinji yenguva nehutatu hwezviratidzo, zvinodaidzwa kuti Adams uye Hakim triad:

• kutadza kuyeuka;
• sphincter disorders (urinary incontinence);
• dambudziko kufamba nekufamba zvishoma.

Brain imaging inogona kuratidza kuwedzera kwecerebral ventricles.

Kutungamira kunonyanya kuenderana nekugadzwa kwemukati ventricular bypass, ingave ventriculo-peritoneal kana ventriculo-atial.

Humwe hutachiona

Kuongororwa kwecerebrospinal fluid kunogona kuratidza mamwe akawanda pathologies:

• subarachnoid hemorrhage nehuchapupu hweropa rinotenderera muCSF;
• zvirwere zvinoputika zvinokanganisa central nerve system (multiple sclerosis, sarcoidosis, nezvimwewo);
• neurodegenerative zvirwere (chirwere cheAlzheimer);
• neuropathies (Guillain-Barré syndrome).