I-Brain Herniation: Izinhlobo, Izimpawu, Izimbangela kanye Nokwelashwa

I-Brain herniation, ngezinye izikhathi ebizwa ngokuthi i-hernia ebuchosheni, yisimo esisongela ukuphila esenzeka lapho izicubu zobuchopho zishintsha noma zihamba phakathi kogebhezi. Lesi simo esiphuthumayo sezokwelapha singabangelwa yizimbangela ezihlukahlukene, okuhlanganisa ukulimala okukhulu ekhanda, ukushaywa unhlangothi, noma izimila ebuchosheni. 

Le ndatshana icubungula ubunkimbinkimbi be-brain herniation, ihlanganisa izinhlobo zayo, izimbangela, izimpawu, kanye nezinkinga ezingaba khona. Sizohlola izindlela zokuxilonga ezisetshenziselwa ukunquma lesi simo futhi sixoxe ngezinketho zokwelashwa ezitholakalayo. Ukwengeza, sizohlinzeka ngemininingwane yokuthi kunini lapho kufanele uthole khona usizo lwezokwelapha futhi sigqamise izinyathelo zokuvimbela ukuze kuncishiswe ingcuphe ye-brain herniation.

Iyini i-Brain Herniation?

I-Brain herniation yisimo esisongela ukuphila esenzeka lapho izicubu zobuchopho zishintsha noma zinyakaza ngendlela engavamile phakathi kogebhezi. Lesi simo esiphuthumayo esibucayi sezempilo senzeka lapho ingcindezi eyandayo ye-intracranial ibangela ukuthi ubuchopho buphushwe ngezintuba emigoqweni eqinile ye-intracranial. Lezi zithiyo zihlanganisa i-falx cerebri, i-tentorium cerebelli, ne-foramen magnum.

Kunezinhlobo eziningana ze-brain herniation. Izinhlobo ezivame kakhulu zihlanganisa:

• I-Subfalcine Herniation: Izicubu zobuchopho zihamba ngaphansi kwe-falx cerebri phakathi nobuchopho.
• I-Transtentorial Herniation: Lolu hlobo lunezinhlobo ezimbili ezingaphansi: 
  • Ukwehla kwe-Transtentorial (Uncal): I-uncus, ingxenye ye-lobe yesikhashana, ishintshela phansi. 
  • I-Ascending Transtentorial: I-cerebellum nesiqu sobuchopho kuya phezulu nge-tentorium cerebelli.
• I-Tonsillar Herniation: Amathoni e-cerebellar aya phansi nge-foramen magnum.
• I-Central Herniation: Womabili ama-lobes esikhashana aphuma nge-notch ye-tentorial.

Izimbangela kanye Nezingozi Nezici Ze-Brain Herniation

I-Brain herniation syndrome inezimbangela eziningi kanye nezici eziyingozi ezingaholela ekwandeni kwengcindezi ye-intracranial. Ezinye zezimbangela yilezi:

• Ukuba khona Kwezilonda Ezithatha Umkhathi Ngaphakathi Kogebhezi: Lezi zilonda zingabandakanya i-hemamatomas, njenge-traumatic epidural kanye ne-subdural hematomas, izimila zobuchopho namathumba. Lezi zixuku zenza ingcindezi kuzicubu zobuchopho ezizungezile, okungase zibangele ukuthi ishintshe.
• I-Cerebral Edema: Kungabangelwa izimo ezihlukahlukene. I-Malignant infarction, uhlobo olunzima lwe-ischemic stroke, lungabangela ukuvuvukala okukhulu kobuchopho. 
• Amagciwane: Lokhu kufaka phakathi amathumba nama-empyemas, okungase futhi kuholele ekwenyukeni kwengcindezi ye-intracranial kanye nokuphuma kwe-herniation okulandelayo.
• I-Hydrocephalus (Ukunqwabelana Kwe-Cerebrospinal Fluid noma i-CSF ebuchosheni): Lokhu kungenzeka ngenxa yokuvinjwa kokugeleza kwe-CSF noma ukukhiqizwa ngokweqile kwe-CSF. 
• Ukusabalalisa ukopha kwe-Subarachnoid: Kungaholela ekwenyukeni kwengcindezi ngaphakathi kogebhezi.
• Izimo Zezokwelapha: Bangakwazi ukubeka abantu phambili ekuguleni kobuchopho. 
• Isifo Sesibindi: Abantu abanesifo sesibindi bangase babe ne-hepatic encephalopathy, engabangela ukuvuvukala kobuchopho. 
• Izinto Zangaphandle: Ukulimala ekhanda okubuhlungu kungase kubangele ukuqunjelwa noma ukopha ngaphakathi kwe-intracerebral, okungase kuholele ekuphumeni kwe-herniation.

