I-Intracranial Pressure

Ukwenyuka kwengcindezi ye-intracranial (ICP) kungenzeka lapho ingcindezi ikhuphuka ngaphakathi kwe-cranial vault. Umfutho ojwayelekile we-intracranial uhlala ungaphansi kwamamilimitha angama-20 we-mercury (mm Hg). Ngokwe-Monroe-Kellie Doctrine, izingxenye ezintathu ze-cranium—izicubu zobuchopho, uketshezi lwe-cerebrospinal (CSF), negazi—zikhona ngokulingana kwevolumu. Ingcindezi iyonke iyakhuphuka uma ingxenye eyodwa ikhuphuka ngevolumu ngaphandle kokuncipha kwezinye.

Izimpawu Zokwenyuka Kwengcindezi Ye-Intracranial

Abantu abanomfutho ophakeme we-intracranial babonisa izimpawu eziyisixwayiso ezihlukile. Lokhu okulandelayo yizimpawu zengcindezi ye-intracranial eziphakanyisiwe:

• Ukuphathwa yikhanda (imvamisa kubi kakhulu ekuseni noma uma ulele)
• I-nausea kanye nokuhlanza
• Isimo sengqondo esishintshile singaba nganoma yiluphi uhlobo, ukusuka ekozeleni kuya ku-coma
• Izinguquko zombono, kufaka phakathi umbono ongenalutho, umbono kabili, nokuzwela ukukhanya
• Ubuthakathaka bemisipha nokuba ndikindiki
• ukuquleka

Izimbangela Zokwenyuka Kwengcindezi Ye-Intracranial

Izizathu zokucindezela kwe-intracranial ziwela ezigabeni eziningana:

• Izicubu zobuchopho ziyakhula: Ukuvuvukala (i-cerebral edema) ngenxa yokulimala, unhlangothi, izimila, noma izifo
• Ukungalingani kwe-CSF: I-Hydrocephalus, ukunciphisa ukumuncwa kabusha, noma ukwanda kokukhiqizwa
• Ukushintsha kwevolumu yegazi: I-aneurysms, i-venous thrombosis, noma ukwehluleka kwenhliziyo

Ezinye izici zihlanganisa idiopathic intracranial nomfutho wegazi ophezulu, ugebhezi lwekhanda, uvithamini A oweqile, kanye nemithi ethile efana ne-tetracycline.

Izingozi Zokwenyuka Kwengcindezi Engaphakathi Ekhanda

Ososayensi abakasitholi isigameko sangempela, nakuba ukulimala kobuchopho okubuhlungu (TBI) kuseyisici esiyingozi esikhulu. 

Izinkinga Zokwenyuka Kwengcindezi Ye-Intracranial

Ukungalashwa kwenyusa iziqondiso zengcindezi ye-intracranial ezinkingeni ezinkulu. Ukulimala kobuchopho kwenzeka ngoba i-ischemia ye-cerebral inciphisa ukugcwala kobuchopho. Ngaphezu kwalokho, iziguli zingase zibe nokuquleka, unhlangothi, ukulimala okungapheli kwemizwa, nokufa ezimweni ezimbi kakhulu. Ingozi enkulu kakhulu ivela lapho umfutho ophakeme ucindezela izicubu zobuchopho phansi, okubangela i-herniation-umphumela ongase ube yingozi.

Sifo

Ukuhlolwa kwesistimu yezinzwa: Phakathi nokuhlolwa kwesistimu yezinzwa, odokotela bahlola izinzwa zesiguli, ibhalansi, nesimo sengqondo. Baphinde bahlole amehlo esiguli nge-ophthalmoscope ukuze babone i-papilledema, okuyizimpawu ezibonisa umfutho ophakeme.

Ukuhlola okuningi kuqinisekisa ukuxilongwa:

• Ukuhlolwa kwesithombe: Ama-CT scan noma ama-MRIs abonisa izithombe ezinemininingwane yokuvuvukala kobuchopho, ama-ventricles akhulisiwe, noma imiphumela emikhulu
• I-Lumbar puncture (impompi yomgogodla): Lokhu kulinganisa umfutho we-cerebrospinal fluid ngqo. Ukufundwa okungaphezulu kuka-20 mm Hg kukhomba ekukhuphukeni kwe-ICP
• Ukuqapha kwe-ICP: Amadivayisi abekwe ngogebhezi lwekhanda ahlinzeka ngokufundwa kwengcindezi okuqhubekayo

Ukwelashwa Kwengcindezi Eyengeziwe Ye-Intracranial

Indlela yokwelapha incike ekutheni isimo sibi kangakanani nokuthi sibangelwa yini. Izinyathelo ezilula ziza kuqala. Lokhu kubandakanya ukuphakamisa ikhanda lombhede ngaphezu kwamadigri angu-30 nokugcina intamo iqondile ukuze kuthuthukiswe ukugeleza kwe-venous.

