Ɓuuɓri hoore, ƴiiƴam subaraknoid, e anewrisma ngaandi ruppitiiɗo¶

Nafoore hoore ɓuuɓnde ko ɓuuɓnde hoore ɓuuɓnde, ɓuuɓnde, ɓuuɓnde, nde ummotoo ko e nokku, nde yettotoo ko ɓuri heewde e \(10\text{-out-of-}10\) e nder leƴƴanɗe haa 60 leƴƴanɗe, no ɓuuɓol hoore ɓuuɓngol no feewi e batte baseball. Kala ɓuuɓri hoore ko ɓuuɓri safaara bonndi nguurndam haa nde selli ko wonaa ɗuum, sibu ko kañum woni maande ganndal ƴiiƴam gonɗam e nder ɓalndu (SAH) mo aneurysme cerebral rupturé saabi. So anewrisma ngaandi nannduɗo e ɓuuɓri yanii e nokku gonɗo e nder ngaandi hee, keewɗo ndiyam, ƴiiƴam ina yalta e les ɓuuɓri ƴiiƴam timmundi, ina ɓeyda ɓuuɓri nder hoore ndee ɗoon e ɗoon. So tawii ko ɗoon e ɗoon, neurosurgical walla endovasculaire waɗaaka, anewrisma ruppitiiɗo ina heewi ruttaade e nder waktuuji 6 haa 24 gadani ɗii, ina addana maayde ɓurnde 50 haa 70 e nder teemedere so ruttii.

Waɗde ɗum jooni¶

1. Noddu limoore emergency nokkuure maa ɗoon e ɗoon, bayyin "Tuumaaɗo ƴiiƴam / Aneurysm ngaandi ruppitiiɗo." Noddu 911 to leyɗeele dentuɗe Amerik e Kanadaa, 112 to Dental Orop, 999 to Dental Dowlaaji Amerik, walla ƴeew fof limooje caɗtuɗe. Ɗaɓɓu ambulance ballitoowo nguurndam jahruɗo yeeso e ɗaɓɓude yah-ngartaa to opitaal jogiiɗo baawɗe neuro-operaasiyoŋ e radiyoloji neuro-interventionnel (Centre Compréhensif de Stroke).
2. Winndu minit tigi-rigi mo ñawu nguu fiyi. So tawii opitaal ina waawi safrude ƴiiƴam ngaandi e CT scan jaawɗo tan (window Ottawa SAH Rule 6-Hour) walla kadi ina foti waɗde puncture lumbar (tap spinal) fawii ko e anndude hojomaaji tigi-rigi ɗi ñawu nguu fuɗɗii the he
3. Toownu hoore neɗɗo oo e ɓanndu mum haa 30 degere e doole deƴƴere ɓanndu timmunde. Prop hoore e koyɗe no feewi e dow pillows e 30 degere tawa wutte oo ina jokki e dow ŋorol hakkundeewol (ngol ŋorol ŋorol ngol ŋorol ŋorol ŋorol ŋorol ŋorol ŋorol ŋorol ŋorol ŋorol ŋorol ŋorol ŋorol ngol ina ŋorol ŋorol ŋorol ŋorol ŋorol ŋorol ŋorol ŋorol ŋorol ŋorol ŋorol ŋorol ŋorol ŋorol ŋorol ŋorol ngol ŋorol ŋorol ŋorol ŋorol ŋorol ŋorol ŋorol ŋorol ŋorol ŋorol ŋorol ngol ŋorol ŋorol ŋorol ŋorol ngol ina ŋorol ŋorol ŋorol ŋorol ngol ina ŋorol ŋorol ŋorol ngol. Hoto ɗaccu neɗɗo oo ummo, yaha, ɓuuɓtoo, ɓuuɓtoo no feewi, walla ɓuuɓtoo e dow ɓuuɓri (no Valsalva straining).
4. Reentaade denndaangal ñawbuuli ɓuuɓɗi (haa teeŋti e aspiriin e AINE), nguura, e ndiyam. Waɗde neɗɗo oo ina tiiɗi hay huunde e hunuko (NPO) ngam waawde waɗde anestesi general urgence, coiling endovasculaire, walla clipping microsurgical, e ngam haɗde ɓuuɓri e aspiraasiyoŋ e nder ƴiiƴam.
5. Niɓɓin suudu nduu, itta kala noppi, kadi neɗɗo oo ina deeƴna ngam haɗde ƴiiƴam ɓuuɓde. Ƴiiƴam subaraknoid ina ɓuuɓna no feewi ƴiye ɓuuɓɗe ngaandi (meninges), ina addana neɗɗo ɓuuɓde no feewi (fotofobi) e ɓuuɓde sonndu. Dim fitirlaaji, muumtu teleeji e telefoŋaaji, kaaldu no feewi mbele mette e kulol ina mbaasa ustude ƴiiƴam sistolik e fusde ɓuuɓri gonndi e dow anewrisma.
6. Yeeɓde no feewi so tawii gite ina ɓuuɓtoo, ina ɓuuɓtoo, ina ɓuuɓtoo, walla ina ɓuuɓtoo ɗoon e ɗoon. So neɗɗo oo ina ɓuuɓtoo walla ina ɓuuɓtoo, ɓuuɓna ɗum no feewi e bannge mum (ina jokki e hoore mum e daande mum) mbele laawol henndu mum ina laaɓa. So ɓe ngoppii foofde no haanirta nii, puɗɗo ɗoon e ɗoon CPR.

