Cavernous sinus thrombosis yog ib qho txhaws ntawm lub qhov ntswg qhov ntswg, uas nyob ntawm lub hauv paus ntawm pob txha taub hau ntawm ob sab ntawm lub eeb Turkish.
Kev ua haujlwm ntawm lub qhov ntswg qhov ntswg yog txhawm rau venous tawm ntawm thaj tsam ntawm lub orbits thiab lub hlwb, nrog rau kev tswj hwm ntawm lub paj hlwb.
Cov kab mob no tsis tshua muaj, tab sis tuaj yeem ua rau muaj qhov tshwm sim loj. Thrombosis ntawm sigmoid thiab transverse sinus kuj tshwm sim infrequently.
Ua rau kab mob
Cavernous sinus thrombosis tuaj yeem tshwm sim rau ntau yam. Predispose rau nws:
- kab mob kis tau tshwm sim hauv daim ntawv mob hnyav hauv thaj tsam ntawm maxillary sinuses, pob ntseg, hniav thiab nasopharynx;
- kev raug mob pob txha taub hau;
- kab mob ntawm qhov xwm txheej autoimmune (systemic lupus erythematosus, rheumatoid mob caj dab);
- cov txheej txheem pathological ntawm hemostasis, uas yog nrog los ntawm kev tsim cov ntshav txhaws (muaj cov polycythemia);
- kab mob ntawm cov hlab ntsha thiab lub plawv (kab mob ischemic plawv, plawv arrhythmias, thiab lwm yam);
- muaj ntshav qab zib;
- abbortion;
- hnub yug.
Kev tsim cov ntshav txhaws muaj qhov sib kis thiab tsis muaj kab mob. Tam sim no, lub hauv paus chiv keeb tsis kis tau raug sau tseg rau ntau dua. Qhov no yog vim kev siv tshuaj tua kab mob ntau zaus, uas tiv thaiv qhov teeb meem loj. Nyob rau hauv cov ntaub ntawv no, nws yog kev cai hais txog ib tug idiopathic daim ntawv ntawm venous thrombosis.
Cov tsos mob ntawm tus kab mob
Dab tsi yog qhov tshwm sim ntawm tus kab mob xws li cavernous sinus thrombosis? Nws lub tsev kho mob nyuaj heev. Qee lub sij hawm tus kab mob tuaj yeem nyuaj rau kev paub txog thaum pib, vim tias cov tsos mob tsis pom tseeb thiab feem ntau zoo ib yam li cov tsos mob ntawm lwm yam kab mob.
Ntawm cov cim tseem ceeb ntawm tus kab mob yuav tsum tau hais txog:
- muaj mob taub hau;
- zoo li xeev siab thiab ntuav;
- poob thiab tsis meej pem;
- kev loj hlob ntawm coma;
- xov xwm.
- mob caj dab thaum khoov rau pem hauv ntej;
- nce lub cev kub;
- muaj exophthalmos (protrusion ntawm lub qhov muag rau pem hauv ntej nrog tom qab hloov mus rau sab).
- txhim kho ophthalmoplegia (tus tuag tes tuag taw ntawm qhov muag cov leeg vim kev puas tsuaj rau cov hlab ntsha uas tswj qhov muag txav);
- tshwm sim ntawm puffiness nyob rau hauv thaj tsam ntawm lub paj hlwb thiab daim tawv muag;
- pom kev poob;
- diplopia;
- mob thiab bluishness ntawm qhov muag qhov txhab, hauv pliaj thiab lub hauv paus ntawm qhov ntswg;
- poob ntsej muag hnov qab;
- Ythrombophlebitisntsej muag veins.
Thrombosis ntawm lub qhov ntswg qhov ntswg yog tus cwj pwm los ntawm qhov kub thiab txias, asthenia, qhov mob ntawm cov leeg thiab pob qij txha. Nyob rau hauv cov ntaub ntawv ntawm tsis muaj kab mob thrombus tsim, cov tsos mob tej zaum yuav tsis tshwm.
Cerebral tsos mob tshwm sim los ntawm cov tsos mob meningeal. Raws li tus kab mob loj tuaj, qhov pib qaug dab peg nce. Hauv qhov xwm txheej hnyav, tus neeg mob yuav poob rau hauv qhov tsis nco qab.
