Ɓoornugol gite (Oklusion arterie retine centrale) e arteritis temporale¶

Bumre ɓuuɓnde, nde alaa ko nafata, walla ɓuuɓgol gite tiiɗngol e nder gite goote, ko huunde nde sahaa mum ina yaaji, nde ƴiiƴam ƴiiƴam (neuro-ophtalmique vasculaire) fotndi e ngaandi iskemiik ɓuuɓndi mboros. So tawii ƴiiƴam ɓuuɓɗam, ɓuuɓɗam kolesterol, walla ɓuuɓri ƴiiƴam gonndi e ɓalndu nduu ina haɗa ƴiiƴam yahde to retina (Ɓuuɓri ƴiiƴam hakkundeejam [CRAO] walla Ɓuuɓri ƴiiƴam cakkital [BRAO]) walla hoore ƴiiƴam gite ca (**Anterior NeuropaION] Arteritis cellal mawngal [GCA / Arteritis temporal]), ƴiye nerwooje ɗe oksijen ŋakkiraa, puɗɗotoo ko maayde tawa mbaylaaka e nder hojomaaji 90 haa 240. Hay so tawii noon ɓuuɓri e gite wootere ina juuta tan ko hojomaaji 2 haa 15, caggal ɗuum ina laaɓta haa laaɓa cer (Amaurosis Fugax, ko ñawu iskemiik gonngu e reedu), haa 25 e nder teemedere ñawɓe ina njogii tawo ɓuuɓri cerebral silencieux concurrents e MRI cerebral, ina njogii kadi baasal heɓɓondirngal e sahaa gooto. Noddude sarwisaaji cafrirɗi ɗoon e ɗoon, nawde ɗum to Designated Stroke Center (meeɗaani faddaade yeewtere optometrist njuɓɓudi), e fuɗɗoraade trombolyse e nder ƴiiƴam ɗoon e ɗoon walla kortikosteroid e nder ƴiiƴam toowɗo e nder waktuuji seeɗa, ina hollita so tawii yiytere e golle ngaandi ina kisnee.

Waɗde ɗum jooni¶

1. Suɗtu gite goote e sahaa gooto ngam tabitinde so tawii ɓuuɓri yiytere ndee woni ko e gite GOOTOL (monokulaar) walla gite ƊIƊI (binokulaare), e winndude minit tigi-rigi mo yitere ndee wayli (waktu "Last Known Well"). Ekipaaji stroke e nder safrirde e neuro-ophtalmologistes ina poti hiisaade minit tigi-rigi fuɗɗoraade.5 windo tromboliis nder ƴiiƴam**.
2. Blackout monocular (yitere nano tan WALLA yitere ñaamo tan ina niɓɓiɗi/ina ŋakki feccere so yitere woɗnde ndee ina suddii): Ina hollita ɓuuɓri ƴiiƴam e yeeso ɓuuɓri gite (Ɓuuɓri ƴiiƴam retina hakkundeejo, ɓuuɓri ƴiiƴam retina calɗi Omicter Ophtisc, Ophtisc Neuropati).
3. Maayde feccere fannu binokulaar (yitere nano ndee E yitere ñaamo ndee fof mbaawataa yiyde bannge nano walla bannge ñaamo suudu nduu): Ina hollita stroke ngaandi lobe occipital (hemianopie homonyme) caggal chiasme optique.
4. Ƴeewto kala ñawɗo mo duuɓi mum njahrata e 50 walla ko ɓuri ɗum ɗoon e ɗoon ngam anndude so tawii ko "Arterite Cellule Gigante (Artérite Temporal) Triade de la Rouge": Naamndo ñawɗo oo jooni jooni:
5. "A heɓii ɓuuɓri hoore kesiri, ɓuuɓri temple, walla ɓuuɓri hoore ɓuuɓndi nde ɓuuɓnataa gaasa maa walla nde fooftotoɗaa e dow pillow?"
6. "Mbele jawdi maa, ɗemngal maa, walla yeeso maa ina muusi, ina ɓuuɓna, walla ina ɓuuɓna caggal nde ɓuuɓɗaa ñaamde fotde hojomaaji seeɗa (jaw claudication)?"
7. "Mbele aɗa wondi e ɓuuɓri tiiɗndi, mettundi e koyɗe walla e koyɗe subaka (polymyalgie rheumatica), ɓuuɓri ndi laaɓaani, ɓuuɓri jamma, walla ɓuuɓri seeɗa e gite ɗiɗi walla gite ɓuuɓɗe?"
8. So tawii jaabawol KALA ko EEY e mawɗo jahroowo e duuɓi \(\ge 50\text{ duuɓi}\): Haalana safrooɓe ɓee e safrooɓe ɓee ɗoon e ɗoon wonde aɗa sikki Neuropati optik iskemiik arteritik ummoriiɗo e arteritis cellule mawɗe ngam ɓe ndokka mi dose toowɗo presolol intravenous me\000 }1,000\text{ mg}$ IV) ɗoon e ɗoon hade mum fadde ƴeewndo ƴiiƴam walla biopsie ngam hisnude yitere banndi.
9. Noddu limngal emergency nokkuure ma law law, ɗaɓɓu yahdu haa suudu nyawndiigu Designated Stroke Center bee Departemaa emergency. Noddu 911 haa lesdi Amerika e Kanadaa, 112 nder Dental Orop, 999 haa lesdi Biritaniya, malla laaru fuu limooje caɗtuɗe. Haala laaɓndal: "Nyawɗo oo ina wondi e ŋakkere yiytere nde alaa ko nafata e gite mum; eɗen cikki ko stroke ocular acute (Occlusion artérielle retinale centrale) walla arteritis cellulaire giant."
10. Joɗɗin ñawɗo oo no haanirta nii nde o fadi ambulance:
11. So tawii ko CRAO / Embolic Eye Stroke mo alaa ko woni e mum so wonaa arteritik (alaa ko bonnata hoore mum walla ko ŋakkere ɓernde tiiɗnde): Lelnude ñawɗo oo ina ɓuuɓtoo haa timma e dow ɓalli mum (supine, \(0\text{ degrees}\)) tawa hoore mum ina ɓuuɓtoo. Lelnude e dow leydi ina ɓeyda ɓuuɓol ƴiiƴam (perfusion artérielle gravitationale) e nder ƴiiƴam gite e retinal hakkundeewal, ina wallita e ɓuuɓnude ƴiiƴam e nder ƴiiƴam walla e nder ƴiiƴam tokosam cilioretinal collateral.
12. So tawii ñawɗo oo ina wondi e ɓuuɓri foofaango e sahaa gooto walla ina tuuma ƴiiƴam ngaandi: Toownu hoore ndee seeɗa haa \(15\text{ haa }30\text{ degrees}\).
13. Ƴeewto maale FAST stroke ngaandi e maale jeertinaango carotid dissection. Ƴeewto so tawii yeeso ina ɓuuɓna, ina ŋakkiraa junngo, walla ina ŋakkiraa haala (ƴeew njillu stroke). So tawii ñawɗo ɓurɗo famɗude (mo duuɓi mum njahrata e 50) ina heɓa gite goote e nder sahaa gooto, tawi ina wondi e nafoore hesere e bannge gooto e wuddu walla yeeso e gite ɓuuɓɗe seeɗa e puccu tokooso e oon bannge gooto (Sindrome de Horner) caggal nde ɓuuɓri wuddu, ɓuuɓri ƴiiƴam, ɓuuɓri teddundi, lif Diisnondiral**.
14. WOTO ɓuuɓnu walla ɓuuɓnude gite ɗee e dow semmbe, WOTO fooftu e nder saak kaayitaaji, e jogaade ñawɗo oo Hay huunde e hunuko (NPO). So tawii defte cafrirɗe ɓooyɗe ina ciftora ɓuuɓnude gite ɗee e doole walla ɓuuɓnude gite ɗee e saak kaayitaaji, **Fedde Ameriknaare ɓernde (AHA)**inre compression or nafoore sellunde alaa, ina waawi bonnude yitere walla saabaade iskemi ɓernde, e leeltinde trombolise stroke-centre urgence.