Triage emergency e lekki pellital ɓuuɓri hoore¶

Huutoro ndee ɗoo nate safaara tuugiiɗe e Kuulal ƴiiƴam ɓuuɓɗam Ottawa e jamirooje Fedde Ameriknaare Ɓernde / Fedde Neurocritical Care Society ngam ƴeewde kala ñawu nguu ina tiiɗi no feewi.

flowchart TD
    Start["Hoore ɓuuɓnde tiiɗnde nde alaa ko bonnata<br/>Yottoo e tiiɗnaare ɓurnde mawnude e nder waktu 1"] --> InstantCheck{"Mbele ɓuuɓri hoore ndee yettiima 10/10 tiiɗnaare<br/>e nder LEƊƊE haa 60 LEƊƊE<br/>(‘Fuɗɗoode ɓuuɓol’)?"}

    InstantCheck -->|"EEY: Peccol gonngol e sahaa gooto"| SuspectSAH["TUMAARE TOOWNDE E ƳIƳAM SUBARAKNOIDE<br/>(Anewrisma ngaandi ɓuuɓɗo, ɓuuɓri sentinel, RCVS, walla CVST)"]

    InstantCheck -->|"NO: Mahi ko e nder hojomaaji keewɗi"| OttawaCheck{"Ƴeewto kuule ƴiiƴam gonɗam e nder Ottawa<br/>(Kala gooto tawaaɗo ina ɗaɓɓi golle SAH ko yaawi):<br/>1. Duuɓi >= duuɓi 40?<br/>2. Naafigaagal daande walla ɓuuɓri daande?<br/>3. Seedeeji majjugol hakkille (faayre)?<br/>4. Fuɗɗoode e nder golle ɓanndu, ƴeftugol, ɓuuɓri, walla jokkondire?<br/>5. Naafigaagal hoore ɓuuɓngal (naafigaagal ɓuuɓngal e oon sahaa)?<br/>6. Flexion daande limtilimtinnde e ekzamen?"}

    OttawaCheck -->|"EEY: Kala 1 e nder 6 sifaaji ina ngoodi"| SuspectSAH

    SuspectSAH --> CallEMS["Noddu 911 / 112 / 999 Ɗoon e ɗoon:<br/>Bayyina 'Naafigaagal Hoore / Ƴiiƴam Subarachnoid Tuumaaɗo'<br/>Winndu hojomaaji TIƊƊI puɗɗagol naafigaagal hoore"]

    CallEMS --> FirstAid["Porotokol ndeenka anewrisma ko adii opitaal:<br/>1. Toownu hoore leeso haa 30 degere (wuddu ina tiiɗi e hakkunde)<br/>2. ALAA aspiriin, ibuprofen, naproksen, walla nguura/ndiyam<br/>3. Suudu niɓɓuru, deeƴndu; zero eɓɓoore ɓanndu walla eɓɓoore Valsalva<br/>4. Ƴeewto almuɓɓe mbele ina njalta bannge gooto walla ina ɓuuɓna gite (CN III)"]

    FirstAid --> HospitalTime{"Hol no ñawɗo oo yaawirta yettaade<br/>skanndeer CT Brain toowɗo ?"}

    HospitalTime -->|"E nder waktuuji 6 caggal nde ɓuuɓri hoore fuɗɗii"| EarlyCT["CT hoore mo alaa ko seerndi ɗum (<br/>98,7% haa 100% ina sensible e ƴiiƴam ɓuuɓɗam,<br/>rewi heen ko CT Angiogram (CTA) ƴiye ngaandi"]

    HospitalTime -->|"Ko ɓuri waktuuji 6 caggal fuɗɗoode (walla fuɗɗoode nde laaɓaani)"| LateWorkup["CT hoore mo alaa ko seerndi ɗum + CT Anjiyogram (CTA)<br/>E Punndi Lumbar (Tap Spinal) ngam Xantochromia<br/>so CT ina moƴƴi, ngam nanngude ɓuuɓri leelndi/sentinel"]

    OttawaCheck -->|"NO: Denndaangal 6 critères ngalaa AND ina jogii ƴeewndo neurologique baseline"| OtherEval["Ƴeewto ngam Migraine, Tension, walla Sinus Headache:<br/>Ƴeewto safaara ko yaawi so tawii nguleeki, waylo-waylo yiytere, walla aura keso ina woodi"]