Imithi yokwelapha ngokuvamile ihlanganisa:

• Imithi: Ama-Osmotic agents adala ama-osmotic gradients adonsa uketshezi ebuchosheni
• I-CSF drainage: I-drain ye-ventricular yangaphandle isusa uketshezi lwe-cerebrospinal ukunciphisa ukucindezela
• I-sedation kanye ne-ventilation: Lokhu kulawula ukuphefumula futhi kunciphisa ukuyaluza okungase kunyuse ingcindezi

Izinketho zokuhlinzwa zidingeka ezimweni ezinenkani. I-decompressive craniectomy isusa ingxenye yogebhezi ukuze ivumele ukuvuvuka kobuchopho futhi isebenze njengendlela yokwelapha yokugcina.

Uzoyibona Nini Udokotela

Shona ngqo esimweni esiphuthumayo uma uhlangabezana: 

• Inhloko ekhanda
• Umbono ophundlekile
• Ukuqapha okuncishisiwe
• Ukuvota
• Ukuziphatha kuyashintsha
• Ukungabi namandla
• Izinkinga zokukhuluma
• Ubuthongo obukhulu
• ukuquleka

Prevention

Unganciphisa izici eziyingozi zokwanda kwengcindezi ye-intracranial ngezindlela eziningi. 

• Ukuzivivinya njalo, isisindo esinempilo nokudla okunomsoco kwehlisa amathuba akho okuba umfutho wegazi ophakeme kanye nestroke. 
• Abantu abadala asebekhulile bangazuza ezinhlelweni zokuvimbela ukuwa ezinciphisa izingozi zokulimala kwekhanda.
• Igiya lokuphepha libalulekile ngesikhathi semidlalo yokuxhumana, ukuhamba ngebhayisikili, noma ngesithuthuthu. 
• Amabhande ezihlalo akuvikela ekulimaleni okulimazayo kwengqondo okungadala ingcindezi eyengeziwe ngenkathi ushayela.

Imibuzo Evame Ukubuzwa

1. Iyini imbangela eyinhloko yengcindezi ye-intracranial?

Izimbangela ezibaluleke kakhulu zokwanda kwengcindezi ye-intracranial zifaka:

• Ukuvuvukala kobuchopho (i-cerebral edema) ngenxa yokulimala, unhlangothi, noma ukutheleleka
• Ukopha ebuchosheni (i-intracerebral noma i-subdural hematomas)
• Amathumba ebuchosheni noma amathumba
• I-Hydrocephalus (ukwakheka okungavamile koketshezi lwe-cerebrospinal)
• I-meningitis noma i-encephalitis
• Umfutho wegazi ophezulu oholela ekopheni kobuchopho

2. Kuyini ukucindezela okuvamile kwe-intracranial?

Abantu abadala ngokuvamile babonisa ukucindezela kwe-intracranial phakathi kwamamilimitha angu-7 kuya kwangu-15 e-mercury (mm Hg). Odokotela bavamise ukwamukela ukufundwa okungaphansi kuka-20 mm Hg.
Odokotela baqala ukwelashwa ukuze behlise i-ICP lapho ingcindezi ingaphezu kuka-20 kuya ku-25 mm Hg. 

3. Yikuphi ukuntula okubangela ukucindezeleka kwekhanda?

Ukucindezela kwekhanda kuhlobene nokushoda kokudla okuningana. Ukuntuleka kwe-Magnesium kuyisici esibaluleke kakhulu, futhi abantu abaningi babonisa ukuntula komtholampilo noma okuncane. Umsebenzi wegazi uvame ukuveza ukuntula kwe-magnesium kubantu abahlukunyezwa yi-migraines.

Amazinga aphansi alezi zakhi zomsoco nawo anendaba:

• I-Riboflavin (Vitamin B2) - idlala indima ebalulekile ekuvimbeleni ubuhlungu bekhanda
• Vitamin D - ukuntula okuvamile okuhlanganiswe nezimpawu zekhanda
• Amafutha acid abalulekile (Omega-3, Omega-6) - ukuntula kwabo kungase kubangele ukucindezeleka kwekhanda

4. Ingabe ukukhathazeka kungabangela ukucindezeleka kwekhanda?

Ukukhathazeka kuvame ukudala imizwa yengcindezi noma ukungezwani ekhanda lakho. Umzimba wakho ukhipha amahomoni okucindezeleka njenge i-cortisol & ne-adrenaline ngesikhathi sokukhathazeka, eqinisa imisipha entanyeni yakho, emahlombe, nasekhanda. Lokhu kungezwani kwemisipha kudala izinhlobo ezahlukene zobuhlungu bekhanda, okuhlanganisa ikhanda elicindezelayo kanye nokuzwa ingcindezi. Lokhu kudala umjikelezo - ukukhathazeka kuletha ukucindezelwa kwekhanda, okwenza ukukhathazeka kube kubi nakakhulu, futhi izimpawu zokuqala zingaba namandla.

UDkt. Mandar G Waghralkar

MBBS, MD (Imithi Yangaphakathi), DM (Neurology), FINR, EDSI
I-Ganga CARE Hospital Limited, eNagpur

Ukuze Ubhukhe Isikhathi, shayela:

+ 91 40-68106529