Cerebrospinal fluid ke mokelikeli o hlatsoang likarolo tsa tsamaiso ea methapo e bohareng: boko le lesapo la mokokotlo. E na le karolo ea ts'ireletso le ts'ireletso ea ts'oaetso. Mokelikeli oa cerebrospinal o boemong bo tloaelehileng, ha o na likokoana-hloko. Ponahalo ea kokoana-hloko ho eona e ka ikarabella bakeng sa li-pathologies tse tebileng tse tšoaetsanoang.

Tlhaloso

Cerebrospinal fluid kapa CSF ke mokelikeli o koahelang tsamaiso ea methapo e bohareng (boko le lesapo la mokokotlo). E potoloha ka tsamaiso ea ventricular (li-ventricle tse teng bokong) le sebaka sa subbarachnoid.

E le khopotso, tsamaiso ea methapo e bohareng e pota-potiloe ke lienfelopo tse bitsoang meninges, tse entsoeng ka lihlopha tse 3:

• the dura, bokantle bo botenya;
• arachnoid, lera le tšesaane pakeng tsa dura le pia mater;
• letlapa la piano, lakane e tšesaane ea ka hare, e khomarelang bokaholimo ba boko.

Sebaka se pakeng tsa arachnoid le pia mater e lumellana le sebaka sa subarachnoid, sebaka sa ho potoloha ha cerebrospinal fluid.

Likaroloana

Kakaretso ea letsatsi le letsatsi ea tlhahiso ea CSF e hakanngoa hore e ka ba 500 ml.

Molumo oa eona ke 150 - 180 ml, ho batho ba baholo, kahoo o nchafatsoa ka makhetlo a 'maloa ka letsatsi.

Khatello ea eona e lekanngoa ka ho phunya lumbar. Ho hakanngoa hore pakeng tsa 10 le 15 mmHg ho batho ba baholo. (5 ho isa ho 7 mmHg ho masea).

Ha u sheba feela, CSF ke mokelikeli o hlakileng oo ho thoeng ke metsi a majoe.

Sebopeho

Celphalo-spinal fluid e entsoe ka:

• metsi;
• leukocyte (lisele tse tšoeu tsa mali) <5 / mm3;
• protheine (e bitsoang proteinorrachia) pakeng tsa 0,20 - 0,40 g / L;
• tsoekere (e tsejoang e le glycorrachia) e emela 60% ea glycemia (boemo ba tsoekere ea mali), kapa hoo e ka bang 0,6 g / L;
• li-ion tse ngata (sodium, chlorine, potasiamo, calcium, bicarbonate)

CSF e nyopa ka ho feletseng, ke hore ha e na likokoana-hloko tsa pathogenic (livaerase, libaktheria, li-fungus).

Likaroloana

Cerebrospinal fluid ke mokelikeli o hlatsoang likarolo tsa tsamaiso ea methapo e bohareng. E na le karolo ea ts'ireletso le ts'oaetso ea ts'oaetso ea morao-rao, haholo-holo nakong ea metsamao le liphetoho tsa boemo. Cerebrospinal fluid e tloaelehile, ha e na kokoana (e nyopa). Ponahalo ea kokoana-hloko ho eona e ka ikarabella bakeng sa mafu a tebileng a tšoaetsanoang a ka lebisang ho sequelae ea methapo ea kutlo kapa esita le lefu la mokuli.

Sephiri le ho potoloha

Mokelikeli oa cerebrospinal o hlahisoa 'me o patoa ke li-choroid plexuses tse tsamaellanang le meaho e boemong ba marako a li-ventricle tse fapaneng (li-ventricle tsa lateral, 3rd ventricle le 4th ventricle) le ho etsa hore ho khonehe ho etsa hore ho khonehe ho kopanya tsamaiso ea mali le bohareng. tsamaiso ea methapo .