Ko kewata so anewrisma ngaandi ruppitii : Patofisiyoloji e "Ƴiiƴam Sentinel".¶

1. Anewrismaaji sakkitiiɗi ("Berry") e taarik Willis¶

Ko ina tolnoo e 85 e nder teemedere ƴiiƴam gonɗam e nder reedu, ko ɓuuɓri anewrisma cerebral sakkulaar (berry) addata ɗum. Nandugol e ƴiye ɓutte tedduɗe e nder juuɗe e koyɗe, ƴiye mawɗe gonɗe e les ngaandi (Circle de Willis) ina njogii ɓuuɓri yaajndi no feewi, ina njooɗii ina ndarii e nder ndiyam ndiyam ɓalndu (CSF) nder espace subarachnoïde. Duuɓi keewɗi e nder stres hemodinamik, tansiyoŋ toowɗo, simmeeji, walla ŋakkere renndo, ɓuuɓri ɓuuɓndi walla ɓuuɓri ɓuuɓndi ina yalta e fork arteriyel (toɓɓere calɗi).

Nde oon dome aneurysm ɓuuɓɗo udditii e joofnirde: - Ƴiiƴam ɗam ina ɓuuɓta e nder ƴiiƴam ɓalndu to bannge ƴiiƴam sistolik (\(120\tekst{ haa }200+\tekst{ mmHg}\)). - E nder leƴƴanɗe seeɗa, ɓuuɓol nder ɓalndu tiiɗndu (ɓuuɓol nder ɓalndu, walla ICP) ina ɓeydoo haa ɓurta fotde ɓuuɓol ƴiiƴam arteriyel. Ndeeɗoo ɓuuɓol doolnungol ina ɓuuɓna meningeeji gonɗi e ɓuuɓri to les ngaandi, ina addana ɓuuɓri hoore ɓuuɓndi, ina heewi kadi dartinde ƴiiƴam ruttaade e ngaandi ko juuti, ina addana waasde hakkille (sinkope) e nder 30 haa 50 e nder teemedere ñawɓe. - E ñawɓe wuurɓe e bursi gadano oo, ɓuuɓri ƴiiƴam e nder ɓalndu e geɗe ɓuuɓɗe nokkuuje ina mbaɗa plug fibrin-platelet fragile dow gonɗi e nder ɓalndu anewrisma e nder hojomaaji 1 haa 3.

2. "Ɓoornugol hoore Sentinel" (Leak jeertinaango): Winndere nguurndam yontere 2¶

Haa e 20 haa 40 e nder teemedere ñawɓe wonduɓe e ɓuuɓri ngaandi mawndi, baawndi warde, keɓii "sentinel headache" (leak warning) ɓurɗo famɗude balɗe 2 haa 21 ko adii ɗuum tawi ko ɗum limtaa ko e migraine bonɗo, ɓuuɓri sinus, walla ɓuuɓri wuddu. - E nder ƴiiƴam sentinel, ɓuuɓol mikroskoop ina udditoo e nder ɓalndu anewrisma, ina ɓuuɓna ƴiiƴam tokosam e nder weeyo subarachnoid, walla ɓalndu anewrisma ina ɓuuɓtoo ɗoon e ɗoon (ƴiiƴam nder ɓalndu). - Neɗɗo oo ina heɓa ɓuuɓri hoore ɓuuɓndi, ɓuuɓndi e nder sahaa gooto, ina waawi jogaade waktuuji seeɗa haa balɗe ɗiɗi, sahaa e sahaa fof ina wondi e ɓuuɓri seeɗa walla ɓuuɓri wuddu, hade mum moƴƴude seeɗa seeɗa. Sabu neɗɗo oo ina waawi yahde e haalde haa jooni, ɓe ƴetta leɗɗe ñawɗe, ɓe ngona e galle. - Ko waɗi anndude ñawu hoore sentinel ina hisna nguurndam: Ñawɗo safraaɗo e nder safrirde caggal nde ɓuuɓri jeertinaango sentinel (so ɓe ngoni ko e ɓuuɓde haa jooni, ɓe limtaa ko e Hunt e Hess Grade 1 walla 2) ina jogii 85 haa 95 e nder teemedere fartaŋŋe wuurde e golle neurologique moƴƴe. So tawii ndeen ɓuuɓri jeertinaango yejjitaama, anewrisma oo ina wondi e ɓuuɓri mawndi balɗe seeɗa caggal ɗuum (Hunt e Hess Grade 4 walla 5), 50 haa 80 e nder teemedere ñawɓe ɓee ina maaya walla ina keddii e ŋakkere haa abada.