Lekki kuulal triage urgence: Ɓooygol yiytere nde alaa ko nafata e sahaa gooto & Arteritis temporal¶

Huutoro ndeeɗoo taƴre safaara ngam renndinde ŋakkeende yiytere iskemiik monokulaar e binokulaar e huutoraade stroke opitaal laaɓtuɗo walla porotokol steroid e nder hojomaaji seeɗa.

flowchart TD
    Start["Majjugol yiytere nde alaa ko nafata,<br/>Nguurndam yiytere, walla ɓuuɓgol gonngol e sahaa"] --> CoverTest{"Suuɗde yitere kala seerndi:<br/>Mbele yiytere ina majja e yitere wootere walla e gite ɗiɗi ɗee kala?"}

    CoverTest -->|"GITE ƊIƊI ƊII fof ina njibina ko nanndi heen tigi<br/>Feccere Nano walla Feccere Nyaamo yiytere"| Occipital["HEMIANOPIA HOMONIME<br/>(Astroke Ɓooyɗo / Occipitaal):<br/>Noddu 911 / 112 / 999 Ɗoon e ɗoon ngam yahde to nokku stroke"]

    CoverTest -->|"YIƊE GOOTOL TAN (Maayde yiytere wootere):<br/>Leydi ndii ina woni e nder reedu, e nder nerwel gite,<br/>walla e nder nerwel gite (arterie carotide/ophtalmique) ipsilateral"| AgeCheck{"Ƴeewto Duuɓi & Arteritis Cellal Mawɗo<br/>(Arteritis Temporal) Banngeeji boɗeeji:<br/>Mbele Duuɓi Ñawɗo >= Duuɓi 50 E<br/>Nafoore Temple, Teddeendi Koppi,<br/>Nafoore Jawdi so ina ɓuuɓna, walla Ɓooygol Baagal?"}

    AgeCheck -->|"EEY (Duuɓi >= 50 + KALA maande GCA,<br/>walla ŋakkere yiytere ɓuuɓnde/toownde):<br/>SIMMAA ARTERITIS CELL GIANT<br/>(AION arteritik walla CRAO arteritik)"| GCAProtocol["ƊOONI 'HISIN YITE ƊIƊAƁO' PROTOKOL:<br/>1. Noddu 911 / 112 / 999 -> Departemaa Jaɓɓungal JOONI<br/>2. Hokkude Stat Metilprednisolon Dose Toownde IV<br/> (500 haa 1 000 mg IV/ñalngu x balɗe 3) ƊOO ƊOO ƊOO (WOTO leeltin steroid ngam laboratuwaaruuji ESR/CRP walla biopsie)<br/>3. Yamiroore Stat ESR, CRP, Pilaate + Ultrason/Biopsie wakkati"]

