Aniwa mu Akisikuru (Central Retinal Artery Occlusion) ne Temporal Arteritis¶

Anifurae a ɛyɛ mpofirim a ɛyaw nnim anaasɛ aniwa biako a ɛyɛ kusuu kɛse yɛ neuro-ophthalmic vascular ntɛmpɛ a ɛho hia bere tenten a ɛne amemene a ɛma mogya tu a emu yɛ den yɛ pɛ wɔ ayaresabea ɔyare a ɛma obi hwe ase. Sɛ mogya a ɛtwetwe, cholesterol crystal, anaa autoimmune arterial inflammation siw mogya a ɛkɔ retina (Central Retinal Artery Occlusion [CRAO] anaa Branch Retinal Artery Occlusion [BRAO]) anaa optic nerve head (Anterior Ischemic Optic Neuropathy [AION] a Giant Cell Arteritis na ɛde ba no kwan a [GCA / Temporal Arteritis]), ntini mu nkwammoaa a oxygen kɔm de wɔn no fi ase wuwu a wontumi nsakra no wɔ simma 90 kosi 240 mu. Sɛ mpo aniwa biako a ɛyɛ tuntum no di simma 2 kosi 15 pɛ na afei ɛho tew koraa (Amaurosis Fugax, retinal transient ischemic attack), ayarefo a wɔboro ɔha biara mu 25 wɔ amemene mu akisikuru a ɛyɛ komm bere koro mu dedaw wɔ amemene mu MRI mu na wohyia asiane ntɛm ara sɛ wobenya hemispheric stroke a ɛbɛma wɔadi dɛm anaasɛ afã abien anifurae. Sɛ wofrɛ adwumayɛfo a wɔhwɛ ntɛmpɛ so ntɛm ara, de wo kɔ Designated Stroke Center tẽẽ (wɔntwɛn da sɛ wɔbɛkɔ aniwa ho oduruyɛfo a wɔyɛ no daa), na wofi ase de thrombolysis a wɔde fa ntini mu ntɛm ara anaasɛ corticosteroids a wɔde fa ntini mu dodow a ɛkɔ soro wɔ nnɔnhwerew mu no na ɛkyerɛ sɛ ebia wɔbɛkora aniwa ne amemene no dwumadi so anaa.

Yɛ eyi mprempren¶

1. Kata aniwa biako so bere koro mu de si so dua sɛ ebia aniwa a ɛyɛ tuntum no wɔ aniwa BAAKO (monocular) anaa aniwa ABIEN no nyinaa mu (binocular), na kyerɛw simma pɔtee a anisoadehu no sesae ("Last Known Well" bere). Ayaresabea akisikuru akuw ne neuro-ophthalmologists hia simma pɔtee a wofii ase buu akontaa sɛ dɔnhwerew 4.5 intravenous thrombolysis window.
2. Aniwa biako a ɛyɛ tuntum (aniwa benkum nkutoo ANAA aniwa nifa nkutoo na ɛyɛ sum/ɛyera fã bere a wɔakata aniwa foforo no so): Ɛkyerɛ sɛ ntini no asiw wɔ aniwa no anim (Central Retinal Artery Occlusion, Branch Retinal Artery Occlusion, Ophthalmic Artery Occlusion, anaa Giant Cell Arteritis Optic Neuropathy).
3. Binocular half-field loss (benkum aniwa NE nifa aniwa nyinaa ntumi nhu dan no benkum anaa nifa): Ɛkyerɛ sɛ occipital lobe amemene mu stroke (homonymous hemianopia) wɔ optic chiasm no akyi.
4. Hwɛ ɔyarefo biara a wadi mfe 50 anaa nea ɛboro saa no mu ntɛm ara hwehwɛ "Giant Cell Arteritis (Temporal Arteritis) Red Flag Triad": Bisa ɔyarefo no mprempren ara:
5. "So woanya tiyɛ foforo, w'asɔre mu ayɛ wo yaw, anaa wo ti nhwi a ɛyɛ mmerɛw bere a worebɔ wo ti nhwi anaasɛ woregye w'ahome wɔ pillow so no?"
6. "So wo hwene, wo tɛkrɛma, anaa w'anim yɛ wo yaw, wo ho yɛ wo yaw, anaasɛ wobrɛ bere a woawe aduan simma biako akyi (jaw claudication)?"
7. "So woanya mmati anaa w'asen a ɛyɛ den, ɛyɛ yaw anɔpa (polymyalgia rheumatica), ɔbrɛ a wontumi nkyerɛkyerɛ mu, fifiri a ɛba wo anadwo, anaasɛ bere tiaa bi a ɛma wohu ade mprenu anaasɛ w'aniwa yɛ kusuu a ɛyɛ chalky?"
8. Sɛ mmuae BIARA yɛ YIW wɔ ɔpanyin bi a wadi \(\ge 50\text{ mfe}\): Ka kyerɛ nnuruyɛfo a wɔboa nkurɔfo ne ɔyarehwɛfo a wɔhwɛ ntɛmpɛ dan mu nhwehwɛmu ntɛm ara sɛ wususuw sɛ Arteritic Ischemic Optic Neuropathy a efi Giant Cell Arteritis enti wɔde methylprednisolone a wɔde fa ntini mu dodow a ɛkɔ soro (\(500\text{ to }1,000\text{ mg}\) IV) ntɛm ara ansa na wɔatwɛn mogya mu nhwehwɛmu anaa biopsy de agye yɔnko aniwa no nkwa.
9. Frɛ wo mpɔtam hɔ ntɛmpɛ nɔma ntɛm ara na bisa sɛ wɔmfa wo nkɔ Designated Stroke Center Hospital a ɛwɔ Emergency Department. Trɛ 911 wɔ United States ne Canada, 112 wɔ European Union nyinaa, 999 wɔ United Kingdom, anaa hwɛ ne nyinaa nɔma ahorow a egye ntɛmpɛ. Ka no pefee sɛ: "Ɔyarefo no aniwa biako a ɛyera mpofirim a ɛyaw biara nni ho; yesusuw sɛ Ocular Stroke (Central Retinal Artery Occlusion) anaa Giant Cell Arteritis a emu yɛ den."
10. Fa ɔyarefo no si baabi a ɛfata bere a woretwɛn ambulance no:
11. Sɛ wosusuw sɛ CRAO / Embolic Eye Stroke a ɛnyɛ ntini mu yare (no ti apira anaasɛ koma a entumi nyɛ adwuma yiye): Fa ɔyarefo no to tratraa koraa wɔ n’akyi (supine, \(0\text{ degrees}\)) a ne ti yɛ petee. Sɛ obi da fam a, ɛma ntini a ɛtwe ade ba fam no nhyɛso a ɛkɔ aniwa ne mfinimfini retina ntini no mu no yɛ kɛse, na ɛboa ma mogya twa mogya a ɛtwetwe no ho anaasɛ ɛfa cilioretinal collateral vessels nketenkete mu.
12. Sɛ ɔyarefo no home tiaa bere koro mu anaasɛ wosusuw sɛ mogya tu wɔ n’amemene mu a: Ma ne ti so kakra kɔ \(15\text{ kosi }30\text{ degrees}\).
13. Hwɛ sɛ FAST amemene mu akisikuru ho sɛnkyerɛnne ne carotid dissection kɔkɔbɔ nsɛnkyerɛnne a ɛkɔ so bere koro mu anaa. Hwɛ sɛ w’anim ahwe ase, wo nsa ayɛ mmerɛw, anaasɛ kasa a ɛyɛ mmerɛw (hwɛ stroke akwankyerɛfo). Sɛ ɔyarefo kumaa bi (a onnii mfe 50) nya aniwa biako a ɛyera mpofirim a ɛne ɛyaw foforo a ɛba ne kɔn anaa n’anim fã biako ne aniwa a ɛkɔ fam kakra a ɛwɔ anim ketewaa bi wɔ saa ɔfã koro no ara (Horner syndrome) wɔ kɔn mu apirakuru, chiropractic manipulation, heavy lifting, anaa ɔfe akyi a, susuw sɛ Internal Carotid Artery Dissection.
14. MMFA ahoɔden nhyɛ aniwa no mu anaasɛ mfa nhyɛ aniwa no mu, MMƆ HOME nkɔ krataa kotoku mu, na fa ɔyarefo no sie Nothing by Mouth (NPO). Bere a aduruyɛ nhoma dedaw ahorow kaa aniwa a wɔde twitwiw no denneennen anaasɛ krataa kotoku a wɔsan home ho asɛm no, American Heart Association (AHA) tu fo sɛ ɛnsɛ sɛ wɔde aniwa a wɔtete no nhyɛ aniwa no mu anaasɛ hypercarbia efisɛ mfaso biara nni so a wɔada no adi sɛ ebetumi asɛe aniwa no anaasɛ kanyan koma mu mogya a ɛtɔ kɔ nipadua no mu, na ɛkyɛ thrombolysis a ɛba ntɛm ara wɔ stroke-center thrombolysis.