3. Maande jeertinaango "Palsy Nerve Oculomoteur" (Yitere ɓuuɓnde + Almuudo ɓuuɓɗo)¶

Maande jeertinaango anatomi keeriiɗo ina waawi feeñde hay so anewrisma ina ɓuuɓtoo haa laaɓa cer: - So anewrisma ƴiiƴam jokkondirɗam caggal (PCom) yaajii, ina ɓuuɓtoo to bannge nerf tataɓo ɓalndu (nerf oculomoteur, CN III) to bannge gite. - Ɗuum ina addana ɓuuɓri nerf tataɓiri mettundi e bannge gooto : gite toowɗe ɗee ina ɓuuɓtoo ina udditoo (ptosis), gite ɗee ina njillondiri e yaasi e les ("dow e yaasi" gite, ina addana gite ɗiɗi yiyde), e **pupille bannge oo ina yaaji ina ɓuuɓtoo (parasympatrique walla fixe to the-pipil fiɓnde ina doga e ŋoral yaajngal nerwel tataɓol ngol). - Kuulal: Kala mo ɓuuɓri hoore mum wondi e ɓuuɓri kesiri walla ɓuuɓri ɓuuɓri bannge gooto, ina foti ruttaade to suudu safrirdu ɗoon e ɗoon ngam waɗde CT angiogram ngam nanngude anewrisma yaajɗo hade mum ruttaade.

4. Sabaabuuji goɗɗi gonɗi e nguurndam, ko wayi no ɓuuɓri hoore¶

Hay so anewrisma ngaandi wonaa sabaabu, ɓuuɓri hoore ina heewi hollirde kiris vaskulaar goɗɗo e nder ɓalndu walla wuddu : - Sindrome de vasoconstriction cerebrale réversible (RCVS): Ko ngonka ɗo ƴiiƴam ngaandi ɓuuɓtata ɗoon e ɗoon e nder taƴe (ina nanndi e "kaɓirgal ɓuuɓngal" e anjiyogram), ina addana ɓuuɓri hoore ɓuuɓndi e nder yontere 1 haa 2 so ɓuuɓri, walla ex (SSRI, ɓuuɓri nofru, triptan, walla ganndal). - Trombose sinus veineuse cerebral (CVST): Ko ƴiiƴam ɓuuɓɗam ɓuuɓɗam ɓuuɓɗam mawɗam e nder ngaandi, haa teeŋti noon e reedu, e sahaa caggal jibinannde, walla e huutortooɓe leɗɗe cafrooje gonɗe e estiroyin. - Seerndude ƴiiƴam ɓalndu (Seerndude ƴiiƴam ɓalndu) : Ɓoornugol ƴiiƴam wuddu caggal mboros tokooso, njuɓɓudi wuddu kiropraktik, ƴeftugol teeŋtungol, walla ɓuuɓri, ina addana ɗum ɓuuɓri hoore bannge gooto walla ɓuuɓri wuddu ina heewi jokkondirde e **Horner sdrome upilop small e bannge gooto). - Apopleksi pituitaire: Ƴiiƴam walla ɓuuɓri gonndi e nder ƴiiƴam to les ngaandi, ina addana ɓuuɓri hoore caggal gite, ɓuuɓri gonndi e gite ɗiɗi ɗii ɗoon e ɗoon (hemianopsia bitemporal), ɓuuɓri gonndi e gite ɗiɗi, e life-thsolre kiris adrenal e ñawu Addison ina ɓuuɓna).

Njiylawu kuuɓtodinɗo : Ƴiiƴam Subarachnoid vs Migraine vs Sabaabuuji goɗɗi ɓuuɓɗi¶

Wonaa kala ɓuuɓri hoore ko anewrisma ruppitiiɗo, wonaa kala ɓuuɓri hoore tiiɗndi ko ɓuuɓri hoore. Cafrooɓe safrooɓe ina kuutoroo sifaaji les ɗii ngam seerndude anewrisma ngaandi ruppitiiɗo e migraine tiiɗɗo e mborosaaji goɗɗi kulɓiniiɗi, baɗɗi kadi ɓuuɓri hoore (RCVS, CVST, Dissection artérielle cervicale, et apoplexie pituitaire) :

Banngeeji boɗeeji kilinikuuji laaɓtuɗi : Kuulal ƴiiƴam subaraknoid Ottawa¶

Ko wiɗtooɓe safaaraaji caɗtuɗi Kanadaa peewni ɗum, Fedde Ameriknaare ɓernde / Fedde Ameriknaare toppitiinde ko fayti e mborosaaji (AHA/ASA) e Kolleeji Ameriknaajo cafrooɓe caɗtuɗi (ACEP) njaɓi ɗum, Kuulal Ottawa SAH ina jogii fotde 100 e nder teemedere sensitivite noncute an-ada ngam anndude ñawɗo yettaade tiiɗnaare ɓurnde mawnude e nder waktu 1 ina ɗaɓɓi wiɗto safaara ɓuuɓngo ngam anndude ƴiiƴam subarachnoïde.

