Bulbar palsy tshwm sim thaum lub paj hlwb puas lawm. Nws tshwm sim nrog ob sab thiab tsawg dua nrog rau qhov tsis sib haum xeeb ntawm cov pab pawg caudal (IX, X thiab XII) nyob rau hauv medulla oblongata, nrog rau lawv cov hauv paus hniav thiab pob tw ob sab hauv thiab sab nraum cov kab noj hniav cranial. Vim qhov sib thooj ntawm qhov chaw ntawm cov qauv anatomical ntawm medulla oblongata, bulbar thiab pseudobulbar tuag tes tuag taw tsis tshua muaj.
daim duab kho mob
Dysarthria thiab dysphagia pom hauv bulbar syndrome. Cov neeg mob, raws li txoj cai, choke rau cov kua, qee zaum lawv tsis muaj peev xwm ua kom nqos tau. Yog li ntawd, cov qaub ncaug feem ntau ntws los ntawm cov ces kaum ntawm lub qhov ncauj hauv cov neeg mob no.
Nyob hauv bulbar palsy, atrophy ntawm cov leeg ntawm tus nplaig pib thiab lub pharyngeal thiab palatine reflexes poob tawm. Hauv cov neeg mob hnyav, raws li txoj cai, kev ua tsis taus pa ntawm kev ua pa thiab kev ua haujlwm ntawm lub plawv yog tsim, uas feem ntau ua rau tuag taus.kev khiav tawm. Qhov no tau lees paub los ntawm qhov chaw nyob ze ntawm cov chaw nruab nrab ntawm cov hlab ntsws thiab cov hlab plawv nrog lub nuclei ntawm pawg caudal ntawm cov hlab ntsha ntawm lub taub hau, thiab yog li tom kawg tuaj yeem koom nrog cov txheej txheem mob.
Yog vim li cas
Tus yam ntxwv ntawm tus kabmob no yog txhua yam kabmob uas ua rau lub hlwb puas tsuaj rau thaj chaw no:
- ischemia lossis hemorrhage hauv medulla oblongata;
- mob ntawm ib qho etiology;
- polio;
- neoplasm ntawm medulla oblongata;
- amyotrophic lateral sclerosis;
- YGuillain-Barré Syndrome.
Nyob rau hauv cov ntaub ntawv no, innervation ntawm cov leeg ntawm lub palate mos mos, pharynx thiab larynx yog tsis pom, uas piav txog qhov tsim ntawm tus txheej txheem cov tsos mob complex.
Symptoms
Bulbar thiab pseudobulbar paralysis muaj cov cim hauv qab no:
- Dysarthria. Kev hais lus hauv cov neeg mob yuav lag ntseg, qhov muag plooj, slurred, qhov ntswg, thiab qee zaum yuav muaj aphonia (tsis muaj suab nrov ntawm lub suab).
- Dysphagia. Cov neeg mob tsis tuaj yeem ua rau nqos txav mus tas li, yog li kev noj mov nyuaj. Tsis tas li ntawd nyob rau hauv kev twb kev txuas nrog qhov no, qaub ncaug feem ntau ntws tawm los ntawm cov ces kaum ntawm lub qhov ncauj. Hauv cov xwm txheej zoo, qhov nqos thiab palatal reflexes yuav ploj mus tag.
YMyasthenia gravis
Myasthenia tshwm sim los ntawm cov tsos mob hauv qab no:
- tsis ua rau qaug zog ntawm ntau pawg leeg;
- ob lub zeem muag;
- qhia rau saumxyoo;
- qaug zog ntawm lub ntsej muag nqaij;
- txo qis hauv qhov pom kev pom.
Aspiration Syndrome
Aspiration syndrome manifests nws tus kheej:
- hnoos tsis zoo;
- ua pa nyuaj nrog kev koom tes ntawm cov leeg nqaij thiab tis ntawm lub qhov ntswg hauv kev ua pa;
- ua pa nyuaj thaum nqus tau;
- xov qw nrov nrov ntawm exhalation.