Ho na le potoloho e tsoelang pele le e sa lefelloeng ea CSF boemong ba li-lateral ventricle, ebe ho ea ho 3rd ventricle ka likoti tsa Monroe ebe ho ea ho 4th ventricle ka Sylvius aqueduct. E ntan'o ikopanya le sebaka sa subarachnoid ka foramina ea Luscka le Magendie.

Ho tsosolosoa ha eona ho etsahala boemong ba arachnoid villi ea Pacchioni (melao e mpe e teng karolong e ka ntle ea arachnoid), e lumellang ho phalla ha eona ho ea ho sinus ea venous (haholo-holo e ka holimo ea longitudinal venous sinus) 'me kahoo e khutlela ho potoloha ha venous. . .

Tlhahlobo ea CSF e etsa hore ho khonehe ho lemoha li-pathologies tse ngata, tseo boholo ba tsona li hlokang tlhokomelo e potlakileng. Tlhahlobo ena e etsoa ke ho phunya lumbar, e nang le ho nka CSF, ka ho kenya nale e tšesaane pakeng tsa li-vertebrae tse peli tsa lumbar (boholo ba maemo, pakeng tsa 4th le 5th lumbar vertebrae e le ho qoba kotsi leha e le efe ea tšenyo ea mokokotlo oa mokokotlo. . , ho ema ho fapana le 2nd lumbar vertebra). Ho phunya lumbar ke ketso e hlaselang, e lokelang ho etsoa ke ngaka, e sebelisa asepsis.

Ho na le li-contraindications (bothata bo matla ba coagulation, matšoao a khatello ea kelello ea intracranial, tšoaetso sebakeng sa ho phunya) le litla-morao (post-lumbar puncture syndrome, tšoaetso, hematoma, bohloko bo tlase ba mokokotlo).

Tlhahlobo ea CSF e kenyelletsa:

• tlhahlobo ea macroscopic (tlhahlobo ka mahlo e lumellang ponahalo le 'mala oa CSF ho hlahlojoa);
• tlhahlobo ea bacteriological (batla libaktheria ka ho lemoha litso);
• tlhahlobo ea cytological (ho batla palo ea lisele tse tšoeu le tse khubelu tsa mali);
• tlhahlobo ea biochemical (batla palo ea liprotheine, tsoekere);
• Litlhahlobo tse eketsehileng li ka etsoa bakeng sa likokoana-hloko tse itseng (kokoana-hloko ea Herpes, Cytomegalovirus, Enterovirus).

Li-pathologies tse tšoaetsanoang

meningitis

E lumellana le ho ruruha ha meninges eo hangata e leng ea bobeli ho tšoaetso ea kokoana-hloko (baktheria, kokoana-hloko kapa esita le likokoana-hloko kapa li-fungus) ka lebaka la ho silafala ha cerebrospinal fluid.

Matšoao a mantlha a meningitis ke:

• hlooho e opang le e matla e nang le bothata ba lerata (phonophobia) le khanya (photophobia);
• feberu;
• ho nyekeloa le ho hlatsa.

Tlhahlobong ea bongaka, motho a ka lemoha ho tiea ha meningeal, ke ho re ho hanyetsa ho ke keng ha hlōloa le ho bohloko ha a koba molala.

Sena se hlalosoa ke ho fokotseha ha mesifa ea para-vertebral mabapi le ho halefa ha meninges.

Haeba ho belaelloa meningitis, ho bohlokoa ho hlobolisa mokuli ka ho feletseng, e le ho batla matšoao a purpura fulminans (letheba la hemorrhagic ea letlalo le amanang le bothata ba ho kopanya, bo sa nyamele ha khatello e le teng). Purpura fulminans ke letšoao la tšoaetso e matla haholo, hangata e le ea bobeli ho tšoaetso ea meningococcus (libaktheria). Ke boemo ba tšohanyetso bo behang bophelo kotsing bo hlokang ente ea intramuscular kapa intravenous ea kalafo ea lithibela-mafu kapele kamoo ho ka khonehang.