Ntɛmntɛm triage gyinaesi dua: Mpofirim a ɛyaw a enni aniwa a ɛyera & Temporal Arteritis¶

Fa saa ayaresabea nhyehyɛe yi kyekyɛ monocular vs. binocular ischemic vision loss na ma ayaresabea stroke anaa steroid protocol pɛpɛɛpɛ no yɛ adwuma wɔ simma kakraa bi mu.

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    CoverTest -->|"ANIWA ABIEN NO nyinaa hwere anisoadehu koro pɛpɛɛpɛ<br/>Benkum Fa anaa Nifa Fam"| Occipital["HOMONYMOUS HEMIANOPIA<br/>(Acute Posterior / Occipital Amemene mu Akisikuru):<br/>Frɛ 911 / 112 / 999 Ntɛm ara ma Stroke Center"]

    CoverTest -->|"ANI BAKO NKUTOO (Monocular Vision Loss):<br/>Akuru no wɔ Retina, Optic Nerve,<br/>anaasɛ Ipsilateral Carotid/Ophthalmic Artery mu"| AgeCheck{"Check Age & Giant Cell Arteritis<br/>(Temporal Arteritis) Red Flags:<br/>So Ɔyarefo Mfe >= Mfe 50 WITH<br/>Asɔredan mu Tiyɛ, Ti nhwi a ɛyɛ mmerɛw,<br/>Asen mu Ɛyaw bere a Woremene, Anaasɛ Mmati a Ɛyɛ Den?"}

    AgeCheck -->|"YIW (Mfe >= 50 + GCA Nsɛnkyerɛnne BIARA,<br/>anaasɛ Chalky/Altitudinal Vision Loss):<br/>SUSPECT GIANT CELL ARTERITIS<br/>(Arteritic AION anaa Arteritic CRAO)"| GCAProtocol["Ntɛm ara 'GYE ANI A ƐTO SO ABIEN NO' PROTOCOL:<br/>1. Frɛ 911 / 112 / 999 -> Dwumadibea a Ɛhwɛ Ntɛmntɛm So MPREMPREN<br/>2. Fa Stat High-Dose IV Methylprednisolone<br/> (500 kosi 1,000 mg IV/da x nnafua 3) Ntɛm ara<br/> (MMFA steroid a wɔde di dwuma no nkyɛ mma ESR/CRP labs anaa biopsy)<br/>3. Order Stat ESR, CRP, Nkwammoaa mu nkwammoaa + Bere mu Ultrasound/Biopsy"]

    AgeCheck -->|"NO GCA Nsɛnkyerɛnne<br/>(anaasɛ Ɔyarefo a onnii mfe 50) ."| DurationCheck{"So Anisoadehu San kɔɔ 100% Normal<br/>Wɔ Simma 2 kosi 15 mu,<br/>anaasɛ Anisoadehu Da so ara yɛ Esum/Yera?"}