    AgeCheck -->|"ALAA Maale GCA<br/>(walla Ñawɗo mo duuɓi mum njahrata e 50)"| DurationCheck{"Mbele Yiytere ndee artii e 100% no woorunoo<br/>E nder hojomaaji 2 haa 15,<br/>walla Yiytere ndee ina WONI HAA JOONI Niwre/Ina ŋakki?"}

    DurationCheck -->|"Yiytere wartii haa timmi e nder hojomaaji 2 haa 15<br/>(‘Nguurndam windooji ɓuuɓnaama les & ƴettaama dow’):<br/>AMAUROSIS FUGAX (TIA retinal)"| TIAProtocol["ƁURI ƁURDE ƁURDE ƁURDE:<br/>1. WOTO jooɗo e galle (Toowɗo mboros e nder ngaandi e nder 24-72h)<br/>2. Yah to suudu safrirdu toɗɗaandu to nokku stroke JOONI<br/>3. Haajuuji stat MRI ngaandi (DWI), CTA/Ultrason karotiid,<br/> ECG/Holter ngam AFib, antiplaquettes ɗiɗi, & Statin"]

    DurationCheck -->|"Yiyngo ina heddii e niɓɓiɗde (Njuumre timmunde)<br/>walla Sektoraaji dow/les ɗi ŋakki:<br/>SIMMAARE RETINAL CENTRAAL WALLA CAAƊOL<br/>OKKLUSIYON ARTERI (CRAO / BRAO)"| CRAOProtocol["ƊAƊƊI GIƊƊI ƁURƊI ƁURDE ('ƊAƊƊI KODE'):<br/>1. Noddu 911 / 112 / 999 -> Nokku toɗɗaaɗo ngam mboros oo JOONI<br/>2. Lelnu ñawɗo oo FLAT e dow ɓalewol (degereeji 0) ngam ɓeydude ɓuuɓri<br/>3. Tesko minit tigi-rigi puɗɗagol (< waktuuji 4,5 IV tPA windo)<br/>4. So tawii ko ɓuuɓri wuddu + pupil tokooso/ɓurɗo ɓuuɓde -> Ƴeewto Diisnondiral Karotiid"]

Patofisiyoloji : No ƴiiƴam gite ɗiɗi ɗii gollortoo e hol ko waɗi minitaaji ina njogii nafoore¶

Yitere ndee ina heɓee e ƴiiƴam gite, ko kañum woni calɗi mawɗi gadani ɗi ƴiiƴam carotid ndernderi no naatirta e ɓalndu gila e wuddu nii. Sabu ƴiiƴam gite ina ɓuuɓtoo e ƴiiƴam ɓalndu ndernderiiru, kala ko kewata e ƴiiƴam gite ko feɗeendu toowndu e nder ƴiiƴam ngaandi e ɓernde.

E nder ɓuuɓri gite, ƴiiƴam gite ina fecca e ɓuuɓri ɗiɗi ceertuɗi no feewi, ñamlirɗi laabi ceertuɗi e nder retina e nerwel gite :

1. Sistem ƴiiƴam hakkundeejam (CRA) (ina ñammina ƴiiƴam nder):
2. Ɓoornugol retina hakkundeewol ngol ina taƴa hakkunde nerwel gite ngol, ina ɓuuɓna e nder ɓalndu nduu, ina waɗa heen geɗe nay (waktu toowɗo, wakkati les, nofru toowndu, e nofru les).
3. Ko arterie anatomique end-arterie jogiinde jokkondire kolaaɗe zero e nder 70 haa 85 e nder teemedere aadee.
4. (Ko selli e anatomi: Fotde 15 haa 30 e nder teemedere yim6e ina njibinaa e vurndi heewde e vurndi moxxude ina wiyee arterie cilioretinale ummoriindi e cirkulaasiyoŋ koronaawiris mo ñamlata macula hakkundeejo oo. E nder ñawzo saɗtuɗo mo ƴiiƴam cilioretinal mum ina wondi e CRAO tick, but maɓɓe pinhole duunde 20/20 hakkundeere janngude yiytere ina wuuri.)
5. Sistem ƴiiƴam ɓalndu juutɗam (SPCAs) (ina ñammina hoore nerf optik e retina yaajɗo):
6. Ɗiɗi haa tati mawɗi ciliari caggal ina peccaa e 10 haa 20 arteriiji ciliari caggal juutɗi tokoosi, ɗi mbaɗata ko cirƴam ƴiiƴam e nder hoore nerwel gite, ina ñamla koroid (ko ñamlata ƴiye fotosintesis yaajɗe e konuuji, ina heen a **fo hakkundeejo).
7. Ko waɗi Arteritis cellal mawngal ina yiɗi ƴiye ciliary caggal juutɗe: Lamina elastik nder ƴiye ciliary caggal juutɗe e ƴiye temporal dowri ko kañum woni #1 target njiyaagu autoimmune e nder Arteritis temporal, ina fammina ko waɗi arteritis cellal mawngal nervesta e nder hoore mum (Neuropati optik iskemiik arteritik [A-AION]) e nder 80 e nder teemedere e ñawɓe yiyooɓe e CRAO arteritik e nder 10 haa 15 e nder teemedere.