Cov tsos mob tshwm sim tshwm sim los ntawm kev tawm ntawm CSF, nce intracranial siab, nce o ntawm lub hlwb, uas thaum kawg tuaj yeem ua rau tus neeg mob tuag.
Diagnosis
Yuav ua li cas thiaj kuaj pom cov kab mob hauv qhov ntswg? Kev kuaj mob yog nyob ntawm ntau yam kev kuaj mob. Tus neeg mob qhov kev tsis txaus siab thiab anamnesis kuj raug suav nrog.
Migraine, piv txwv li, muaj ntau yam nta:
- pib mob hnyav thiab maj mam ua ntev. Mob yuav tiv taus cov tshuaj tua kab mob.
- Mob hnyav dua los ntawm kev tawm dag zog lub cev thiab hauv txoj haujlwm supine. Xws li qhov tshwm sim ntawm mob taub hau qhia tias ib tug neeg muaj thrombosis ntawm cirrus sinus.
- Thaum nias ntawm Greenstein cov ntsiab lus, tus neeg mob yws ntawm qhov mob. Muaj o ntawm lub orbits thiab protrusion ntawm lub qhov muag.
Txhua tus neeg mob uas muaj cov tsos mob zoo sib xws xav tau mus ntsib kws kho mob lub chaw haujlwm.
Nyob rau ntawm fundus, koj tuaj yeem soj ntsuam qhov muaj tortuosity ntawm cov hlab ntsha, ooptic disc.
Los ntawm cov txheej txheem ntawm kev soj ntsuam kev kuaj mob yog siv:
- CBC.
- blood collection for sterility culture.
- ua ib coagulogram,
- kev txiav txim siab ntawm D-dimer index,
- tshuaj xyuas cov kua cerebrospinal.
Cov kev ntsuam xyuas no ua rau nws muaj peev xwm kuaj tau qhov mob kis tau, nrog rau cov kab mob hauv lub cev hemostasis.
Los ntawm cov kev tshawb fawb ntawm cov cuab yeej siv, nws yuav tsum tau sau tseg:
- contrast by CT;
- Magnetic Resonance Imaging;
- cerebral angiography.
Basic of Therapy
Thrombosis ntawm lub qhov ntswg qhov ntswg, nrog rau cov sigmoid thiab transverse sinus, yuav tsum muaj kev kho mob ib txwm. Kev kho mob tuaj yeem yog kev saib xyuas thiab phais. Qhov kev ntsuas zaum kawg yog qhia nyob rau hauv lub xeev siab ntawm tus kab mob.
Txoj kev kho kom zoo
Cavernous sinus thrombosis kho tau li cas? Kev kho mob nrog kev saib xyuas muaj ntau lub hom phiaj:
- detoxification;
- tawm tsam ntshav txhaws;
- tshem tawm ntawm lub hlwb o;
- tso tseg txoj kev sib kis;
- neuroprotective therapy.
Kev tshem tawm thiab tshuaj tua kab mob yog siv thaum muaj thrombosis ntawm kis kab mob. Detoxification ua rau nws muaj peev xwm tshem tawm thiab tshem tawm cov tshuaj lom. Rau lub hom phiaj no, infusions nrog isotonic sodium chloride tov yog siv,"Reopoliglyukin", "Hemodez".
Tom qab noj ntshav rau kab lis kev cai, tshuaj tua kab mob raug tshuaj. Raws li cov txiaj ntsig ntawm kev txheeb xyuas, cov tshuaj uas muaj qhov dav ntawm qhov kev txiav txim tau raug sau tseg. Nyob rau tib lub sijhawm, cov tshuaj tua kab mob yuav raug sau tseg kom tsis txhob kis kab mob anaerobic ("Metronidazole").
Txhawm rau rov ua kom cov ntshav zoo li qub, cov ntshav txhaws yuav tsum raug tshem tawm. Rau lub hom phiaj no, kev kho mob heparin yog nqa tawm. Tom ntej no, cov tshuaj tiv thaiv kab mob ncaj qha raug muab tshuaj, uas tau noj rau peb lub hlis.
Tom qab chav kawm, cov neeg mob raug pom zoo kom noj cov tshuaj tiv thaiv kab mob xws li Aspirin, Dipyridamole, Clopidogrel.