    DurationCheck -->|"Anisoadehu Sane Koraa wɔ Simma 2 kosi 15 mu<br/>(‘Wɔtwe Mfɛnsere Sunsuma Aba fam & Wɔama So’):<br/>AMAUROSIS FUGAX (Retinal TIA)"| TIAProtocol["ACUTE RETINAL TIA NKYEKYƐMU:<br/>1. MMA NTƐ fie (Asiane kɛse sɛ wobɛma amemene mu akisikuru wɔ 24-72h mu)<br/>2. Kɔ Designated Stroke Center Emergency Room MPREMPREN<br/>3. Hia stat Amemene mu MRI (DWI), Carotid CTA/Ultrasound,<br/> ECG/Holter ma AFib, Nkwammoaa a Ɛko Tia Ntini Abien, & Statin"]

    DurationCheck -->|"Anisoadehunu Da so Yɛ Esum (Afiri a Ɛyɛ Blackout)<br/>anaasɛ Ɛyera Atifi/Ase Sector:<br/>SUSPECT CENTRAL ANA BRANCH RETINAL<br/>ARTERY OCCLUSION (CRAO / BRAO)"| CRAOProtocol["AKWANKYERƐ AKWANKYERƐ AKWANKYERƐ (‘CODE STROKE’):<br/>1. Frɛ 911 / 112 / 999 -> Stroke Center a Wɔakyerɛ MPREMPREN<br/>2. Fa ɔyarefo FLAT to akyi (0 degrees) na ama perfusion no ayɛ kɛse<br/>3. Hyɛ simma pɔtee a efi ase (< dɔnhwerew 4.5 IV tPA mfɛnsere)<br/>4. Sɛ kɔn mu yaw + aniwa ketewa/droopy lid -> Check Carotid Dissection"]

Pathophysiology: Sɛnea aniwa no mogya abien no yɛ adwuma ne nea enti a simma ho hia¶

aniwa ntini a ɛyɛ nkorabata kɛse a edi kan koraa a efi internal carotid artery no mu na ɛma aniwa no ma bere a efi kɔn no mu hyɛn ti nhwi no mu ara pɛ. Esiane sɛ aniwa ntini no nkorabata fi carotid ntini a ɛwɔ mu no mu tẽẽ nti, biribiara a ɛkɔ so wɔ aniwa no ntini mu no yɛ mfɛnsere a ɛkɔ amemene ne koma ntini mu tẽẽ.

Wɔ aniwa no mu no, aniwa ntini no mu paapae yɛ ntini abien a ɛsono emu biara koraa a ɛma retina ne aniwa ntini no mu ntoatoaso ahorow aduan:

1. Mfinimfini Retina Artery (CRA) System (Ɛma Inner Retina no aduan):
2. Mfinimfini retina ntini no tow aniwa ntini no mfinimfini na ɛyɛ nkorabata fa retina no mu fã anan (a ɛwɔ soro, akyi a ɛwɔ fam, hwene a ɛwɔ soro, ne hwene a ɛwɔ fam nkorabata).
3. Ɛyɛ anatomical end-artery a ɛwɔ colateral connections biara wɔ nnipa ɔha biara mu nkyem 70 kosi 85 mu.
4. (Anatomical exception: Wɔwo nnipa bɛyɛ ɔha biara mu nkyem 15 kosi 30* a wɔde ntini foforo a ɛka ho a wɔfrɛ no cilioretinal artery a efi choroidal circulation a ɛma mfinimfini macula no aduan. Wɔ ɔyarefo a ɔwɔ anigye a ɔwɔ cilioretinal artery a ɔwɔ CRAO mu no, wɔn peripheral vision nyinaa yɛ tuntum, nanso pinhole island of 20/20 mfinimfini akenkan anisoadehu no tra ase.)*
5. Akyi Ntini Tiatiaa (SPCAs) Nhyehyɛe (Ɛma Optic Nerve Ti & Outer Retina aduan):
6. Akyi ntini atitiriw abien kosi abiɛsa kyekyɛ mu yɛ no akyi ntini ntiantiaa 10 kosi 20 a ɛyɛ ntini ring twa aniwa ntini no ti ho hyia na ɛma choroid (a ɛma abɔnten so photoreceptor rods ne cones no aduan, a mfinimfini fovea ka ho) no aduan.
7. Nea enti a Giant Cell Arteritis dɔ Short Posterior Ciliary Arteries: Akyi ciliary ntini ntiantiaa ne superficial temporal arteries no mu elastic lamina no ne #1 botae a autoimmune giant-cell ntua no de ba wɔ Temporal Arteritis mu, na ɛkyerɛkyerɛ nea enti a Giant Cell Arteritis de optic nerve head infarction a ɛyɛ hu ba (Arteritic Anterior Ischemic Optic Neuropathy [A-AION]) wɔ ɔha biara mu nkyem 80 a wɔde aniwa hu ne Arteritic CRAO wɔ ɔha biara mu nkyem 10 kosi 15 mu.

Retinal Ischemic Survival Clock (Nea Enti a Simma 90 kosi 240 ne Aboboano) .¶

Classic primate neuro-ophthalmology sɔhwɛ ahorow (Hayreh ne afoforo) ne nnipa akisikuru ho sɔhwɛ ahorow de abɔde mu nkwaadɔm dɔn pɔtee a ɛwɔ retina ganglion nkwammoaa mu bere a wɔakyekyere retina ntini a ɛwɔ mfinimfini no mu no si hɔ: - Simma 0 kosi 90 a wɔde siw ano koraa: Retina ntini no yɛ nwonwa (ischemic penumbra), nanso sɛ mogya no san kɔ ntɛm ara a, ebetumi aba sɛ aniwa no ho tɔ no yiye anaasɛ ɛkame ayɛ sɛ ɛyɛ yiye. - Simma 90 kosi 240 ( nnɔnhwerew 1.5 kosi 4): Retina ganglion cell layer a ɛwɔ mu no mu a ɛyɛ mmerɛw a ɛkɔ so yɛ mmerɛw no ba; wɔda so ara tumi nya ahoɔden fã bi denam mogya a wɔsan de ma ntɛm so. - Sɛ ɛboro simma 240 (nnɔnhwerew 4+) a wɔde siw ano koraa: Necrosis kɛse a wontumi nsakra wɔ retina a ɛwɔ mu no ba, na ɛma aniwa a ɛyera a emu dɔ daa (mpɛn pii no nsateaa a wɔkan [CF], nsa a wɔde kankan [HM], anaa hann a wohu [LP] nkutoo) gye sɛ cilioretinal anaasɛ ntini a entumi nsiw koraa no kora a penumbra a ɛyɛ fɛ.