Litlhahlobo tse ling hangata lia hlokahala bakeng sa bonnete ba lefu lena:

• ho phunya lumbar (ntle le maemong a contraindication) ho lumella tlhahlobo hore e etsoe;
• tlhahlobo ea likokoana-hloko (palo ea mali, tlhahlobo ea mali, CRP, ionogram ea mali, glycemia, serum creatinine le meetlo ea mali);
• ho nahana ka potlako ha boko maemong a latelang a hananang le ho phunya lumbar: tšitiso ea kelello, khaello ea methapo le / kapa ho tsietsana.

Tlhahlobo ea CSF e etsa hore ho khonehe ho lebisa ho mofuta oa meningitis le ho netefatsa boteng ba moemeli oa pathogenic.

Kalafo e tla itšetleha ka mofuta oa kokoana-hloko e teng ka har'a cerebrospinal fluid.

Meningoencephalitis

E hlalosoa ke ho kopana ha ho ruruha ha boko le lienfelopo tsa meningeal.

E ipapisitse le kamano ea lefu la meningeal (hlooho, ho hlatsa, ho nyekeloa ke pelo le ho satalla ha meningeal) le ho senyeha ha boko ho tsamaisoang ke ho ba teng ha mathata a kelello, ho tsietsana ka mokhoa o sa fellang kapa ka ho felletseng kapa esita le letšoao la khaello ea methapo (khaello ea koloi). , aphasia).

Meningoencephalitis ke lefu le tebileng le ka lebisang lefung la mokuli mme ka hona le hloka tlhokomelo e potlakileng ea bongaka.

Pelaelo ea meningoencephalitis e hloka litšoantšo tse potlakileng tsa boko, 'me e tlameha ho etsoa pele ho phunngoa lumbar.

Litlhahlobo tse ling tse eketsehileng li tiisa lefu lena:

• tlhahlobo ea likokoana-hloko (palo ea mali, CRP, ionogram ea mali, meetlo ea mali, tlhahlobo ea hemostasis, serum creatinine);
• EEG (electroencephalogram) e ka etsoa, ​​​​e ka 'nang ea bontša matšoao a tšehetsang tšenyo ea boko.

Tsamaiso ea phekolo ea meriana e tlameha ho potlaka 'me joale e ikamahanye le kokoana e senotsoeng.

Carcinomatous meningitis

Carcinomatous meningitis ke ho ruruha ha meninges ka lebaka la boteng ba lisele tsa mofetše tse fumanoang ho CSF. Ha e le hantle, ke potso ea metastases, ke hore ho phatlalatsoa ha bobeli ho bakoang ke mofetše oa mantlha (haholo-holo mofetše oa matšoafo, melanoma le mofetše oa matsoele).

Matšoao a polymorphic, a kenyelletsa:

• meningeal syndrome (ho opa, ho nyekeloa ke pelo, ho hlatsa, ho satalla molala);
• tšitiso ea kelello;
• phetoho ea boitšoaro (ho lahleheloa ke mohopolo);
• ho oa;
• khaello ea methapo ea kutlo.

Litlhahlobo tse ling lia hlokahala ho netefatsa lefu lena:

• ho etsa setšoantšo sa boko (MRI ea boko) e ka bontšang matšoao a lumellanang le tlhahlobo;
• ho phunya lumbar ho sheba boteng ba lisele tsa mofetše ho CSF ​​'me kahoo ho netefatsa hore na ho fumanoa eng.

Polelo ea lefu la kankere ea meningitis e ntse e le lerootho le kajeno ka mekhoa e fokolang ea phekolo.

Hydrocephalus

Hydrocephalus ke ho bokellana ha mokelikeli o feteletseng oa cerebrospinal ka har'a tsamaiso ea cerebral ventricular. E bontšoa ka ho etsa setšoantšo sa boko se fumanang ho atolosoa ha li-ventricle tsa boko.

