Cudurada Degenerative iyo Demyelinating ee habka dareemayaasha

El Paso, TX. Chiropractor, Dr. Alexander Jimenez ayaa diiradda saaraya xumaan iyo cudurrada demyelinating ee habka dareemayaasha, calaamadahooda, sababaha iyo daaweynta.

Cudurrada Degenerative & Demyelinating

Gawaarida Motor Neuron

• Daciifnimada dhaqdhaqaaqa iyada oo aan isbeddelin dareenka
• Amyotrophic lateral sclerosis (ALS)
• Kala duwanaanshaha ALS
• Cudurka 'sclerosis' ee aasaasiga ah
• Curyaanka hurdiga ah
• Xaalado la iska dhaxlo oo sababa xumaanshaha unugga geesaha hore
• Cudurka Werdnig-Hoffmann ee dhallaanka
• Cudurka Kugelberg-Welander ee carruurta iyo dadka waaweyn

Amyotrophic Lateral Sclerosis (ALS)

• Waxay saamaysaa bukaanka 40-60 sano jir
• Waxyeello soo gaadhay:
• Unugyada geesaha hore
• Nuclei motor neerfaha cranial
• Corticobulbar iyo marinnada corticospinal
• Natiijooyinka neerfayaasha maskaxda ee hoose (atrophy, fasciculations) IYO natiijooyinka neerfayaasha sare ee matoorka (basbaas, hyperreflexia)
• Badbaadada ~saddex sano
• Dhimashadu waxay ka dhalataa daciifnimada guluubka iyo murqaha neefsiga iyo natiijadeeda infekshanka sarreeya

Kala duwanaanshaha ALS

• Caadi ahaan aakhirka waxay isu beddeshaa qaabka caadiga ah ee ALS
• Cudurka Sclerosis ee dambe
• Calaamadaha maskaxda ee sare ee dareemayaasha ayaa marka hore bilaabma, laakiin bukaanadu waxay leeyihiin calaamado hoose oo neerfaha sidoo kale
• Badbaadadu waxay noqon kartaa toban sano ama ka badan
• Horumarka Bulbar Palsy
• Xulashada waxay ku lug leedahay murqaha madaxa iyo qoorta

Xaaladaha Neuron ee Baabuurka ee la dhaxlo

• Unuggii hore ee geesaha oo xumaada
• Cudurka Werdnig-Hoffmann
• Waxay saamaysaa dhallaanka
• Cudurka Kugelberg-Welander
• Waxay saamaysaa carruurta iyo dadka waaweyn

Kaniisadda, Archibald. Xanuunada neerfaha iyo maskaxda. WB Saunders Co., 1923.

Cudurka Alzheimers

• Waxaa lagu gartaa tangles neurofibrillary (isku-darka borotiinka hyperphosphorylated tau) iyo lakabyada beta-amyloid
• Guud ahaan dhaca da'da 65 ka dib
• Waxyaabaha halista ah ee halista ah
• Isbeddellada ku jira hidda-wadaha beta amyloid
• Epsilon 4 nooca apolipoprotein

Cilad-

• Cilad-sheegid-cilmiyeedka ayaa ah habka kaliya ee si dhab ah loogu ogaan karo xaaladda
• Sawirku wuxuu awood u yeelan karaa inuu meesha ka saaro sababaha kale ee waallida
• Daraasadaha sawir-qaadista ayaa laga yaabaa in la sii horumariyo si ay u noqdaan kuwo waxtar leh mustaqbalka
• Daraasadaha CSF ee lagu baarayo borotiinnada tau iyo beta amyloid waxay noqon karaan kuwo faa'iido leh sida baaritaannada ogaanshaha mustaqbalka

Amyloid Plaques & Tangles Neurofibrillary

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Meelaha Maskaxda ee uu saameeyay Cudurka Alzheimers

• Hippocampus

• Luminta xusuusta dhow

• Xagga dambe ee ku meel-gaadhka-parietal aagga ururka

• Anomia khafiif ah & apraxia dhismaha

• Nucleus basalis of Meynert (neurons cholinergic)

• Isbedelka fahamka muuqaalka

Horumarka

• Marka meelo badan oo kortikal ah ay ku lug yeeshaan, bukaanku wuxuu yeelan doonaa cillado garasho oo aad u daran, si kastaba ha ahaatee paresis, luminta dareenka, ama cilladaha goobta muuqaalka ayaa ah astaamo.