Ntotoho a edi mũ a ɛfa ischemic ocular ergencies atitiriw 5 no ho¶

Fa ayaresabea pon yi kyerɛ nsonsonoe a ɛda embolic CRAO, branch retinal artery occlusion, amaurosis fugax, arteritic optic neuropathy (Giant Cell Arteritis), ne non-arteritic optic neuropathy ntam:

Tebea 1: Mfinimfini ne Nkorabata Retinal Artery Occlusion (CRAO & BRAO) .¶

Nea enti a Amerika Koma Fekuw no hyɛ sɛ wɔnyɛ "Code Stroke" mma CRAO¶

Abakɔsɛm mu no, ayarefo a wɔn ani biako hweree aniwa no dii kan kɔ aniwa ho oduruyɛfo anaa aniwa ayaresabea, faako a wɔde nnɔnhwerew anaa nna pii yɛ aniwa mu nhwehwɛmu ansa na obiara ahwɛ wɔn amemene anaa wɔn kɔn mu ntini ahorow. Wɔ afe 2021 mu no, Amerika Koma Fekuw (AHA) ne Amerika Akisikuru Fekuw (ASA) de Nyansahu mu Asɛm titiriw bi mae a ɛsakraa CRAO hwɛ wɔ wiase nyinaa: 1. CRAO yɛ Acute Ischemic Stroke: Esiane sɛ retina no yɛ embryologically fã bi wɔ central nervous system no mu na carotid artery a ɛwɔ mu no na ɛma aduan nti, occlusion of the central retinal artery yɛ ischemic stroke of the retina ankasa. 2. CRAO Ayarefo 4 biara mu 1 wɔ Amemene mu Akisikuru a Ɛyɛ Komm Mprempren: Diffusion-weighted brain MRI (DWI) nhwehwɛmu ahorow di adanse sɛ ayarefo a wɔde CRAO anaa BRAO a emu yɛ den ba no mu ɔha biara mu nkyem 19 kosi 25 nya akisikuru a emu yɛ den a ɛma mogya tu wɔ amemene no fã bere koro mu a ɛnam mogya a ɛtɔ kɔ amemene no mu a ɛpaapae saa ara na ɛba carotid plaque anaa koma dan mu, bere mpo a ɔyarefo no nsa nyɛ den anaasɛ ɔkasa mu haw biara. 3. Intravenous Thrombolysis Window (\(\le 4.5\text{ Hours}\)): Sɛ ɔyarefo bi a ɔwɔ CRAO a ɛnyɛ ntini mu yare no du Designated Stroke Center wɔ ** nnɔnhwerew 4.5** akyi bere a wɔayɛ ti CT a ɛnyɛ nsonsonoe ntɛm ara akyi no, ɛmma amemene mu mogya ntu na labs pow Giant Cell Arteritis, stroke neurologists ne aniwa ho animdefo betumi de ntini mu ntini mu plasminogen activator (alteplase anaa tenecteplase) ama. Ayaresa mu meta-nhwehwɛmu ahorow kyerɛ sɛ IV thrombolysis a wɔde ma wɔ nnɔnhwerew 4.5 ntam no ma aniwa a ɛma obi ho tɔ no a ntease wom no kɔ soro kɛse bere a wɔde toto nea wɔde hwɛ ade a ɛyɛ katee ho no.

Dɛn ne "Cherry-Red Spot" a ɛwɔ aniwa mu nhwehwɛmu mu?¶

Sɛ oduruyɛfo anaa aniwa ho ɔyaresafo a ɔhwɛ ntɛmpɛ so de aniwa a wɔde hwɛ aniwa anaa fundus mfoninitwa afiri hwɛ aniwa mu a ɔwɔ CRAO wɔ nnɔnhwerew kakraa bi akyi wɔ ntua no akyi a: - Retina no mu ntini (a mfinimfini retina ntini a asiw no ma no aduan) no hohoro ne nkwammoaa mu nsu (cytotoxic edema), na ɛdan opaque milky white. - Nanso, nantwinini aniwa a awu a ɛwɔ macula (foveola) no nipadua mu yɛ teateaa te sɛ krataa na enni retinal ganglion layers a ɛwɔ mu biara nni mu, choroid a ɛwɔ ase (a akyi ciliary arteries a enni dɛm no ma no aduan) na ɛma no aduan. - Esiane sɛ ntini mu choroid kɔkɔɔ a ɛhyerɛn no hyerɛn fa mfinimfini a ɛyɛ tratraa a ɛyɛ mmerɛw no mu pɛɛ bere a halo a ɛyɛ nufusu fitaa a ɛyɛ infarcted retina atwa ho ahyia nti, ɛma ɛyɛ "Cherry-Red Spot" a ɛyɛ tete de a ɛyɛ Central Retinal Artery Occlusion.