Sena se fetelletseng se ka baka keketseho ea khatello ea methapo ea mali. Ka 'nete, khatello ea intracranial e tla itšetleha ka mekhahlelo e mengata e leng:

• parenchyma ea boko;
• mokelikeli oa cerebrospinal;
• molumo oa cerebrovascular.

Kahoo ha e 'ngoe kapa tse ling tsa li-parameter tsena li fetoloa, li tla ba le tšusumetso khatellong ea intracranial. Intracranial hypertension (HTIC) e hlalosoa e le boleng> 20 mmHg ho batho ba baholo.

Ho na le mefuta e 'maloa ea hydrocephalus:

• hydrocephalus e sa buisaneng (e thibelang): e lumellana le ho bokellana ho feteletseng ha cerebrospinal fluid tsamaisong ea ventricular ho ea ho tšitiso e amang ho potoloha ha CSF 'me kahoo ho tsosolosoa ha eona. Hangata, ke ka lebaka la boteng ba hlahala e hatellang tsamaiso ea ventricular, empa hape e ka ba ea bobeli ho holofala ho teng ho tloha tsoalong. E fella ka keketseho ea khatello ea intracranial e hlokang phekolo e potlakileng. Hoa khoneha ho etsa phepelo ea kantle ea ventricular ea CSF (tharollo ea nakoana) kapa esita le morao tjena, ho phethahala ha endoscopic ventriculocisternostomy (pōpo ea puisano pakeng tsa cerebral ventricular system le liliba tse lumellanang le ho atolosoa ha subbarachnoid). space) ka hona ho lumella ho feta tšitiso le ho fumana phallo e lekaneng ea CSF;
• ho buisana le hydrocephalus (e sa thibeleng): e tsamaisana le ho bokellana ho feteletseng ha cerebrospinal fluid mabapi le gene nakong ea ho kenngoa hape ha CSF. Hangata ke ea bobeli ho hemorrhage ea subarachnoid, ho sithabela ha hlooho, meningitis kapa mohlomong idiopathic. E hloka tsamaiso ka CSF shunt e ka hare e bitsoang ventriculoperitoneal shunt (haeba mokelikeli o lebisitsoe ho peritoneal cavity) kapa ventriculo-atrial shunt (haeba mokelikeli o lebisitsoe pelong);
• hydrocephalus e sa foleng ka khatello e tloaelehileng: e tsamaellana le mokelikeli o mongata oa cerebrospinal ka har'a cerebral ventricular system empa ntle le keketseho ea khatello ea methapo. Hangata e ama batho ba baholo, ka mor'a lilemo tse 60 le banna ba bangata. Mokhoa oa pathophysiological o ntse o sa utloisisoe hantle. E ka fumanoa ho batho ba nang le histori ea subarachnoid hemorrhage, bohloko ba hlooho kapa ba kileng ba etsoa opereishene ea intracranial.

E hlalosoa hangata ke matšoao a mararo, a bitsoang Adams le Hakim triad:

• ho holofala ha mohopolo;
• mathata a sphincter (ho se khonehe ha moroto);
• bothata ba ho tsamaya ka ho tsamaya butle.

Ho nahana ka boko ho ka bontša ho atoloha ha li-ventricle tsa boko.

Tsamaiso e thehiloe haholo-holo ho thehoeng ha ventricular bypass bypass, ebang ke ventriculo-peritoneal kapa ventriculo-atial.

Maloetse a mang

Tlhahlobo ea cerebrospinal fluid e ka senola li-pathologies tse ling tse ngata:

• subarachnoid hemorrhage e nang le bopaki ba mali a potolohang ho CSF;
• mafu a ho ruruha a amang tsamaiso ea methapo e bohareng (multiple sclerosis, sarcoidosis, joalo-joalo);
• mafu a neurodegenerative (lefu la Alzheimer's);
• neuropathies (lefu la Guillain-Barré).