Fursadaha Daaweynta

• Daawooyinka xakameynaya habdhiska dareenka dhexe ee acetylcholinesterase

• Donepezil
• Galantamiin
• Rivastigmine

• Jimicsiga Aerobic, 30 daqiiqo maalintii

• Daryeelka PT/OT si loo ilaaliyo dhaqdhaqaaqyada nolol maalmeedka

• Antioxidant iyo daawaynta caabuqa
• Marxaladda hore, waxay u baahan kartaa wakhti buuxa, daryeelka guriga

Vascular Dementia

• Cerebral arteriosclerosis oo keena istaroog
• Bukaanku wuxuu diiwaangelin doonaa taariikhda istaroogga ama calaamadaha istaroogga ka hor (spasticity, paresis, pseudobulbar palses, aphasia)
• Waxaa laga yaabaa in lala xiriiriyo Cudurka Alzheimers haddii ay sabab u tahay amyloid angiopathy

Waallida Frontotemporal (Cudurka la soo qaado)

• Qoyska

• Waxay saamaysaa lafaha hore iyo kuwa ku meel gaadhka ah

• Waxaa laga yaabaa in lagu arko sawir-qaadista haddii ay xumaatay meelahan

• Calaamadaha

• arxandarro

• Dhaqan xumo

• Dhiirigelinta
• Dhaqan bulsho ahaan aan ku habboonayn
• Saameyn la'aan

• Dhibaatooyinka luqadda

• Guud ahaan xasuus la'aan ama dhib xagga goobta ah

• Pathology waxay daaha ka qaadaysaa meydadka xubnaha neerfaha

• Natiijooyinka dhimashada 2-10 sano gudahood

Dooro Qaybaha Jirka/Cytoplasmic

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Daaweynta

• Dawooyinka lid ku ah diiqadda

• Sertraline
• Citalopram

• Jooji daawooyinka keeni kara daciifnimo xusuusta ama wareer

• Sedatives
• Benzodiazepines

• Jimicsiga

• Wax ka beddelka qaab nololeedka
• Daaweynta dib u habeynta dabeecadda

Cudurka Parkinson

• Waxay dhici kartaa da' kasta, laakiin naadir ka hor da'da 30, waxayna kordhisaa korodhka baahsanaanta dadka da'da ah

• U janjeerta qoyska laakiin sidoo kale waa la'aanteed taariikhda qoyska

• Waxaa keeni kara arrimo deegaanka qaarkood

• Soo-gaadhista 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)
• Isku-dhafka kuwaas oo soo saara xagjirayaal xor ah oo xad-dhaaf ah

• Waxay saamaysaa substantia nigra pars compacta

• Dopaminergic neurons

• On pathology, joogitaanka Lewy Bodies

• Ururinta alfa-synuclein

Lewy Bodies

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Calaamadaha cudurka Parkinsonism

• Adag (dhammaan diyaaradaha)

• ROM dadban
• Dhaqdhaqaaq firfircoon
• Waxaa laga yaabaa in dabeecadda cogwheel ay sabab u tahay calaamadaha gariir

• Bradykinesia

• Gaabis dhaqdhaqaaqa
• Awood la'aanta in la bilaabo dhaqdhaqaaqa
• Hakinta

• Gariir nasasho leh (�pill-roll�)

• Waxaa sameeyay rogrogmida kooxaha murqaha ee iska soo horjeeda

• Cilladaha dambe

• Xagga hore oo dabacsan (fooray)
• Awood la'aanta in la magdhabo dhibaatooyinka, taasoo keentay dib u soo noqoshada

• Maaskaro u eg maaskaro

• Waallida fudud ilaa dhexdhexaad

• Ka dib horumarka, sababtoo ah ururinta jidhka lewy

Pathology

• Yaraanta dopamine ee striatum (caudate iyo putamen) ee ganglia basal

• Dopamine caadi ahaan waxay leedahay saamaynta kicinta wareegga tooska ah iyada oo loo marayo ganglia basal, iyada oo la joojinayo dariiqa aan tooska ahayn