So tawii ñawɗo oo ina jogii kala GOOTO e ɗeeɗoo balle boɗeeje 6, ɗe mbaawataa laɓɓineede tawa neuroimaging opitaal waɗaani : 1. Duuɓi \(40\binndol{ duuɓi}\) walla ko ɓuri ɗum 2. Nafoore daande walla ɓuuɓri daande (Tesko: ƴiiƴam ɓuuɓɗam ƴiiƴam ɗam ina ƴetta waktuuji 3 haa 12 ngam saabaade ɓuuɓri daande ɓanndu goonga, ko ɗum waɗi ŋakkeende daande tiiɗnde e nder waktuuji 2 gadani ɗii meeɗaa haɗde ƴiiƴam anewrisma) 3. Seede majjugol hakkille (faayde walla ɓuuɓde so ɓuuɓri hoore yanii) 4. Fuɗɗoode e nder golle (ƴeftude teddungal, doggudu, ɓuuɓde e dow ŋoral, ɓuuɓde, walla jokkondirde) 5. Naafigaagal hoore ɓuuɓngal (naafigaagal ina yettoo tiiɗnaare mum e sahaa gooto e nder leƴƴanɗe haa hojomaaji 1) 6. Flection wutte limtilimtinɗo e ƴeewndo (waasde meemde hunuko e ɓalndu walla ƴeftude hoore \(8\text{ santimeeteer}\) [\(3\text{ inches}\)] e dow leeso)

Ko waɗi "waktu 6" ina jogii nafoore: CT hoore vs.¶

So a noddii 911 / 112 / 999 ɗoon e ɗoon, a winndii hojom tigi-rigi mo ñawu nguu fuɗɗii, aɗa waawi faamde no opitaal oo waawirta ƴeewde ƴiiƴam ɗam no laaɓiri e no yaawiri:

1. Nder Winndere Waktuuji 6 (Sensibilite CT -98,7% haa 100%):
2. Ƴiiƴam kesam e nder weeyo subarachnoid ina nanndi e daneejo jalboowo e dow CT scan hoore mo alaa ko seerndi ɗum mo jamaanu mum heewi slice.
3. E fawaade e jamirooje AHA/ASA, ACEP, e UK NICE, so tawii CT scan hoore toownde waɗaama e nder waktuuji 6 e nder hojomaaji 6 ɗi ɓuuɓri hoore ndee fuɗɗii, tawa kadi ko doktoor neuroradiyoloji keewɗo humpito firti ɗum ko huunde woowaande no feewi, ɗum ina haɗa heomorhaver9 ɓuuɓɗo 99,9 e nder teemedere laaɓal (hay so tawii noon safrooɓe ina keewi ɓeydude haa jooni CT Angiogram [CTA] e ƴiiƴam ngaandi ngam ƴeewde so tawii ko anewrisma mo ɓuuɓnaaka, so tawii ko ƴiiƴam reedu, walla RCVS).
4. Ko ɓuri waktuuji 6 caggal fuɗɗoode (Ko waɗi CT tan ina waawi waasde ƴiiƴam):
5. Sabu ndiyam cerebrospinal ndiyam ina cirƴa, ina loota e nder weeyo subarachnoid (ina lomtina hoore mum laabi keewɗi e ñalawma), ƴiiƴam kesam fuɗɗotoo ko ɓuuɓde e ɓuuɓde e CT scan standard so waktuuji ina njahra :
   • E nder waktuuji 6: Senngo CT ko \(98,7\%\binndol{ haa }100\%\).
   • E waktuuji 12 haa 24: Senngo CT ina ustoo haa \(90\%\binndol{ haa }93\%\).
   • E balɗe 3 haa 5 (ko heewi caggal ɓuuɓri hoore sentinel): Sensitibilite CT ina ustoo haa \(50\%\text{ haa }75\%\).
6. Ko ɗum waɗi, so ñawɗo ina fadi haa janngo mum yahde to suudu safrirdu, tawa CT scan hoore mum laaɓtunde ina "normal", CT scan normal caggal waktuuji 6 WAƊATAA aneurysm ruptured. Ekipaaji cafrirɗi ɗii ina poti waɗde maa Puncture Lumbar (tap spinal) ngam ƴeewde ƴiiƴam mboɗejam e xanthochromia (pigment bilirubin mboɗeejo peeñɗo so ƴiiƴam mboɗejam ɓuuɓɗam e nder ƴiiƴam ɓalndu, ko ɗum feeñata waktuuji 6 haa 12 caggal ƴiiƴam, ina heddoo yiyeede haa wee**A e)2 ƴiye ngaandi.