Izimpawu ze-Brain Herniation

I-Brain herniation syndrome ibonakala ngezimpawu ezihlukahlukene ze-brain hernia, ezingahlukahluka kuye ngendawo ethintekile yobuchopho. Lokhu kungase kuhlanganise:

• Iphethini yokuphefumula engavamile, engase ingajwayelekile noma ingashoni. 
• Ukufinyela kwemisipha okungahlosiwe ngokuvamile kubangela ukuma komzimba okungajwayelekile. Isibonelo, umuntu angase abonise ukuqina kwe-decerebrate, lapho ikhanda litshekela emuva ngezingalo nemilenze enwetshiwe, noma ukuhlobisa ukuqina, okubonakala ngezingalo ezigobile nemilenze enwetshiwe.
• Izinkinga zamehlo lapho umfundi oyedwa noma bobabili bengase bavuleke futhi bangaphenduli ekukhanyeni, noma babonakale bebancane ngokungavamile. 
• Ukunyakaza kwamehlo okungavamile noma ukuntuleka okuphelele kokunyakaza kwamehlo nakho kungase kwenzeke. 
• Umfutho wegazi ophansi kakhulu noma umfutho wegazi ophakeme
• Ukwazi okukhubazekile, kusukela ekozeleni nobunzima bokugxila kuye ekuqulekeni nasekuqulekeni.
• Isicanucanu, ukuhlanza, intamo eqinile, nekhanda elibuhlungu elibuhlungu. 
• ukuquleka 

Izinkinga

I-Brain herniation syndrome ingaholela ezinkingeni ezinzima futhi ezingase zibulale uma zingabhekwanga ngokushesha, njenge:

• Ukushintsha ukwazi, ukulahlekelwa ukwazi ngokuphelele, noma i-coma 
• Ukuma okungavamile
• Ukuboshwa kokuphefumula
• Ukucindezelwa kwemithambo yegazi emikhulu kungabangela i-brainstem noma i-cortical ischaemia, okuholela ku-infarction ezindaweni ezithintekile. 
• Ezinye izinkinga ezisongela ukuphila, njenge ukuboshwa komzimba, isigqi senhliziyo esingavamile, nokukhubazeka. 

Sifo

• Umlando Wezokwelapha: Odokotela bazohlola kahle umlando wezokwelapha womuntu kanye nezimpawu zamanje. Banaka kakhulu izinguquko ekuqapheni nasekuqapheleni, okungaba yinkomba yokwanda kwengcindezi ye-intracranial. 
• Ukuhlolwa Kwezinzwa: Ukuhlolwa kwemizwa okugxilile kwenziwa ukuze kuhlolwe ukukhalipha okuhlobene nobuchopho kanye nemisebenzi yezinzwa, njengoba lokhu kungathinteka kuye ngokuthi ubukhulu kanye nendawo ye-herniation.
• Ukuhlolwa Kwezithombe: Izikena ze-Computed tomography (CT) noma i-magnetic resonance imaging (MRI) zingaveza izimbangela ezingaba khona zokwanda komfutho we-intracranial, njengokuvuvukala, ukopha, ukungahambi kahle kwesakhiwo, noma izixuku zobuchopho. Ukwengeza, bangakwazi ukubona ngeso lengqondo i-brain herniation, eqinisekisa ukuxilongwa nokunquma uhlobo oluthile lwe-herniation.
• I-X-ray yogebhezi lwekhanda nentamo: Zingase zenzelwe ukuqoqa ulwazi olwengeziwe. 
• Ukuhlolwa kwegazi: Lezi zingase zi-odwe uma ithumba noma inkinga yokopha kusolwa njengento enomthelela.