Waktu nguurndam iskemiik retinal (Ko waɗi 90 haa 240 minit ko Ɓooygol)¶

Jarribooji neuro-ophtalmologie primates (Hayreh et al.) e jarribooji stroke aadee ina kollita waktuuji nguurndam biyoloji laaɓtuɗi e nder geese ganglion retinal so tawii ƴiiƴam retinal hakkundeejam ina udditaa : - 0 haa 90 minit ɓuuɓri timmundi : Ɓoornugol ƴiiƴam ina ɓuuɓtoo (penumbra ischémique), kono cellal yiytere timmunde walla ɓadtiinde timmunde ina waawi waɗeede so tawii ƴiiƴam artii ɗoon e ɗoon. - 90 haa 240 minit (waktuuji 1,5 haa 4) : Infark gonɗo e ɓalndu, ɓuuɓɗo, gonɗo e nder ɓalndu ina waɗa ; cellal feccere ina waawi waɗeede haa jooni e reperfusion urgence. - Ko ɓuri hojomaaji 240 (waktuuji 4+) e ɓuuɓri timmundi: Nekrosis mawɗo, mo waylataa e nder reedu ina waɗa, ina addana ɗum ŋakkere yiytere luggiɗnde duumiinde (ko heewi ko limde koppi [CF], dille juuɗe [HM], walla **faamde lewlewndu [LPterte ci.li or tan) reeni ko penumbra.

Njiylawu kuuɓtodinɗo e 5 mawɗe emergency ocular iskemiik¶

Huutoro ndeeɗoo alluwal kilinik ngam seerndude CRAO embolik, ɓuuɓri ƴiiƴam calɗi, amaurosis fugax, ɓuuɓri ƴiiƴam (Arteritis cellulaire giant), e ɓuuɓri ƴiiƴam ndi wonaa ƴiiƴam :

Sarɗi 1 : Ɓooygol ƴiiƴam hakkundeejo e calɗi (CRAO & BRAO)¶

Ko waɗi Fedde Ɓernde Amerik yamiri "Code Stroke" wonande CRAO¶

E nder daartol, ñawɓe ɓe gite mum en njiyataa e gite mum en, ko adii fof ina njaha to safrirde gite walla to safrirde gite, ɗo waktuuji walla balɗe mbaɗata ƴeewndo gite hade hay gooto ƴeewndaade ƴiye ngaandi walla wuddu mum en. E hitaande 2021, Fedde Ameriknaare Ɓernde (AHA) e Fedde Ameriknaare Stroke (ASA) njaltinii bayyinaango ganndal maantinngo waylude toppitagol CRAO e nder winndere ndee: 1. CRAO ko stroke iskemiik akuut: Nde tawnoo retina ina jeyaa e nerwooji hakkundeeji e nder embriyoloji, ina ñamlee ɗum e ƴiiƴam carotid nder, oksidaa ƴiiƴam retina hakkundeejam ko stroke iskemiik retina. 2. 1 e nder 4 ñawɓe CRAO ina njogii stroke ngaandi silsil jooni jooni: Wiɗtooji MRI ngaandi (DWI) teeŋtiniiɗi diffusion ina kollita wonde 19 haa 25 e nder teemedere ñawɓe wonduɓe e CRAO walla BRAO ina njogii stroke iskemiik ɓuuɓɗo e nder cerebral heer showmissed e nder cerebral he ko noon kadi plaque carotide walla suudu ɓernde, hay so tawii ñawɗo oo ina jogii zero tampere junngo walla caɗeele haala. 3. Winndere Trombolyse nder ƴiiƴam (\(\le 4.5\text{ Waktuuji}\)): So ñawɗo CRAO mo alaa ko woni e mum oo arii e Centre Stroke toɗɗaaɗo e nder waktuuji 4.5 caggal nde maale ɗee puɗɗii, caggal nde CT hoore nde alaa ko seerndi ɗum ɗoon e ɗoon, ina haɗa ƴiiƴam ɓalndu yaltude e ɓalndu, ina haɗa ɗum yaltude e ƴiiƴam ngaandi annduɓe ƴiye e gite ina mbaawi waɗde aktiratoor plasminogen e nder ƴiiƴam (alteplase walla tenekteplase). Meta-analyses cliniques ina kollita wonde trombolyse IV rokketeeɗo e nder waktuuji 4,5 ina ɓeyda no feewi njuuteendi cellal yiytere laaɓtunde so yerondiraama e ƴeewndo gonngo e mbaydi teskinndi.

Hol ko woni "Toɓɓere Boɗeere-Ceri" e ƴeewndo gite?¶

So cafroowo walla doktoor gite ƴeewii gite e nder CRAO e huutoraade ophtalmoscope walla kamera fundus e nder waktuuji seeɗa caggal nde o heɓi : - Laabi nder reedu (ɗi ñamlata ko ƴiiƴam reedu hakkundeejam ɓuuɓɗam) ina ɓuuɓta e ndiyam nder reedu (edema sitotoksik), ina mbaɗta daneejo ɓuuɓɗo. - Kono tan, bullseye maayɗo-cakaare makula (foveola) ina waɗi anatomiiji ɓuuɓɗi no kaayitaaji nii, ina waɗi alaa laylayti ganglion retinal nder reedu, ina ñamlee ɗum fof e koroid les oo (ko ƴiiƴam ciliary caggal mo alaa ko bonnata) ñamlata ɗum. - Sabu koroid vaskulaar boɗeejo jalboowo oo ina jalba haa laaɓa cer e nder cakkital ɓuuɓngal, tawa ina taarnaa e ŋorol gonngol e reedu ɓuuɓndu, ina sosa "Cherry-Red Spot" (Cherry-Red Spot"**) gonɗo e ŋorol reedu hakkundeewol ngol.