-
Ua pa tsis ua haujlwm feem ntau pom:
- mob plab;
- ua pa nrawm thiab lub plawv dhia;
- ua tsis taus pa;
- hnoos;
- o caj dab veins;
- daim tawv nqaij xiav;
- passing out;
- txo qis ntshav siab.
Cardiomyopathy yog nrog ua pa luv nrog kev tawm dag zog lub cev, mob hauv siab, o ntawm sab qis, kiv taub hau.
Pseudobulbar tuag tes tuag taw, ntxiv rau dysarthria thiab dysphagia, yog tshwm sim los ntawm kev quaj hnyav, qee zaum luag. Cov neeg mob yuav quaj thaum lawv cov hniav bark los yog tsis muaj laj thawj.
Distinction
Qhov sib txawv tsawg dua qhov zoo sib xws. Ua ntej ntawm tag nrho cov, qhov sib txawv ntawm bulbar thiab pseudobulbar palsy nyob rau hauv lub hauv paus ua rau ntawm qhov teeb meem: bulbar syndrome yog tshwm sim los ntawm kev raug mob mus rau lub medulla oblongata thiab cov hlab ntsha nuclei nyob rau hauv nws. Pseudobulbar - insensitivity ntawm cortical-nuclear kev sib txuas.
Yog li qhov sib txawv ntawm cov tsos mob ua raws li:
- bulbar palsy yog qhov hnyav dua thiab nqakev hem thawj rau lub neej (mob stroke, kab mob, botulism);
- qhov qhia tau tseeb ntawm bulbar syndrome - ua txhaum ntawm kev ua pa thiab lub plawv dhia;
- nrog pseudobulbar palsy tsis muaj txheej txheem ntawm cov leeg nqaij txo qis thiab rov zoo;
- Pseudo-syndrome yog qhia los ntawm lub qhov ncauj qhov taw qhia (rub daim di ncauj mus rau hauv lub raj, qhov tsis xav tau grimaces, xuav), hais lus tsis txaus ntseeg, txo qis kev ua haujlwm thiab kev puas tsuaj ntawm kev txawj ntse.
Txawm tias qhov tseeb tias qhov tshwm sim ntawm tus kab mob no zoo ib yam lossis zoo sib xws, muaj qhov sib txawv tseem ceeb ntawm txoj kev kho mob. Nrog bulbar tuag tes tuag taw, qhov cua ntawm lub ntsws, "Prozerin" thiab "Atropine" yog siv, thiab nrog pseudobulbar tuag tes tuag taw, ntau mloog mus rau cov ntshav ncig hauv lub hlwb, lipid metabolism thiab txo cov roj cholesterol.
Diagnosis
Bulbar thiab pseudobulbar tuag tes tuag taw yog cov teeb meem ntawm lub hauv nruab nrab paj hlwb. Lawv zoo sib xws hauv cov tsos mob, tab sis lawv muaj qhov sib txawv ntawm qhov tshwm sim.
Qhov kev kuaj mob tseem ceeb ntawm cov kab mob no feem ntau yog los ntawm kev soj ntsuam ntawm kev kho mob tshwm sim, tsom mus rau tus kheej nuances (cov cim qhia) hauv cov tsos mob uas paub qhov txawv ntawm tus kab mob bulbar palsy los ntawm pseudobulbar palsy. Qhov no yog qhov tseem ceeb vim tias cov kab mob no ua rau muaj qhov sib txawv, sib txawv rau lub cev.
Yog li, cov tsos mob tshwm sim rau ob hom kev tuag tes tuag taw yog qhov tshwm sim hauv qab no: kev ua tsis taus pa nqos (dysphagia), suabKev ua haujlwm tsis zoo, tsis meej pem thiab hais lus tsis zoo.