Hol ɓurɗo waawde heɓde anewrysm ngaandi?¶

Renndinde ɗee geɗe baawɗe bonnude renndo e safaara e safrooɓe e safrooɓe e nder suudu safrirdu ina yaawi ƴeewndo ƴiiƴam : - Taariindi ɓesngu degere adannde: Jogaade banndiraaɓe ɗiɗo walla ko ɓuri ɗum degre adannde (jibinannde, miñi mum, miñi mum debbo, walla cukalel) wonduɓe e anewrisma ngaandi walla ƴiiƴam subarachnoïde ina ɓeyda baasal neɗɗo laabi 4 haa 8. - Rafi ƴiiƴam polikistik ɓurɗo heewde (ADPKD): Ko ina tolnoo e 10 haa 15 e nder teemedere ñawɓe wonduɓe e rafi ƴiiƴam polikistik ina njogii anewrismaaji berry nder reedu. - Rafiiji jokkondirɗi e ƴiye: Ñawu Ehlers-Danlos (Sifaa IV), Rafi Marfan, Rafi Loeys-Dietz, Rafi fibromuskulaar (FMD), e koarktaasiyoŋ aorta. - Geɗe tiiɗɗe baawɗe wayleede: Simme (ko huunde wootere ɓurnde tiiɗde baawnde wayleede ngam feeñninde anewrisma, mawnude, e ruppitde), hipertension mo alaa ɗo haaɗi, huutoraade alkol no feewi, e kuutoragol kokayin walla metamfetamin (ko ɓuuɓnata ƴiiƴam). - Anewrism ɓennuɗo: Haa e 20 e nder teemedere ñawɓe anewrism ina njogii anewrismaaji keewɗi (anewrismaaji miroir banngeeji ɗiɗi ɗii fof e Circle of Willis).

Ballal gadanal ɗaɗol-taƴre nde ina fadi ambulance¶

Kala golle baɗaaɗe hade safrirde e nder ƴiiƴam tuumaaɗam e nder ɓalndu, ina fawii e haɗde ƴiiƴam ruttaade e reende laawol henndu.

Ɗatal 1: Jokkondire (Kuulal 30-Degree hakkundeewal)¶

• Wallu neɗɗo oo lelnude e leeso walla sofa tawa hoore mum e ɓanndu mum toowndu ina toowa e 30 degere.
• Waɗde hoore maɓɓe e wutte maɓɓe ina njuɓɓina juutɗo e nder hakkundeere (ina ƴeewa yeeso, ina njirloo no feewi to bannge nano walla to bannge ñaamo, tawa kadi alaa kolce tiiɗɗe e wutte). Wirtude wutte ina ɓuuɓna ƴiye nder ɓalndu, ina haɗa ƴiiƴam yaltude e hoore, ina ɓeyda ɓuuɓri nder reedu.
• So tawii neɗɗo oo ina ɓuuɓtoo, ina ɓuuɓtoo no feewi, walla ina ɓuuɓtoo no feewi: Ɗoon e ɗoon, waɗ ɗum e bannge mum e nder recovery position (jogaade hoore mum ina jokkondiri e ɓalndu mum) mbele ɓuuɓri ina waasa foofde e nder ƴiiƴam.

Ɗatal 2: Doole "Zero Valsalva" e Ƴellitaare Senngo Lowre¶

• Ko waɗi re-rupture ina waɗa: Ƴiiƴam ɓuuɓɗam ɓuuɓɗam ɓuuɓɗam e nder dome anewrisma ruppitiiɗo oo, ina jogoo e nokku mum tan ko e balans hakkunde ɓuuɓol nder ƴiiƴam e ɓuuɓol yaasi ƴiiƴam. So tawii neɗɗo oo ina ɓuuɓtoo, ina ɓuuɓtoo e doole, ina ɓuuɓtoo no feewi, ina darii ngam yahde, walla ina ɓuuɓtoo, ƴiiƴam mum sistolik ina ɓeydoo haa ɓura \(180\text{ haa }220\text{ mmHg}\), ina fuɗa ƴiiƴam ɗam e nder anewrisma (re-rupture).
• Yimtu fitirlaaji dow, ɓuuɓna ɓuuɓri windooji, ɓuuɓna teleeji, haɗa kullon ladde e ƴeewooɓe ɓe ngonaa kulɓiniiɓe yaltude e suudu nduu, yamira neɗɗo oo yoo foof seeɗa seeɗa e hunduko udditiingo (hoto meeɗaa jogaade foofaango mum).