Ko waɗi aɗa foti tuugnaade e galle "Masaas gite" walla "Fooftere-saak kaayitaaji".¶

Defte janngirɗe ɓooyɗe ina kollita toɓɓude e doole gite udditiiɗe (massage oculaire numérique) walla foofde e nder saak kaayitaaji ɓaleeji (thérapie carbonique) ngam CRAO. - Njiylawu kilinik jamaanu (AHA & AAO): Golle ɗee ɗiɗi fof ko ɓe cemmbinaaka wonande yiyooɓe. Toɓɓude gite e doole ina waawi ɓuuɓnude gite e seppooji baɗanooɗi ko ɓooyaani, ɓeyda ɓuuɓri gite, walla addana reflexe bradycardie vagal (reflexe oculocardiaque). Fooftude e nder saak kaayitaaji ina addana ñawɓe mawɓe ŋakkere oksijen (hypoxie systémique) tawa ina moƴƴina nguurndam retina. Golle goote baawɗe waɗeede ko adii opitaal ko lelnude ñawɗo oo e dow ɓalewol mum e noddude 911 / 112 / 999 ngam nawde mo to Stroke Center ko yaawi.

Sabaabu keeriiɗo e mawɓe ɓe duuɓi mum en njahrata e 50 : Ƴeewndo ƴiiƴam nder ɓalndu¶

So tawii suka mawɗo (duuɓi 20 haa 50) ina wondi e ɓuuɓri gite gootol walla amaurosis fugax, naamndo-ɗee so tawii ina njogii nafoore daande, ɓuuɓri hoore bannge gooto, walla ɓuuɓri yeeso, ƴeewto-ɗee gite mum en e puɗi mum en e nder annoore ɓuuɓnde : - Ɓoornugol e nder ɓalndu ndernderiiru ƴiiƴam ɓalndu e nder wuddu (Dissection de l'artère carotide interne), heewi arde ko e ɓuuɓri wuddu, e ɓuuɓri yoga, e ɓuuɓri ƴiiƴam, e ƴeftugol teeŋtungol, walla e ɓuuɓri tiiɗndi, ina ɓuuɓna fibres nerveux sympathiques ati the wra. - Ɗum ina addana Sindrome Horner ipsilateral (ɓuuɓri gite toowndi ɓuuɓndi seeɗa [ptosis] e puccu ɓurngu famɗude ɓuuɓngu [miosis] e bannge gooto e ɓuuɓri wuddu) e sara emboli retinal walla cerebral. Anjiyogaraafi CT (CTA) ɗoon e ɗoon e hoore e wuddu e nder departemaa emergency ina tabitina ɓuuɓri ndii.

Sarɗi 2 : Amaurosis Fugax (Maayde yiytere wootere / TIA retinal)¶

Ko waɗi "yiytere wartaade no woorunoo e nder hojomaaji 5" ko haa jooni ko 911 / 112 / 999 emergency¶

Amaurosis fugax ("niɓɓere ɓuuɓnde") ina waɗa so feccere kolesterol (plaque Hollenhorst) walla mikroo-klot-fibrin ina ɓuuɓtoo e plaque e nder ƴiiƴam ɓalndu nder daande (walla ummoraade e ɓernde e nder fibril atrial caɗtuɗo e nder ina fecca e nder hojomaaji 2 haa 15: - Ñawɓe ina ciftora ɗum ko "ɓuuɓri windo niɓɓo ina ɓuuɓtoo les dow gite GOOTOL" haa yitere ndee wonta ɓaleere walla ɓaleere, duumotoo ko e hojomaaji 3 haa 10, caggal ɗuum ina ƴetta caggal haa yiytere ndee wonta 100 e nder teemedere no woorunoo. - The Trap: Sabu gite ina ngarta e no woorunoo caggal hojomaaji 5 tawa alaa ko nafata, heewɓe ina njuppa ɗum no gite nii walla no migraine nii, ina njooɗii e galleeji. - Goonga oo: Amaurosis fugax ko Attaque ischémique transitoire (TIA). So tawii ƴeewndo safrirde waɗaaka, safaara ɓuuɓɗo (aspiriin + klopidogrel), safaara statin toowɗo, e endarterektomi walla stent yaawɗo (so tawii ɓuuɓgol karotiid ko \(70\%\text{ haa }99\%\)), ɓuuɓgol gonngol caggal ngol ina waawi ɓuuɓde artery**, saabaade ɓuuɓri duumiindi e waasde haalde.

No anndirten Amaurosis Fugax so wonaa Aura Migraine Visuelle moƴƴo walla Papilledema¶

Sarɗi 3 : Arteritis cellal mawɗo (GCA / Arteritis temporal) e mawɓe yahrooɓe e duuɓi 50 e ko ɓuri ɗum¶

Ko waɗi Arteritis Giant Cell ko sabaabu ɓurɗo waawde haɗeede e wumre timmunde banngeeji ɗiɗi¶

Arteritis cellulaire géant (GCA), anndiraango kadi Arteritis temporal, ko ñawu nguu ina wiyee « vasculitis granulomatose autoimmune » e nder ƴiye hakkundeeje e mawɗe, tawi ina heɓtoo e mawɓe tan, yahrooɓe e duuɓi 50 e ko ɓuri ɗum (ko ɓuri heewde e mum en ko hakkunde duuɓi 70 e 85).