Cov tsos mob zoo sib xws no muaj qhov sib txawv tseem ceeb, xws li:
- nrog bulbar tuag tes tuag taw, cov tsos mob no yog tshwm sim ntawm atrophy thiab nqaij puas;
- nrog pseudobulbar palsy, tib cov tsos mob tshwm sim vim paresis ntawm lub ntsej muag cov leeg ntawm lub ntsej muag spastic, thaum lub reflexes tsis tsuas yog khaws cia, tab sis kuj muaj ib tug pathologically exaggerated ua cim (uas yog hais nyob rau hauv nruj heev luag, quaj., muaj cov cim qhia ntawm qhov ncauj automatism).
Kev kho mob
Yog tias muaj qhov txhab ntawm lub paj hlwb, tus neeg mob yuav ntsib cov txheej txheem pathological loj thiab txaus ntshai uas txo tus qauv kev ua neej, thiab tuaj yeem ua rau tuag taus. Bulbar thiab pseudobulbar palsy yog ib hom kab mob ntawm lub paj hlwb, cov tsos mob ntawm qhov txawv ntawm lawv cov etiology, tab sis muaj qhov zoo sib xws.
Bulbar tsim los ntawm kev ua haujlwm tsis zoo ntawm medulla oblongata, uas yog lub nuclei ntawm hypoglossal, vagus thiab glossopharyngeal paj nyob rau hauv nws. Pseudobulbar syndrome tshwm sim vim kev ua haujlwm tsis zoo ntawm cortical-nuclear txoj hauv kev. Tom qab txiav txim siab pseudobulbar palsy, nws yog thawj zaug uas yuav tsum tau kho nrog cov kab mob hauv qab.
Yog li, yog tias cov tsos mob tshwm sim los ntawm kev kub siab, vascular thiab antihypertensive therapy feem ntau yog muab. Nrog tuberculous thiab syphilitic vasculitis, tshuaj tua kab mob thiabtshuaj tua kab mob. Kev kho mob hauv qhov no kuj tuaj yeem ua los ntawm cov kws kho mob nqaim - tus kws kho mob phthisiatrician lossis kws kho mob dermatovenereologist.
Ntxiv rau cov kev kho tshwj xeeb, tus neeg mob tau qhia txog kev teem sijhawm ntawm cov tshuaj uas pab txhim kho microcirculation hauv lub hlwb, normalizes kev ua haujlwm ntawm cov paj hlwb thiab txhim kho kev sib kis ntawm paj hlwb rau nws. Rau lub hom phiaj no, cov tshuaj anticholinesterase, ntau yam nootropic, metabolic thiab vascular agents raug sau tseg. Lub hom phiaj tseem ceeb ntawm kev kho mob rau bulbar syndrome yog kev saib xyuas cov haujlwm tseem ceeb rau lub cev ntawm qhov qub. Rau kev kho mob ntawm tus mob bulbar palsy tau sau tseg:
- noj nrog kev sojntsuam;
- lub ntsws ua pa;
- "Atropine" nyob rau hauv rooj plaub ntawm salivation ntau;
- "Prozerin" los kho qhov nqos reflex.
Tom qab ua tau raws li qhov ua tau ntawm kev ntsuas kev rov qab los, kev kho mob nyuaj feem ntau yog muab rau cov kab mob hauv qab - thawj lossis theem nrab. Qhov no yuav pab tswj thiab txhim kho lub neej zoo, nrog rau txo tus neeg mob tus mob.
Tsis muaj kev kho thoob plaws ntiaj teb uas yuav kho tau cov kab mob pseudobulbar zoo. Nyob rau hauv txhua rooj plaub, tus kws kho mob yuav tsum xaiv ib tug complex txoj kev kho, uas tag nrho cov uas twb muaj lawm kev ua txhaum cai raug coj mus rau hauv tus account. Tsis tas li ntawd, koj tuaj yeem siv physiotherapy, ua pa ua pa raws li Strelnikova, nrog rau kev tawm dag zog rau cov leeg ua haujlwm tsis zoo.