Ɗatal 3: Ƴeewtaade e winndude maandeeji ƴiiƴam (Hunt & Hess / WFNS Clues)¶

Ƴeewto ɗeeɗoo maandeeji nay koyɗi, winndu ɗi ngam safrooɓe ɓee : 1. Toɓɓere jeertinaango (Glasgow Coma Scale): Mbele gite maɓɓe ina udditoo e hoore mum? Mbele eɓe nganndi innde maɓɓe, nokku maɓɓe e lewru maɓɓe? 2. Pupil Check: Jalnude annoore suudu no woorunoo (wonaa lampa ɓuuɓka to bannge gite fotofobi so wonaa tawa aɗa anndi) walla ƴeewde no feewi almuɓɓe ɗiɗo ɓee fof. Mbele ɗe poti ko mawneeki, walla almuudo gooto ina teskaa ina mawni (dilated) walla ina jokkondiri e gitere toownde ɓuuɓnde? 3. Doole terɗe & Haala: Mbele eɓe mbaawi ɓuuɓnude juuɗe maa ɗiɗi fof no fotiri, eɓe kaala laaɓɗo? 4. Jeertinaango rimɗude ɓernde (Miyokardium ɓuuɓɗo neurogenic): Ƴiiƴam mawɗam e nder ɓalndu ina yaltina ɓuuɓri mawndi e nder ɓalndu (adrenaline) tawa ina yahdi e ɓuuɓri ɓernde, ina waawi kadi saabaade ɓuuɓri ɓernde kulɓiniindi (arritmiiji, e ɓuuɓri gonndi e ɓuuɓri gonndi e ɓuuɓri ƴiiƴam ruppitde. Waɗde ƴeewto foofaango e pulse kala minit haa safrooɓe njokkondira e monitor ɓernde.

Ɗatal 4: Ko waɗata e nder safrirde (Koygol, Taƴgol, e Nimodipine)¶

So terɗe galle ina nganndi ko njiɗi so ɓe ngartii e nokku kuuɓtodinɗo Stroke / Neurosurgical: - Ƴeewndo ƴiiƴam ko yaawi: Doktooruuji ina kuutoroo ƴiiƴam jaawɗam (hono nikardipin, klevidipin, walla labetalol) ngam addude ƴiiƴam sistolik no moƴƴiri les \(140\text{ to }160\text{ mmHg}e-\) to pre - Reentaade Aneurysm e nder waktuuji 24: - Endovascular Coiling: Neuro-interventionniste ina jolna mikroo-kateter ummoraade e ƴiiƴam junngo walla ƴiiƴam ɓalndu haa e nder ƴiiƴam ngaandi, ina fawa ɗum e ɓuuɓri platinum softundi (walla ina waɗa stent/web device) ngam siifde ɗum gila e nder mum tawa udditaani ɓalndu nduu. - Microsurgical Clipping: Neurosurgeon ina waɗa craniotomie, ina waɗa heen ɓuuɓri titanium tokosiri e daande ƴiiƴam ngam seerndude ɗum haa abada e ƴiiƴam. - Haɗde Hidrosefalus e Vasospasm cerebral leeltuɗo: Doktoor ina rokka nimodipine e hunuko waktuuji 4 kala fotde balɗe 21 (ko kañum tan woni ɓuuɓri kalsiyum-kanaal holliraaɗo ina reena ƴiye ngaandi e leeltugol aneeral spasm mo ɓuri heewde hakkunde balɗe 4 anu ina waawi ɓuuɓri ƴiiƴam yaajndi (EVD) so tawii ƴiiƴam ina haɗa ɓuuɓri ƴiiƴam ɓalndu (hydrocéphalie aiguë).

Binndol jokkondiral laaɓtungol wonande 911 / 112 / 999 e Triage Hospitaal¶

Huutoro ɗee kelme kilinik laaɓtuɗe mbele diisneteeɗo e infirmiye triage ina ngannda ɗoon e ɗoon emergency neurosurgical mo sahaa mum ina tiiɗi, wonaa ñawu hoore moƴƴu :

• So aɗa nodda 911 / 112 / 999:

  *"Miɗo haani ambulance urgence to [Adresse Exact]. Ñawɗo oo ko [Duuɓi]-duuɓi [gorko/debbo] mo ƴellitii e sahaa gooto, 10-e-10 ɓuuɓri hoore ɓuuɓndi e [Wakkati laaɓtuɗo] mo yettii tiiɗnaare ɓurnde mawnude e nder leƴƴanɗe. [O [Shein famiting a /in] kadi gite ɓuuɓɗe / puɗɗagol e nder ƴettugol teeŋtungol]. Min cikkata ko ƴiiƴam Subarachnoid ummoraade e aneurysm ngaandi ruppitiiɗo.

• So aɗa haalda e Infirmiye Triage mo Departemaa Emergency (haa teeŋti e tuumaaɗo "Sentinel Leak"):

  "Oo ñawɗo ina haani ƴeewteede ko yaawi e nder kuulal Ottawa SAH. E [waktu timmuɗo], [o/o] ina wondi e ɓuuɓri hoore ɓuuɓndi, ndi ɓuuɓri mum tolnii e leƴƴanɗe 60, tawa ina wondi e [duuɓi ko ɓuri 40 / ɓuuɓri wutte / ɓuuɓri ɓuuɓri fuɗɗorde hakkille moƴƴitii, min ngoni ko e sunaare e ɓuuɓri ngaandi sentinel."