E nder GCA, ƴiye T immune e ƴiye mawɗe ina naata e nder ɓalndu caɗeele ekstrakraniyal ƴiye karotiid e vertebral : - Koɗorɗe ƴiiƴam ina ɓuuɓta e nder (hiperplasie intimale) haa ɓuuɓri gonndi e ƴiiƴam ɗam uddita. - So ndeeɗoo ɓuuɓri ɓuuɓndi yanii e ƴiye ciliari caggal juutɗe walla ƴiiƴi retina hakkundeeji, hoore nerwel gite maayata ko e heege oksijen ɗoon e ɗoon (Neuropathie optique ischémique artéritique antérieure [A-AION]), acca yitere ndee ina niɓɓiɗi haa laaɓi e nder teemedere e nder teemedere 500. - Waktu "Fellow Eye": So yitere adannde ndee majjii yiytere e GCA, ndeen yitere adannde ndee ina famɗi ɗo heɓata yiytere maantinnde. Kono so tawii safaara kortikosteroid toowɗo oo leeltinaama, 30 haa 50 e nder teemedere ñawɓe ɓee ina keɓa mboros nannduɗo e gite mum en ƊIƊAƁE (heddiiɗe ɗee) e nder waktuuji 24 haa balɗe 7, ɗum noon ina addana ɓe wumde haa abada e gite ɗiɗi ɗee kala. GCA mo safraaka ina waawi kadi ɓuuɓnude ar**tiebral e **vertal strokes) e aorta torasik (saabaade ɓuuɓri aorta).

Doggol ƴeewndo maandeeji bannge boɗeejo timmuɗo ngam arteritis cellal mawngal (Duuɓi \(\ge 50\))¶

Sabu 20 e nder teemedere ñawɓe wonduɓe e ŋakkeende yiytere ummoraade e GCA ina njogii "GCA cuuɗiiɗo" (nafoore hoore ɓurnde famɗude, tawa ina waɗi jawdi tan walla maale gonɗe e nder ɓalndu), ƴeewto kala huunde e ndee doggol e kala mawɗo mo duuɓi mum njahrata e 50 tawa ina waɗi waylo-waylo yiytere :

• 1. Jaw Claudication (Maande ɓurnde laaɓtude e GCA, ina woodi e -50%): Naamndo ñawɗo oo: *"So aɗa ƴakka ñaamdu ɓuuɓndu hono kosam walla mburu ɓuuɓɗam fotde hojomaaji 1 haa 2, mbele ƴiye maa walla ɗemngal maa ina puɗɗoo ɓuuɓde, ɓuuɓde, walla ɓuuɓde, walla ɓuuɓde, ko ɗum waɗi aɗa foti woppude ɓuuɓde e fooftaade sabu ma**xilla happens?" ƴiye ɓuuɓɗe e ɗemngal ina ɓuuɓtoo e arteritis, ina addana ƴiye ɗee ustaade (iskemi) sabu fijirde.
• 2. Naamnal hoore kesal (ina woodi e 70% haa 80%): Naamnal kesal ɓuuɓngal, ɓuuɓngal, walla ɓuuɓngal dow temples gooto walla ɗiɗi, tiinde, walla caggal hoore e nder mawɗo mawɗo.
• 3. Teddeendi hoore e ƴiiƴam waktuuji ɗi ngonaa no haanirta nii : Ɓoornude hoore, fooftinde hoore e dow ŋoral, walla ɓoornaade gite ina nanndi e ɓuuɓri e hoore. Dogde junngo e nofru e dow arterie temporale superficielle (e yeeso noppi e dow temple) ina hollita arterie tedduɗo, nodule, tedduɗo mo ɓuuɓri mum famɗi walla alaa.
• 4. Maandeeji jeertinaango yiytere : Ɓooygol juutngol e nder hojomaaji 5 (amaurosis fugax) walla diplopi (yiyngo ɗiɗmo, tawa ina tawee e 10% haa 15%) saabi ɗum ko iskemii e ƴiye gite.
• 5. Polymyalgia Rheumatica (PMR) e maale doosɗe (ina tawee e 40% haa 50%): Ɓooygol subaka simmetiri e ɓuuɓri e nder baagal, wuddu, e ɓuuɓri ko ɓuri hojomaaji 45 caggal nde neɗɗo ummii, tawa ina wondi e **ɓuuɓri ɓuuɓndi, ɓuuɓndi jamma walla ɓuuɓri jamma.