Hauv cov xwm txheej hnyav tshwj xeeb, nrog rau kev txhim kho ntawm o ntawm lub hlwb, cov txheej txheem pathological raug tshem tawm los ntawm diuretics.
Neuroprotective therapy yog sau rau lub sijhawm rov qab los. Nws yog nqa tawm nrog kev pab los ntawm vasodilating agents, nrog rau cov neurometabolic agents.
Surgery
Kev phais yog qhia thaum txoj kev khaws cia tsis tau coj cov txiaj ntsig xav tau. Lub cavernous sinus yog qhov nyuaj heev los mus cuag vim nws qhov chaw anatomical. Yog li ntawd, kev ua haujlwm suav nrog kev qhib qhov sinuses thiab kev huv huv ntawm qhov tseem ceeb kis kab mob.
Muaj Teeb Meem
Cavernous sinus thrombosis (daim duab ntawm cov neeg mob uas muaj tus kab mob no tau nthuav tawm hauv kab lus no) tuaj yeem ua rau muaj teeb meem loj. Cov txheej txheem kuaj mob ua ntej tau uathiab kev kho yog pib, qhov tsawg dua yuav muaj teeb meem.
Kev nyuaj siab muab faib ua lig thiab ntxov.
Los ntawm tom qab nws yuav tsum tau sau tseg:
- tsis pom kev pom;
- abducens hlab ntsha paresis;
- presence of ptosis (drooping eyelid);
- kev txhim kho ntawm arachnoiditis;
- hypopituitarism;
- anisocoria.
Txij thaum ntxov:
- lub hlwb o;
- ib nrab qaug dab peg;
- cerebral infarction.
Ntau zaus, cavernous sinus thrombosis ua rau tus neeg mob:
- tag nrho dig muag.
- mob stroke (mob circulatory disorder nyob rau hauv lub hlwb, uas feem ntau provokes kev tsis taus thiab tuag);
- ua txhaum txoj haujlwm ntawm lub caj pas pineal, uas yog lub luag haujlwm rau inhibition ntawm kev tso tawm cov tshuaj hormones loj hlob;
- slow down the development of qog;
- kev ua txhaum kev loj hlob ntawm kev sib deev thiab kev coj cwj pwm.
Cov teeb meem no tshwm sim li ntawm ib feem peb ntawm cov xwm txheej.
ntsuas kev tiv thaiv
Txhawm rau kom tsis txhob poob mob nrog cov mob zoo li no, yuav tsum tau saib xyuas ntau yam kev tiv thaiv los pab tiv thaiv kev txhim kho ntawm pathology:
- kho raws sijhawm ntawm cov txheej txheem inflammatory hauv lub cev;
- Tswj kev noj qab nyob zoo;
- ncua sij hawm xa mus rau tus kws kho mob tshwj xeeb hauv cov kab mob uas tshwm sim nyob rau hauv daim ntawv mob ntev thiab nrog kev hloov pauv ntawm cov phab ntsa ntawm cov hlab ntsha thiab cov tsos ntawm cov ntshav viscosity.
kab mob prognosis
Kev ntsuas tus kab mobyog ncaj qha nyob ntawm kev kuaj mob raws sij hawm thiab kev kho mob. Lub xub ntiag ntawm tus kab mob sai sai thiab pib kho, qhov kev pheej hmoo rov qab ntau dua.
Txoj kev kho mob siv los ntawm cov tshuaj niaj hnub no tau txo qis qhov pib ntawm kev tuag los ntawm tus kab mob no. Qhov taw qhia yog 20%. Kwv yees li ntawm 10% ntawm cov neeg mob tau rov ua dua ntawm thrombosis hauv ib xyoos tom qab kho.
Zoo kawg
Cavernous sinus thrombosis, cov tsos mob uas tau piav nyob rau hauv tsab xov xwm no, yog ib yam kab mob loj heev. Tus kab mob no nyuaj kho.
Feem ntau ntawm cov mob, cov kab mob ua rau tus neeg mob tsis taus thiab feem ntau xaus rau kev tuag. Yog li ntawd, cov txheej txheem kuaj mob raws sij hawm thiab kev kho mob tseem ceeb heev.