Nea enti a ƐNSƐ sɛ wode wo ho to fie "Ocular Massage" anaa "Paper-Bag Breathing" so.¶

Nhoma dedaw ahorow a wɔde sua ade kyerɛe sɛ wɔmfa ahoɔden mia aniwa a wɔato mu no so (digital ocular massage) anaasɛ wɔmfa home nkɔ krataa kotoku a ɛyɛ bruu mu (carbogen therapy) mma CRAO. - Modern Clinical Verdict (AHA & AAO): Nneyɛe abien no nyinaa yɛ abam bu mma wɔn a wɔrehwɛ no. Sɛ wɔde ahoɔden mia aniwa mu a, ebetumi abubu aniwa bi denam oprehyɛn a wɔayɛ no nnansa yi so, ama retina a ɛpaapae no ayɛ kɛse, anaasɛ ɛbɛma vagal bradycardia reflex (oculocardiac reflex) aba. Sɛ wɔhome kɔ krataa kotoku mu a, ɛma ayarefo a wɔn mfe akɔ anim nya oxygen hypoxia wɔ nhyehyɛe mu a ɛmma retina nkwa nna nkɔ anim. Adeyɛ biako a etu mpɔn a wɔyɛ ansa na wɔakɔ ayaresabea ne sɛ wɔde ɔyarefo no bɛto n’akyi petee na wɔafrɛ 911 / 112 / 999 ama Stroke Center akwantu ntɛm ara.

Ade titiriw a ɛde ba wɔ Mpanyimfo a wonnii mfe 50 mu: Internal Carotid Artery Dissection¶

Sɛ ɔpanyin kumaa bi (a wadi mfe 20 kosi 50) nya aniwa biako a ɛyera mpofirim anaasɛ amaurosis fugax a, bisa sɛ ebia wɔwɔ kɔn mu yaw, ɔfã biako ti yɛ wɔn yaw, anaasɛ wɔn anim yɛ wɔn yaw, na hwɛ wɔn aniwa anim ne wɔn ani anim wɔ hann a ano nyɛ den mu: - Tetew a ɛba carotid ntini a ɛwɔ kɔn no mu no mu (Internal Carotid Artery Dissection), a mpɛn pii no ɛnam kɔn mu mpire, yoga hyperextension, chiropractic manipulation, ade a emu yɛ duru a wɔma so, anaa ɔfe a basabasayɛ wom na ɛkanyan no, trɛw sympathetic nerve fibers a wɔabɔ ho ban wɔ carotid artery fasu no akyi no mu. - Eyi ma ipsilateral Horner Syndrome (aniwa a ɛwɔ soro a ɛkɔ fam kakra [ptosis] ne aniwa a ɛyɛ ketewaa a ɛyɛ mmerɛw [miosis] wɔ ɔfã koro no ara a ɛne kɔn mu yaw no) ba retina anaa amemene mu emboli nkyɛn. CT angiography (CTA) a wɔyɛ no ntɛm ara wɔ ti ne kɔn ho wɔ dwumadibea a wɔhwɛ ntɛmpɛ so no si so dua sɛ wɔatwa no.

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Tebea 2: Amaurosis Fugax (Aniwa biako a ɛyera bere tiaa bi / Retinal TIA) .¶

Nea enti a "anisoadehu a ɛsan ba sɛnea ɛte wɔ simma 5 mu" da so ara yɛ 911 / 112 / 999 ntɛmpɛ¶

Amaurosis fugax ("sum a ɛtra hɔ bere tiaa bi") ba bere a srade asinasin bi (Hollenhorst plaque) anaa platelet-fibrin micro-clot bi bubu fi plaque bi a ɛwɔ kɔn no mu carotid artery mu (anaasɛ efi koma no mu wɔ atrial fibrillation mu), kɔtra retina ntini a ɛwɔ mfinimfini no mu bere tiaa bi, na afei ɛpaapae wɔ 2 kosi Simma 15: - Ayarefo ka ho asɛm sɛ "mfɛnsere mu sunsuma a ɛyɛ sum a ɛtwe kɔ fam yiye wɔ aniwa BAAKO so" kosi sɛ aniwa no bɛyɛ fitaa anaa tuntum, a ɛtra hɔ simma 3 kosi 10, na afei ɛsan ma so kɔ soro kosi sɛ aniwa no bɛyɛ nea ɛfata ɔha biara mu nkyem 100. - Afiri no: Esiane sɛ anisoadehu san ba sɛnea ɛte wɔ simma 5 akyi a ɛyaw biara nni mu nti, nnipa pii brush no sɛ aniwa mu nhyɛso anaasɛ atiridiinini na wɔtra fie. - Nokware no: Amaurosis fugax yɛ Retinal Transient Ischemic Attack (TIA). Sɛ wɔanyɛ ayaresabea nhwehwɛmu a egye ntɛmpɛ, aduru abien a ekum mogya nkwammoaa (aspirin + clopidogrel), statin a emu yɛ den kɛse, ne carotid endarterectomy anaa stenting a egye ntɛmpɛ (sɛ carotid a ɛyɛ teateaa yɛ \(70\%\text{ kosi }99\%\)) a, mogya a ɛtɔ a edi hɔ a ɛpaapae nnɔnhwerew pii akyi no betumi asiw amemene mu ntini a ɛwɔ mfinimfini no mu, na ɛde obubuafo a ɛtra hɔ daa aba ne kasa a wɔhwere.

Sɛnea wobɛkyerɛ Amaurosis Fugax a ɛda nsow wɔ Visual Migraine Aura anaa Papilledema a ɛnyɛ hu ho¶

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Tebea a Ɛto so 3: Nkwammoaa Kɛse Ntini (GCA / Temporal Arteritis) wɔ Mpanyimfo a Wɔadi Mfe 50 ne Nea ɛboro saa mu¶

Nea enti a Giant Cell Arteritis ne ade a wobetumi asiw ano sen biara a ɛde afã abien anifurae koraa ba¶

Giant Cell Arteritis (GCA), a wɔsan frɛ no Temporal Arteritis, yɛ autoimmune granulomatous vasculitis a ɛwɔ ntini a ɛwɔ mfinimfini ne akɛse a ɛba mpanyimfo a wɔadi mfe 50 ne akyi nkutoo (ɛkɔ soro sen biara wɔ mfe 70 kosi 85).