Porotokol urgence opitaal ngam tuumaaɗo arteritis cellal mawɗo¶

E fawaade e jamirooje gollorɗe safaara Koldaa Ameriknaajo toppitiiɗo ko fayti e ñawu nguu (ACR), Fedde Oropnaare ngam ñawu nguu (EULAR), e Fedde ñawu nguu to Angalteer (BSR) : 1. Fuɗɗoode Kortikosteroid Doseeji Toowɗi ƊOONI ƊOO SO A Sikkaama e Safrirde (Ko adii Biopsy walla Labs Ngarta): - So tawii KALA maale yiytere ina ngoodi (ɓurtugol yiytere, amaurosis fugax, walla yiytere ɗiɗi): Waɗde metilprednisolon e nder ƴiiƴam \(500\text{ haa }1,000\text{ mg}\) IV ñalawma kala fotde balɗe 3 jokkondirɗe, rewi heen ko dose toownde nis gooto/ñalngu mg$k}d e hunuko ko ɓuri heewde ko \(60\binndi{ haa }80\binndi{ mg}\) ñalawma kala) e miijaade tocilizumab. - So tawii maale GCA cranial ina ngoodi ALAA maale yiyteede tawo: Fuɗɗoo prednison oral \(40\text{ haa }60\text{ mg}\) ñalawma kala ɗoon e ɗoon. 2. Hoto meeɗ leeltinde steroid Faandaare Biopsy arterie temporale walla Ultrasound: Waylooji ɓuuɓɗi e cellal mawngal nder wall arterie temporale ina njokki fotde balɗe 10 haa 14 caggal nde puɗɗii-ɗaa steroid toowɗo, tawi noon leeltude steroid hay waktuuji 12 ina waawi heddaade eye ñawɗo oo. 3. Ƴeewndo ƴiiƴam yamiraama ɗoon e ɗoon e nder ER: Njaajeendi ɓuuɓri ƴiiƴam (ESR), Protein C-Reactive (CRP), e Limto ƴiiƴam timmungo (CBC) (ƴeewndo so tawii ko trombositosis gonɗo e ɓuuɓri ƴiiƴam $>0$}mu).

Binndol jokkondiral laaɓtungol wonande 911 / 112 / 999 e ƴeewndo safrirde¶

Sabu ŋakkere yiytere nde alaa ko nafata ina addana yaasi yitere ndee nanndude e 100 e nder teemedere (sklera daneejo, kornea laaɓɗo), gollotooɓe triage e nder opitaaluuji mawɗi ina mbaawi ustude yaawre mum so wonaa tawa a huutoriima helmere stroke e vasculitis laaɓtunde :

• Ngam tuumeede ɓuuɓri ƴiiƴam (CRAO) e nder waktuuji 4,5:

  "Miɗo haani ambulance urgence to [Adresse tigi-rigi]. Ñawɗo oo ko [duuɓi]-duuɓi [gorko/debbo] mo heɓi wumre ɓuuɓnde, timmunde, nde alaa ko nafata e gite [nano/nyaamo] to [Minut tigi-rigi fuɗɗorde]. E fawaade e jamirooje Fedde Arte Ameriknaare Reetin St Occlusion) e ina haani jolnude Code Stroke ko yaawi to nokku Stroke toɗɗaaɗo e nder waktuuji 4,5 e nder windo trombolyse nder ƴiiƴam."

• Ngam tuumeede arteritis cellal mawɗo (arteritis temporal) e mawɗo mo duuɓi mum njahrata e 50+:

  "Triage emergency: oo ñawɗo mo duuɓi mum [duuɓi] ina jogii ŋakkeende yiytere e nder gite [nano/nyaamo] tawa ina wondi e [nafoore temple keso / ɓuuɓri ɓalndu / ɓuuɓri jawdi so ina ɓuuɓna ñaamdu]. En cikkatnoo ko Arteritic Ischemic Cemediat Optic ina haani ƴeewndo cafroowo ngam stat doseeji toowɗi metilprednisolon e nder ƴiiƴam (500 haa 1,000 mg IV) JOONI ngam haɗde wumre duumiinde e gite banndiraaɓe."

• Ngam Fugax amaurosis (TIA retinal) ɓuuɓɗo:

  "Nyawɗo oo ko [Duuɓi]-duuɓi, mo heɓi ɓuuɓri timmundi ndi alaa ko nafata ('ɓuuɓri windo') e nder gite [nano/nyaamo] duumiiɗi [Limre] hojomaaji e [Waktu] hannde. Hay so yiytere ndee artii e no woorunoo, ko ɗum Amaurosis Fugax, ko TIA ɓuuɓɗo Retinal St Mediroke, ina ɗaɓɓi Hoto ƴeewndo ƴiiƴam ɓalndu, e ECG."

Naamne keewɗe naamneede¶

Hol ko waɗi yaasi gite ina nanndi e daneejo haa laaɓa cer, ina wayi no no woorunoo e sahaa mboros ocular (CRAO) walla arteritis temporal ?¶

Ƴiiƴam ɗam waɗata ɓalndu nduu ina wayi no boɗeejo e nder yitere pinndi walla ɓuuɓri ƴiiƴam ko ƴiiƴam gonɗam e yeeso gite. E nder ɓuuɓri ƴiiƴam hakkundeejo e ɓuuɓri ƴiiƴam mawndi, ɓuuɓri ƴiiƴam ina waɗa e nder luggiɗnde e nder ɓalndu gite e nder ƴiiƴam retina hakkundeejo tokooso walla ƴiiƴam ciliari caggal juutɗam ñamloowo retina e nerf optik, ko noon yeeso yitere heddotoo ko daneejo haa laaɓa cer, tawa ina wondi e oksijen e nder hoodere nde.