Ukwelashwa kwe-Brain Herniation

Ukwelashwa kwe-brain herniation syndrome kudinga ukungenelela kwezokwelapha ngokushesha ukuze kuncishiswe ukucindezela kwe-intracranial nokuvimbela ukulimala okwengeziwe kobuchopho. Lokhu kungase kuhlanganise:

• Ukukhishwa kwe-Mas Lesions: Lokhu kungase kuhilele ukukhishwa ngokuhlinzwa kwama- haematomas, ukuqunjelwa, amathumba, noma amathumba abangela ukucindezela okukhulu phakathi kogebhezi. 
• I-Decompressive Hemicraniectomy: Kule nqubo, ingxenye yogebhezi iyasuswa ukuze kuvunyelwe isikhala esiningi sobuchopho obuvuvukele.
• I-Physiological Neuroprotection: Lokhu kuhlanganisa i-sedation kanye ne-analgesia ukuthulisa isiguli kanye nokunciphisa izidingo ze-metabolic ebuchosheni. 
• I-Mechanical Ventilation: Kudingeka ukusekela ukuphefumula nokulawula amazinga e-carbon dioxide. 
• Ukuphathwa Kwe-Fluid Ngokucophelela: Ukuvimbela i-edema eyengeziwe ngenkathi ugwema kwamanzi emzimbeni kubalulekile.
• I-Osmotherapy: Idlala indima ebalulekile ekwehliseni ukuvuvuka kobuchopho. Izidakamizwa (i-mannitol noma i-hypertonic saline) zinikezwa ukukhipha uketshezi oluphuma ezicubu zobuchopho. 
• I-Ventriculostomy: Kuyasiza ku-cerebrospinal fluid drainage ukunciphisa ingcindezi.
• Ezinye Izinketho Zokwelashwa: 
  • I-Hyperventilation ibangela i-vasoconstriction kanye nengcindezi ephansi ye-intracranial
  • I-hypothermia yokwelapha ukunciphisa umzimba wobuchopho 
  • I-Corticosteroids ingasetshenziswa ezimweni ezithile, njenge-edema ehlobene nesimila.

Uzoyibona Nini Udokotela

Abantu kufanele bayothola usizo lwezokwelapha ngokushesha uma bona noma othile abamaziyo ebonisa izimpawu zalesi simo esisongela ukuphila, njenge: 

• Ukuqonda okushintshile
• Inhloko ekhanda
• Abafundi abahlukunyeziwe
• Ukulala
• Ukubunzima ukugxila
• Ukuma okungavamile
• Ukunyakaza komzimba okuqinile
• Izikhundla zomzimba ezingajwayelekile

Prevention

Nakuba kungenzeki ngaso sonke isikhathi ukuvimbela i-brain herniation, kunezinyathelo ezimbalwa abantu abangazithatha ukuze banciphise ubungozi babo. Lezi izi:

• Abantu abanezimo ezivele zikhona ngaphambili njengezimila zobuchopho noma ukungahambi kahle kwemithambo yegazi, njengalokhu i-aneurysms, basengozini enkulu yokuba ne-brain herniation. Ngakho-ke, ukuhlolwa njalo kwezokwelapha kanye nokubambelela ekwelashweni okunqunyiwe kubalulekile kulaba bantu.
• Ngomphakathi jikelele, isihluthulelo sokuvimbela sisekugwemeni ukulimala ekhanda. Lokhu kuhlanganisa:
  • Ukugqoka izinto zokuzivikela ezifanele
  • Ukugwema ukuziphatha okuyingozi
  • Imfundo ngokubaluleka kwezinyathelo zokuphepha kanye nemiphumela engase ibe khona yokulimala ekhanda ingakhuthaza abantu ukuba bathathe izinyathelo zokuphepha ezidingekayo.