Wɔ GCA mu no, nipadua no mu tumi a ɛko tia nyarewa T-nkwaboaa ne nkwammoaa akɛse hyɛn carotid ne vertebral ntini no nkorabata a ɛwɔ akyi no fasu mu: - Ntini no fasu no hohoro kɔ mu (intimal hyperplasia) kosi sɛ mfinimfini kwan no bɛto mu. - Sɛ saa ɔfe a ɛsiw yi bɔ akyi ciliary ntini ntiantiaa anaa central retinal artery a, aniwa ntini ti no wu esiane oxygen kɔm a ɛba mpofirim nti (Arteritic Anterior Ischemic Optic Neuropathy [A-AION]), na ɛma aniwa no yɛ sum koraa wɔ bɛboro ɔha biara mu nkyem 50 mu. - The "Fellow Eye" Clock: Sɛ aniwa a edi kan no hwere aniwa fi GCA mu pɛ a, saa aniwa a edi kan no ntaa nnya aniwa a ɛho hia bio. Nanso, sɛ wɔkyɛ corticosteroid a wɔde di dwuma kɛse no mu a, ayarefo ɔha biara mu nkyem 30 kosi 50 nya ntua a ɛte saa ara wɔ wɔn aniwa a ƐTO SO ABIEN (a aka) no mu wɔ nnɔnhwerew 24 kosi nnafua 7 mu, na ɛma wɔn ani afura koraa wɔ aniwa abien no nyinaa mu. GCA a wɔansa no nso betumi ama akyi berɛmo ne carotid ntini a ɛwɔ mu (a ɛde amemene no mu akisikuru) ne... thoracic aorta (a ɛde ba aortic a wɔpaapae mu).

Red Flag Symptom Checklist a edi mũ a ɛfa Giant Cell Arteritis ho (Mfe \(\ge 50\)) .¶

Esiane sɛ ayarefo a wɔn ani nhu ade yiye esiane GCA nti no mu ɔha biara mu nkyem 20 wɔ "accult GCA" (tiyɛ kakraa bi, a anom anaa nhyehyɛe mu sɛnkyerɛnne a ɛnyɛ anifere nkutoo na ɛwɔ mu) nti, hwɛ ade biara a ɛwɔ saa din yi mu wɔ ɔpanyin biara a wadi boro mfe 50 a n'ani mu nsakrae wɔ hɔ no mu:

• 1.1. Jaw Claudication (Most Specific Symptom of GCA, present in -50%): Bisa ɔyarefo no sɛ: "Sɛ wowe aduan a ɛyɛ mmerɛw te sɛ nam anaa paanoo a ɛyɛ mmerɛw simma 1 kosi 2 a, so wo jaw ntini anaa wo tɛkrɛma fi ase yɛ wo yaw, ɛyɛ wo yaw, anaasɛ wote nka sɛ woabrɛ enti ɛsɛ sɛ wugyae wew na wohome?" Eyi ba efisɛ facial ne maxillary arteries no de ma ntini a ɛwe ne tɛkrɛma no yɛ teateaa esiane ntini mu yare nti, na ɛde ntini mu ntini a ɛyɛ mmerɛw a apɔw-mu-teɛteɛ de ba no ba.
• 2.1. New-Onset Localized Headache (Ewɔ hɔ wɔ 70% kosi 80%): Ɛyaw foforo a ɛbɔ, ɛyɛ mfonoe, anaa ɛhyew wɔ asom biako anaa abien no nyinaa, moma so, anaa ti akyi wɔ ɔpanyin a ne mfe akɔ anim mu.
• 3.1. Ti nhwi a ɛyɛ mmerɛw ne bere mu ntini a ɛnyɛ ne kwan so: Sɛ wobɔ wo ti nhwi, wode wo ti to pillow so, anaasɛ wohyɛ aniwa ahwehwɛ a, ɛte sɛ yaw wɔ wo ti nhwi so. Sɛ wode nsateaa tu mmirika brɛoo fa superficial temporal artery (aso no anim ne asɔredan no atifi) a, wuhu ntini a ɛyɛ den, ɛyɛ ntini, ɛyɛ mmerɛw a ne koma bɔ yɛ mmerɛw anaasɛ enni hɔ.
• 4.1. Premonitory Visual Warning Signs: Simma 5 a ɛma ɛyɛ kusuu tiawa (amaurosis fugax) anaa bere tiaa mu diplopia (anisoadehu mmɔho abien, ɛwɔ 10% kosi 15%) a aniwa ntini mu ischemia na ɛde ba.
• 5.1. Polymyalgia Rheumatica (PMR) ne Ɔman Mmara mu Nsɛnkyerɛnne (Ɛwɔ hɔ wɔ 40% kosi 50%): Anɔpa a ɛyɛ den a ɛyɛ pɛpɛɛpɛ na ɛyɛ yaw wɔ mmati, kɔn, ne asen abien no nyinaa so a ɛtra hɔ bɛboro simma 45 wɔ bere a woanyane akyi, a atiridii a ɛba fam, anadwo fifiri, anorexia, anaasɛ mu duru a wɔanhyɛ da ka ho.

Ayaresabea Ntɛmntɛm Nhyehyɛe a Wɔde Hwɛ Nkwammoaa Kɛse a Wosusuw sɛ Ɛyɛ Ntini Kɛse¶