Hol no ƴeewtortoo-mi e galle so tawii yiytere ɓuuɓnde ɗoon e ɗoon ina woni e gite goote (monoculaire) walla gite ɗiɗi ɗee kala (binoculaire) ?¶

So yitere wootere majjii ɗoon e ɗoon yiytere walla ƴellitii ɗoyngol niɓɓol, ngaandi neɗɗo ina etoo hawrude e natal no feewi ummoraade e gite moƴƴe e natal ɓalewal ummoraade e gite bonɗe, ɗum noon ina addana neɗɗo oo nan’de gite ɗiɗi ɗee fof njaltii ɓuuɓɗe walla ɓuuɓɗe. Waɗde sahaa kala, ɓuuɓna gite maa nano haa timma e junngo maa ngam ƴeewndaade gite maa ñaamo tan, caggal ɗuum ɓuuɓna gite maa ñaamo ngam ƴeewndaade gite maa nano tan; ɗumɗoo ina hollita ɗoon e ɗoon so tawii ɓuuɓri ndii ina tiiɗi e gite goote walla ina toɗɗii feccere nano walla ñaamo gite ɗiɗi ɗee kala.

Hol ko waɗi nafoore jawdi so neɗɗo ina ɓuuɓna ñaamdu (claudication jaw) ko maande jeertinaande ɓurnde teeŋtude e Arteritis Cellule Giant ?¶

Nanduɗo e artrite temporomandibulaire (TMJ), mo mettinata sahaa nde udditataa hunduko maa walla nde ɓuuɓnata huunde tiiɗnde, ɓuuɓri jawdi e nder Giant Cell Arteritis ina safra ɓuuɓri autoimmune ina ɓuuɓna ƴiye dokkooje ƴiiƴam e ƴiye maa ɓuuɓɗe e ɗemngal maa. Sabu ƴiye ɗee mbaawataa dañde oksijen no feewi e nder ekkorse ɓuuɓɗo, ƴiye maa ina njiya ko moƴƴi e ɓuuɓri adanndi, ina ƴellitoo ɓuuɓri luggiɗndi walla ɓuuɓri caggal nde ɓuuɓnaa fotde leƴƴanɗe 60 haa 90, ina weltoo so a woppii ɓuuɓde ; anndude ndeeɗoo maande e yahde to ER ngam ƴeewde steroid ina haɗa wumde ɗoon e ɗoon.

So tawii gite am ina niɓɓiɗi e gite am fotde hojomaaji 5, caggal ɗuum ngarta 100 e nder teemedere no woorunoo, hol ko waɗi mi waawaa tan ɗaminaade yiyde doktoor gite am e yontere aroore?¶

Ɓooygol gite gootol ngol alaa nafoore fotde hojomaaji 5 (amaurosis fugax) firti ko ɓuuɓri ƴiiƴam walla ɓuuɓri kolesterol taƴii e ƴiiƴam ɓuuɓɗam e nder daande maa walla e ɓernde maa, ɓuuɓtii ƴiiƴam mawɗam gite maa, caggal ɗuum taƴii. Haa e 1 e nder 4 ñawɓe wonduɓe e kewuuji ƴiiƴam retinal ina njogii tawo toɓɓe kese deƴƴuɗe e nder MRI ngaandi, tee baasal mboros mawɗo, duumotooɗo ina ɓuri heewde e nder waktuuji 24 haa 72 gadani caggal oon sahaa jeertinaango, ina ɗaɓɓi njillu to opitaal Stroke Center ko yaawi.

Fuɗɗoode ƴeewtaama¶

• Fedde Ameriknaare Ɓernde (AHA) e Fedde Ameriknaare Ɓoornugol (ASA, Dental Dowlaaji Amerik): Njuɓɓudi Ɓoornugol ƴiiƴam hakkundeejo: Haala ganndal ummoraade e Fedde Ɓernde Amerik (Mac Grory et al., Ɓoornugol 2021; sosde CRAO ko \(ro\xt the Code emergency, St4 hour}\) IV tPA porotokol, e ustude leelgol e masiŋaaji gite konservatiif).
• Koldaa Ameriknaajo ko faati e ƴiiƴam (ACR, leyɗeele dentuɗe Amerik) e Fedde Oropnaaɓe ngam ƴiiƴam (EULAR): 2021 Kuulal ACR/Vasculitis e wasiyaaji EULAR ngam ƴellitde ƴiiƴam ƴiiƴam mawɗam (metylprednisolotext IV ko yaawi,{0}to \(50 mg/ñalngu}\) ngam waasde yiyde ko adii biopsie arterie temporale walla ultrasound).
• Fedde Angalteer ngam Ɓooygol (BSR, Royaume-Uni) e Duɗal Ngenndiwal ngam Cellal e Toppitagol (NICE, Royaume-Uni): Laabi ƴeewndo e safrude ñawu nguu e nder ƴiiƴam mawɗam e *NICE NG128: stroke e ñawu iskemiik juutngu e nder duuɓi ɓurɗi 16s TIAxga).
• Akademi Ameriknaajo ko faati e gite (AAO, Amerik): Nokku ɓurɗo yiɗeede (PPP): Ɓoornugol ƴiiƴam gite e ƴiiƴam.
• Koldaa laamɗo gite (RCOphth, Royaume-Uni): Ardorde sarwisaaji gite: Njuɓɓudi ɓuuɓri ƴiiƴam e ɓuuɓri ƴiiƴam mawndi.

Ardiiɓe jokkondirɓe¶

• Yiytere ɓuuɓnde, ɓuuɓgol retina, e ɓuuɓgol gonngol e ŋorol
• Anndinde stroke (FAST) e jaabawol e nder sahaa ɓuuɓɗo
• Sellulit orbital, ɓuuɓri gite, e trombose sinus kavernous
• Diisnondiral aorta e ruppitde anewrisma aorta reedu
• Anndinde ñawu ɓernde e ballal gadanal