Carbidopa/Levodopa

• Daawaynta ugu badan waa daawo isku dhafan

• Levodopa

• Hordhac dopamine ah oo ka gudba xannibaadda dhiigga-maskaxda

• Carbidopa

• Dopamine decarboxylase inhibitor oo aan dhaafin BBB
• Amino acids waxay hoos u dhigi doontaa waxtarka (tartanka) sidaas darteed daawada waa in laga saaraa borotiinka

Daaweynta Dheeraadka ah ee Carbidopa/Levodopa

• Awoodda bukaanka ee lagu keydiyo dopamine ayaa hoos u dhacda isticmaalka daawadu, sidaas darteed hagaajinta daawadu waxay socon doontaa muddo gaaban iyo gaaban inta daawada la isticmaalayo.

• Waqti ka dib waxay keeni kartaa kororka daaweeyayaasha dopamine

• Dyskinesia ee qiyaasta ugu sarreysa

• Isticmaalka muddada dheer wuxuu culays saarayaa beerka

• Waxyeellooyinka kale waxaa ka mid noqon kara lallabbo, hypotension iyo dhalanteed

Ikhtiyaarada Daawaynta Kale

• Daawooyinka

• Anticholinergics
• Dhicinta dopamine
• Dopanime burburka horjoogayaasha (Monoamine oxidase ama catechol-O-methyl transferase inhibitors)
• Qiyaasta sare ee glutathione

• Isku dheelitirka maskaxda ee jimicsiga neuro-rehab functional

• gariirka
• Kicinta dib u soo celinta
• Kicinta falcelinta soo noqnoqda
• CMT/OMT la beegsaday

Atrophy Nidaamka Badan

• Calaamadaha Cudurka Parkinson ee lagu lammaaniyo mid ama in ka badan oo ka mid ah kuwan soo socda:

• Calaamadaha Ahraamta (Striatonigral degeneration)
• cillad iskeed u shaqeysta (ShyDrager syndrome)
• Helitaanka Cerebellar (Olivopontocerebellar atrophy)

• Guud ahaan aan ka jawaabin daaweynta caadiga ah ee Cudurka Parkinson

Curyaanka Supranuclear Progressive

• Burburinta degdega ah ee ku lug leh borotiinka tau meelo badan oo ay ku jiraan maskaxda dhexe ee rostral

• Calaamaduhu waxay badanaa bilaabaan da'da 50-60

• Socodka oo ku adkaada

• Dysarthria oo muhiim ah

• Dhibaato aragga toosan ee ikhtiyaariga ah

• Retrocollis (kordhinta qoorta ee dystonic)

• dysphagia daran

• Laability shucuur

• Isbedelka shakhsiga

• Dhibaatada garashada

• Si fiican ugama jawaabto daawaynta caadiga ah ee PD

Cudurka Lewy ee Diffous

• Asaasaqa horu-socodka ah
• dhalanteed daran iyo dhalanteed paranoid suurto gal
• Jahwareer
• Calaamadaha cudurka Parkinsonian

sclerosis Multiple

• Nabaro badan oo cadcad ah (plaques of demyelination) ee ku jira CNS

• Kala duwanaansho ahaan
• Si wanaagsan loo soo koobay
• Ka muuqda MRI

• Nabarada dareemayaasha indhaha waa wax caadi ah

• Dareemaha durugsan kuma jiraan

• Wax aan caadi ahayn carruurta ka yar 10, laakiin badanaa waxay soo bandhigaan ka hor da'da 55

• Caabuqa fayrasku wuxuu kicin karaa jawaab celin difaac oo aan habboonayn oo leh unugyada difaaca jirka fayraska-myelin antigen

• Hababka caabuqa iyo difaaca jirka ayaa gacan ka geysta

Noocyada MS

• Horumarka aasaasiga ah ee MS (PPMS)

• Horumarka sare ee MS (SPMS)

• Dib-u-soo-noqoshada sclerosis badan (RRMS)