Sɛnea American College of Rheumatology (ACR), Europa Alliance of Associations for Rheumatology (EULAR), ne British Society for Rheumatology (BSR) no nkabom akwankyerɛ a ɛfa ayaresabea adwumayɛ ho kyerɛ no: 1. Fi ase Nnom Corticosteroids a Ɛdɔɔso Ntɛm ara Bere a Ayaresa mu Adwene Mu (Ansa na Woayɛ Biopsy anaa Labs Sane): - Sɛ aniwa mu sɛnkyerɛnne BIARA wɔ hɔ a (anisoadehu a ɛyera, amaurosis fugax, anaasɛ anisoadehu mmɔho abien): Fa methylprednisolone a wɔde fa ntini mu \(500\text{ kosi }1,000\text{ mg}\) IV ma da biara nnafua 3 a ɛtoatoa so, na fa prednisone a wɔnom no dodow kɛse (\(1\text{ mg/kg/da}\), mpɛn pii no \(60\text{ kosi }80\text{ mg}\) da biara) ne tocilizumab a wosusuw ho. - Sɛ cranial GCA sɛnkyerɛnne wɔ hɔ A ENNI aniwa so sɛnkyerɛnne biara a: Fi ase oral prednisone \(40\text{ kosi }60\text{ mg}\) da biara ntɛm ara. 2. Ntwentwɛn Steroid ase da Twɛn Temporal Artery Biopsy anaa Ultrasound: Nsakrae a ɛba ɔhyew mu ne nkwammoaa akɛse a ɛwɔ temporal artery fasu no mu no tra hɔ nnafua 10 kosi 14 bere a wɔafi ase de steroid a wɔde di dwuma kɛse adi dwuma akyi, bere a sɛ wɔtwentwɛn steroid ase nnɔnhwerew 12 mpo a, ebetumi ama ɔyarefo no ahwere n’ani a aka no. 3. Mogya mu Nhwehwɛmu a Wɔahyɛ Ntɛm ara wɔ ER: Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP), ne Mogya Dodow a Edi Mu (CBC) (wɔhwɛ sɛ ɛyɛ thrombocytosis a ɛyɛ adwuma a mogya nkwammoaa \(>400,000/\mu\text{L}\) wom anaa).

Nkitahodi nkyerɛwee pɔtee ma 911 / 112 / 999 ne ayaresabea triage¶

Esiane sɛ aniwa a ɛyera a ɛyaw biara nni mu no ma aniwa no akyi yɛ te sɛ nea ɛteɛ ɔha biara mu nkyem 100 (sclera fitaa, ani a ɛyɛ mmerɛw) nti, adwumayɛfo a wɔpaw wɔn wɔ ayaresabea akɛse mu no betumi abu sɛnea egye ntɛmpɛ no adewa gye sɛ wode nsɛmfua pɔtee a ɛfa ɔyare a ɛma obi hwe ase ne ntini mu yare no di dwuma:

• Sɛ wosusuw sɛ Central Retinal Artery Occlusion (CRAO) wɔ Nnɔnhwerew 4.5 Mu:

  "Mehia ambulance a egye ntɛmpɛ wɔ [Address Pɛpɛɛpɛ]. Ɔyarefo no yɛ [Mfe]-afe [ɔbarima/ɔbea] a onyaa anifurae mpofirim, koraa, a ɛyaw nnim wɔ [benkum/nifa] aniwa mu wɔ [Simma Pɛpɛɛpɛ a Efi Ase]. Sɛnea Amerika Koma Fekuw no akwankyerɛ kyerɛ no, yesusuw sɛ Ocular Stroke a emu yɛ den (Central Retinal Artery Occlusion) na yehia Mmara ntɛm ara Akisikuru a wɔde kɔ Akisikuru Ayaresabea a Wɔapaw no mu wɔ nnɔnhwerew 4.5 a wɔde fa ntini mu thrombolysis mfɛnsere no mu."

• Wɔ Wosusuw sɛ Giant Cell Arteritis (Temporal Arteritis) wɔ Ɔpanyin a Wadi Mfe 50+ mu:

  "Emergency triage: saa ɔyarefo a wadi mfe [Mfe] yi wɔ anisoadehu a ɛyera mpofirim [anaasɛ nhumu abien / bere tiaa mu dimming] wɔ [benkum/nifa] aniwa no mu a [asɔredan mu tiyɛ foforo / ti nhwi a ɛyɛ mmerɛw / anom yaw bere a ɔrewe aduan ka ho]. Yesusuw sɛ Arteritic Ischemic Optic Neuropathy a efi Giant Cell Arteritis mu na ehia ntɛmpɛ oduruyɛfo nhwehwɛmu ma stat high-dose intravenous methylprednisolone (500 to 1,000 mg IV) MPREMPREN na amma anifurae a ɛbɛtra hɔ daa wɔ ne yɔnko aniwa no mu."

• Wɔama Amaurosis Fugax (Retinal TIA) a wɔasiesie no:

  "Ɔyarefo no yɛ [Mfe] afe a onyaa tuntum a ɛnyɛ yaw koraa ('mfɛnsere sunsuma') wɔ [benkum/nifa] aniwa no mu a ɛkyɛ [Number] simma wɔ [Bere] mu nnɛ. Ɛwom sɛ anisoadehu asan aba sɛnea na ɛte kan no de, nanso eyi yɛ Amaurosis Fugax, Retinal TIA a emu yɛ den, na ɛhwehwɛ sɛ wɔyɛ Stroke Center ntɛmpɛ nhwehwɛmu ntɛm ara, amemene MRI, carotid artery mfoninitwa, ne ECG."

Nsɛm a wɔtaa bisa¶

Dɛn nti na aniwa no akyi yɛ fitaa koraa na ɛte sɛ nea ɛte bere a aniwa mu akisikuru (CRAO) anaa bere mu ntini a ɛyɛ mmerɛw no?¶

Mogya ntini a ɛma aniwa no ani yɛ kɔkɔɔ bere a aniwa no yɛ pink anaasɛ glaucoma no yɛ ntini a ɛwɔ ani a ɛwɔ ani ne episcleral a ɛwɔ aniwa no anim. Wɔ Central Retinal Artery Occlusion ne Giant Cell Arteritis mu no, ntini a esiw no ba aniwa no akyi akyi tɔnn wɔ mfinimfini retina ntini ketewaa no mu anaasɛ akyi ciliary ntini ntiantiaa a ɛma retina ne aniwa ntini no aduan, enti aniwa no anim kɔ so yɛ fitaa koraa na ɛnyɛ yaw bere a retina a ɛwɔ mu no kɔm de oxygen.