Isiphetho

I-Brain herniation iyisimo esiphuthumayo sezokwelapha esinomthelela omkhulu emiphumeleni yesiguli. Lesi sihloko sihlole izinhlobo ezahlukene, izimbangela, izimpawu, kanye nezinkinga zalesi simo, sigqamisa ukubaluleka kokuxilonga nokwelashwa ngokushesha. Ngokuqonda izici eziyingozi kanye nokuqaphela izimpawu eziyisixwayiso, abantu ngabanye bangathatha izinyathelo zokuphepha ukuze bazivikele futhi bafune usizo lwezokwelapha olufika ngesikhathi lapho kudingeka.

Imibuzo Evame Ukubuzwa

1. Ungakwazi yini ukululama esiqwini sobuchopho se-herniated?

Ukululama ku-brain stem herniation kuyinselele futhi kuncike ezintweni ezihlukahlukene. Ubukhulu be-herniation, imbangela eyisisekelo, kanye nesivinini sokungenelela kwezokwelapha kudlala indima ebalulekile ekunqumeni umphumela. Ngezinye izikhathi, ukwelashwa ngokushesha kungaholela ekululameni. Isiqu sobuchopho silawula imisebenzi ebalulekile, futhi ukulimala kule ndawo kungaba nemiphumela emibi kakhulu. Iziguli ezisindile zingase zibhekane nezinkinga zesikhathi eside zemizwa.

2. Ingabe i-herniation iyabuyiselwa emuva?

I-brain herniation ingahlehliswa kwezinye izimo uma iphathwa ngokushesha nangempumelelo. Okubalulekile kusekubhekaneni nembangela ewumsuka kanye nokunciphisa ingcindezi ye-intracranial. Isibonelo, uma i-tumor ebuchosheni noma i-hematoma ibangela i-herniation, ukususwa kokuhlinzwa kungase kunciphise ingcindezi futhi kuguqule i-herniation. Kodwa-ke, lapho ubuchopho buhlala isikhathi eside bune-herniated, ayanda ingozi yokulimala unomphela noma ukufa.

3. Kwenzekani ngemva kwe-brain herniation?

Ngemuva kokuvela kwe-brain herniation, imiphumela ingaba nzima futhi isongela ukuphila. Izicubu zobuchopho eziguquguqukayo zingacindezela izakhiwo ezibalulekile, okuholela ekuqubukeni kwezinkinga zemizwa. Iziguli zingase zibe nokwehla okusheshayo kokwazi, amaphethini okuphefumula okungavamile, nosayizi womfundi kanye nezinguquko zokuphinda zisebenze. Ezimweni ezimbi kakhulu, i-brain herniation ingaholela ekuhlulekeni kokuphefumula, ukuboshwa kwenhliziyo, futhi, ekugcineni, ukufa kobuchopho uma kungelashwa ngokushesha.

4. Iluphi uhlobo oluvame kakhulu lwe-brain herniation?

Uhlobo oluvame kakhulu lwe-brain herniation i-subfalcine herniation, eyaziwa nangokuthi i-midline shift. Kulolu hlobo, izicubu zobuchopho zihamba ngaphansi kolwelwesi olubizwa ngokuthi i-falx cerebri phakathi nobuchopho, ludlulele ngaphesheya. Lokhu kuvame ukwenzeka ngenxa yokwanda kwengcindezi ohlangothini olulodwa lobuchopho, okuvame ukubangelwa izimo ezifana nezimila, i-hematomas, noma ukuvuvukala okukhulu.