• Nooca ugu badan
• Si degdeg ah ayuu u kobci karaa, si kedis ah ayay u muuqan kartaa inay xalliso oo soo noqoto
• Ugu dambeyntii waxay noqotaa sida SPMS

Ku lug lahaanshaha Dareemaha indhaha

• 40% kiisaska MS

• Xanuun leh dhaqdhaqaaq indho

• Cilad goob muuqaal ah (scotoma dhexe ama bartamaha)

• Baaritaanka funduscopic

• Waxaa laga yaabaa inay muujiso papilledema haddii huurada ay ku lug leedahay saxanka indhaha
• Waxaa laga yaabaa inaysan u muuqan wax aan caadi ahayn haddii tabeelooyinku ay ka dambeeyaan saxanka indhaha (retrobulbar neuritis)

Dhexdhexaadinta Dhererka Fasciculus

• Demyelination of the MLF waxay keentaa ophthalmoplegia internuclear

• Inta lagu jiro fiirsashada lateral waxaa jira paresis ee malawadka dhexe iyo nystagmus ee isha iska soo horjeeda

• Isku dhafka ayaa ah mid caadi ah

Calaamadaha kale ee MS ee suurtogalka ah

• Myelopathy

• Hemiparesis spastic
• Jidadka dareenka daciifka ah (DC-ML)
• Paresthesias

• Ka-qaybgalka Cerebellar

• Ataxia
• Dysarthria

• Ku lug lahaanshaha nidaamka Vestibular

• Isma dhigma
• vertigo khafiif ah
• Nystagmus

• Tic douloureux (trigeminal neuralgia)

• Calaamadaha Lhermitte

• Toogashada ama dareenka dareenka ayaa loo tixraacaa jirridda iyo addimada inta lagu jiro qallooca luqunta
• Daal
• Qubayska kulul ayaa inta badan ka sii dara calaamadaha

Kala Duwanaanshaha Lagu Tixgelinayo

• Emboli badan iyo vasculitis

• Waxaa laga yaabaa inay u muuqato waxyeellada walxaha cad ee MRI

• habka dhexe ee neerfayaasha sarcoidosis

• Waxay soo saari kartaa neuritis-ka indhaha oo dib loo rogi karo iyo calaamadaha kale ee CNS

• Cudurka jilibka

• Nabaro bararsan
• Dhaqdhaqaaqa indhaha ee caadiga ah

• Vitamin B12 yaraanta

• Asaasaqa
• Murqaha
• Tiirka dhabarka

• Isfiilitada Meningovascular

• Waxyeellada CNS-da-focal ee badan

• CNS Lyme cudurka

• Cudurrada faraha badan

Cilad-sheegid Kala Duwan: Cilmi-baadhisyo lagu ogaanayo

• Tijaabooyinka dhiigga ayaa kaa caawin kara in la kala saaro

• Tirada dhiigga oo buuxa
• Ka-hortagga unugyada nukliyeerka (ANA)
• Baaritaanka serum ee waraabowga (RPR, VDRL, iwm.)
• Fluorescent treponemal baaritaanka antibody
• Lyme titer
• ESR
• Angiotensin oo u beddelaya heerka enzyme (R/o sarcoidosis)

Cilmi-baarista Cudurka MS

• MRI leh oo aan ka duwanayn

• 90% kiisaska MS waxay leeyihiin natiijooyin MRI la ogaan karo

• Natiijooyinka CSF

• Kor u qaadista unugyada dhiigga cad ee mononuclear
• Kooxda OligOclonal IgG

• Kordhinta globulin ilaa saamiga albumin

• Tan waxaa sidoo kale lagu arkaa 90% kiisaska MS

• Kordhinta heerarka borotiinka aasaasiga ah ee myelin

Sadaalin

• Celceliska badbaadada cudurka ka dib waa ~ 15 ilaa 20 sano
• Dhimashadu inta badan waxay ka timaadaa infekshan sare oo aan sabab u ahayn saamaynta cudurka laftiisa

Ilaha

Alexander G. Reeves, A. & Swenson, R. Dhibaatooyinka habka dareemayaasha. Dartmouth, 2004.
Swenson, R. Cudurada Degenerative ee habka dareemayaasha. 2010.