Mɛyɛ dɛn ahwɛ wɔ fie sɛ ebia aniwa biako (aniwa biako) anaa aniwa abien no nyinaa (aniwa abien) a ɛyɛ mmerɛw mpofirim?¶

Sɛ aniwa biako hwere aniwa mpofirim anaasɛ ɛyɛ sunsuma tuntum a, onipa amemene no bɔ mmɔden sɛ ɛde mfonini a ɛteɛ a efi aniwa pa no mu no bɛka mfonini a ɛyɛ tumm a efi aniwa bɔne no mu no abom, na ɛma onipa no te nka te sɛ nea n’ani abien no nyinaa ayɛ kusuu anaasɛ n’ani ayɛ kusuu. Bere nyinaa fa wo nsateaa kata w’ani benkum so koraa na woasɔ w’ani nifa nkutoo ahwɛ, na afei kata w’ani nifa so na woasɔ w’ani benkum nkutoo ahwɛ; eyi da no adi ntɛm ara sɛ ebia tuntum no wɔ aniwa biako mu katee anaasɛ ɛka aniwa abien no nyinaa benkum anaa nifa fã.

Dɛn nti na anom yaw a ɛba bere a wɔrewe aduan (jaw claudication) yɛ kɔkɔbɔ sɛnkyerɛnne a ɛho hia sen biara wɔ Giant Cell Arteritis ho?¶

Nea ɛnte sɛ temporomandibular joint (TMJ) arthritis a ɛyɛ yaw bere a wubue w’ano anaasɛ woka biribi a ɛyɛ den no, anom a ɛyɛ mmerɛw wɔ Giant Cell Arteritis mu no fi ɔfe a nipadua no tumi ko tia nyarewa a ɛma ntini a ɛma mogya kɔ wo ntini a wowe ne wo tɛkrɛma mu no yɛ ketewaa. Esiane sɛ ntini no ntumi nnya mframa pa a ɛdɔɔso bere a woreteɛteɛ w’apɔw mu mpɛn pii nti, wo hwene te nka yiye wɔ aduan a edi kan a wobɛka no mu, ɛyɛ wo yaw kɛse a ɛyɛ wo yaw anaa ɔbrɛ bere a woawe sikɔne 60 kosi 90 akyi, na sɛ wugyae adidi ara pɛ a, ɛma wo ho tɔ wo; sɛ wohu saa sɛnkyerɛnne yi na wɔkɔ ER kɔhwehwɛ steroid a, esiw anifurae mpofirim ano.

Sɛ m’aniwa biako yɛɛ sum wɔ aniwa biako mu simma 5 na afei ɛsan bae ɔha biara mu 100 sɛnea ɛte daa a, dɛn nti na mintumi ntwɛn kɛkɛ sɛ mɛkɔ akɔhwɛ m’ani duruyɛfo dapɛn a edi hɔ no?¶

Simma 5 a ɛyɛ tuntum a ɛnyɛ yaw wɔ aniwa biako mu (amaurosis fugax) kyerɛ sɛ mogya a ɛtɔ anaasɛ srade a ɛwɔ wo koma mu no mu tetew fii carotid ntini a ɛyɛ teateaa a ɛwɔ wo kɔn mu anaa wo koma mu, siw w’ani ntini titiriw no mu, na afei ɛpaapae. Ayarefo 4 biara mu 1 a wɔwɔ retina ntini mu nsɛm a esisi no wɔ amemene mu MRI mu akisikuru foforo a ɛyɛ komm dedaw, na asiane a ɛwɔ hɔ sɛ amemene mu akisikuru kɛse a ɛma obubuafo daa no dɔɔso sen biara wɔ nnɔnhwerew 24 kosi 72 a edi kan wɔ saa kɔkɔbɔ bere no akyi, na ɛhwehwɛ sɛ wɔkɔ ayaresabea Stroke Center ntɛm ara.

Sources a wɔhwɛɛ mu¶

• Amerika Koma Fekuw (AHA) ne Amerika Stroke Fekuw (ASA, United States): Management of Central Retinal Artery Occlusion: Nyansahu mu Asɛm a Efi Amerika Koma Fekuw (Mac Grory ne afoforo, Stroke 2021; wɔde CRAO sii hɔ sɛ Code Stroke ntɛmpɛ, \(\le 4.5\text{ dɔnhwerew}\) IV tPA protocol, ne abasamtu a ɛfa akyɛde ho efi aniwa a wɔde twitwiw nipadua no mu a wɔde di dwuma wɔ ɔkwan a ɛyɛ katee so).
• American College of Rheumatology (ACR, United States) ne European Alliance of Associations for Rheumatology (EULAR): 2021 ACR/Vasculitis Foundation Akwankyerɛ ne EULAR Nyansahyɛ ahorow a ɛfa Giant Cell Arteritis a Wɔhwɛ So (ntɛm ara IV methylprednisolone \(500\text{ kosi }1,000\text mg/day}\) ma aniwa a wɔhwere ansa na bere tiaa bi aba ntini mu nhwehwɛmu anaa ultrasound).
• British Society for Rheumatology (BSR, United Kingdom) ne National Institute for Health and Care Excellence (NICE, United Kingdom): Akwankyerɛ a ɛfa Giant Cell Arteritis a Wohu na Wɔsa ne NICE NG128: Stroke ne Transient Ischemic Attack wɔ Bɛboro mfe 16 mu (amaurosis fugax urgent TIA pathway).
• Amerika Aniwa Ho Adesuabea (AAO, United States): Adeyɛ a Wɔpɛ (PPP): Retina ne Aniwa Ntini a Ɛsiw.
• Royal College of Ophthalmologists (RCOphth, United Kingdom): Aniwa Ho Dwumadibea Akwankyerɛ: Acute Retinal Arterial Occlusion ne Giant Cell Arteritis a Wɔhwɛ so.

Akwankyerɛ ahorow a ɛfa ho¶

• Anisoadehu a ɛyera mpofirim, retina a ɛtwetwe, ne acute angle-closure glaucoma
• Stroke recognition (FAST) ne ntɛmpɛ ho mmuae
• Orbital cellulitis, aniwa a ɛho ahonhon, ne cavernous sinus thrombosis
• Aortic dissection ne yafunu mu aortic aneurysm a apaapae
• Komayare a wohu ne mmoa a edi kan