Raws li kev xyaum qhia, kho tau zooPseudobulbar tuag tes tuag taw tsis ua haujlwm, vim tias cov kab mob no tshwm sim los ntawm kev puas hlwb loj heev, thiab ob sab. Feem ntau lawv tuaj yeem nrog los ntawm kev puas tsuaj ntawm cov paj hlwb thiab kev tuag ntawm ntau cov neurons.
Kev kho mob, ntawm qhov tod tes, ua rau nws muaj peev xwm los them nyiaj rau kev cuam tshuam ntawm kev ua haujlwm ntawm lub hlwb, thiab cov chav kawm kho mob tsis tu ncua tso cai rau tus neeg mob hloov kho cov teeb meem tshiab. Yog li, koj yuav tsum tsis txhob tsis kam lees tus kws kho mob cov lus pom zoo, vim tias lawv pab txo qis kev loj hlob ntawm tus kab mob thiab ua rau cov hlab ntsha hauv lub cev. Qee cov kws tshaj lij pom zoo qhia cov qia hlwb rau hauv lub cev kom kho tau zoo. Tab sis qhov no yog qhov teeb meem sib cav sib ceg: raws li cov neeg txhawb nqa, cov hlwb no pab txhawb kev rov ua haujlwm ntawm neuronal, thiab lub cev hloov mycelin. Cov neeg tawm tsam ntseeg tias qhov ua tau zoo ntawm txoj hauv kev no tsis tau ua pov thawj, thiab tseem tuaj yeem ua rau muaj kev loj hlob ntawm cov qog nqaij hlav cancer.
Nrog rau cov tsos mob pseudobulbar, qhov kev mob tshwm sim feem ntau loj heev, thiab nrog cov tsos mob ntawm bulbar, qhov ua rau thiab qhov hnyav ntawm kev loj hlob ntawm tus tuag tes tuag taw tau muab rau hauv tus account. Bulbar thiab pseudobulbar syndromes yog qhov mob hnyav thib ob ntawm lub paj hlwb, kev kho mob uas yuav tsum tau tsom rau kev kho cov kab mob hauv qab thiab ib txwm nyob hauv txoj kev nyuaj.
Nrog kev kho tsis raug thiab tsis raws sijhawm, bulbar palsy tuaj yeem ua rau mob plawv thiab ua pa. Qhov kev kwv yees nyob ntawm tus kab mob hauv qab no lossis tej zaum tseem tsis meej.
Txhais tau
Txawm tias zoo sib xwsCov tsos mob thiab kev tshwm sim ntawm bulbar thiab pseudobulbar mob muaj qhov sib txawv etiologies thiab, yog li ntawd, ua rau muaj kev sib txawv rau lub cev. Nrog bulbar tuag tes tuag taw, cov tsos mob tshwm sim lawv tus kheej vim atrophy thiab degeneration ntawm cov nqaij ntshiv, yog li yog hais tias tsis tau ceev resuscitation ntsuas, qhov tshwm sim yuav hnyav heev. Tsis tas li ntawd, thaum cov kab mob cuam tshuam rau qhov chaw ua pa thiab cov hlab plawv ntawm lub paj hlwb, kev ua pa nyuaj thiab lub plawv tsis ua haujlwm tuaj yeem txhim kho, uas, dhau los, ua rau tuag taus.
Pseudobulbar palsy tsis muaj cov leeg nqaij atrophic thiab muaj cov yam ntxwv antispasmodic. Localization ntawm pathologies tau pom saum toj no medulla oblongata, yog li tsis muaj kev hem thawj ntawm kev ua pa ntawm lub ntsws thiab lub plawv tsis ua haujlwm, tsis muaj kev hem thawj rau lub neej.
Lub ntsiab tsis zoo ntawm tus kab mob pseudobulbar muaj xws li:
- unilateral paralysis ntawm lub cev nqaij daim tawv;
- paresis ntawm limbs.
Ntxiv rau, vim qhov muag ntawm qee qhov ntawm lub hlwb, tus neeg mob yuav ntsib kev puas hlwb, dementia, ua haujlwm tsis zoo.