Doggol ƴeewndo peewnugol emergency nde ina fadi safrooɓe¶

• Waktu waktuuji laaɓtuɗi puɗɗagol ñawu nguu winndaa (ina anndi so tawii ñawɗo oo ina woni e nder windo sensitivite CT waktuuji 6).
• Ko ñawɗo oo waɗatnoo e sekonnde tigi rigi nde ɓuuɓri hoore ndee yani (ƴeftude, ɓuuɓnude, ɓuuɓnude tuubaako, fijde, walla fooftaade).
• So tawii ñawɗo oo ina ɓalee seeɗa walla ina ɓuuɓtoo e fuɗɗoode.
• Doggol timmungol leɗɗe ɓuuɓnooje ƴiiƴam walla ɓuuɓnooje ƴiiƴam (warfarin, apiksaban, rivaroksaban, dabigatran, klopidogrel, aspiriin, walla AINE) mbele opitaal ina waawa waɗde leɗɗe cafrorteeɗe ko yaawi so tawii ƴiiƴam ina selli.
• Kala daartol galle gonngol e anewrisma ngaandi walla ñawu ƴiiƴam polikistik teskaama.

Naamne keewɗe naamneede¶

Hol ko woni "koppi ɓuuɓɗi" tigi rigi, hol no ɗum seertiri e migraine bonɗo ?¶

Sifaa sifotooɗo ɓuuɓri hoore ɓuuɓndi wonaa tan no ɓuuɓri ndii tiiɗiri nii, kono ko no ndi yaawirta yettaade tiiɗnaare mum nii : ɓuuɓri hoore ɓuuɓri ina yahra e ɓuuɓri zero haa e ɓuuɓri 10-e-10 ɓurndi heewde e nder leƴƴanɗe haa 60 leƴƴanɗe, no ɓuuɓri hoore ɓuuɓndi nii, walla fiyde haa ɓuuɓri ɓuuɓri. E ko feewti heen, hay mboros ɓurɗo mettude oo fuɗɗotoo ko seeɗa seeɗa, ina ƴetta hojomaaji 30 haa waktuuji keewɗi ngam mahde haa ɓurta tiiɗde.

Hol ko woni "hoore sentinel", hol ko waɗi ɗum ina bonna so neɗɗo yejjitaani ɗum ?¶

Naamne hoore sentinel (walla ɓuuɓri jeertinaango) ko naamne hoore ɓuuɓɗe, ɗe ɓuuɓol jeertinaango tokosol walla ɓuuɓol e nder ɓalndu ƴiiƴam balɗe 2 haa 21 hade ƴiiƴam ɗam ɓuuɓde haa yaaji. Sabu ɓuuɓri sentinel ina yaltina ƴiiƴam seeɗa tan, neɗɗo oo ina waawi weltaade seeɗa caggal ñalawma gooto walla ɗiɗi, o sikka ko migraine ; nanngude ɓuuɓri sentinel e nder suudu safrirdu ina addana safrooɓe coilde walla ɓuuɓnude anewrisma oo e 85 haa 95 e nder teemedere nguurndam hade rupture mawnde baawnde warde.

Hol ko waɗi mi waawaa ƴettude aspiriin walla ibuprofen ngam ɓuuɓri hoore tiiɗndi ɗoon e ɗoon?¶

So anewrisma ngaandi fuɗɗiima yaltude walla ɓuuɓde, ko ɓuuɓri ƴiiƴam e fibrin tan haɗata ƴiiƴam ɗam ruttaade e nder ɓalndu nduu tawa ina jokki. Ƴettude aspiriin, ibuprofen, walla naproxen ina haɗa ƴiiƴam ɗam, ina leefna oon ɓuuɓri gonndi e sahaa, ina ɓeyda no feewi baasal ƴiiƴam ruttaade e nder ngaandi, bonɗam, bonɗam.

So tawii CT scan opitaal ina moƴƴi, hol ko waɗi safrooɓe ina mbaawi wasiyaade haa jooni waɗde tap spinal (punction lumbaire) walla CT angiogramme ?¶

CT scan hoore nde alaa ko woni e mum so wonaa 99 haa 100 e nder teemedere ina laaɓti e yiytude ƴiiƴam kesam subarachnoid tan so tawii scanning oo waɗaama e nder waktuuji 6 e nder hojomaaji 6 ɗi ɓuuɓri hoore ndee fuɗɗii. Caggal waktuuji 6, ndiyam ɗam cirƴam fuɗɗotoo ko lootde e ɓuuɓnude ƴiiƴam ɗam mbele CT scan laaɓtuɗo ina waawa waasde ƴiiƴam ɗam ; waɗde punndi lumbaar ina yiytoo ƴiiƴam mboɗejam e pigment oole (xanthochromie) fotde jonte 2, tawi noon anjiyogram CT ina yiytoo ƴiiƴam ɗam no feewi ngam yiytude ƴiiƴam ɗam e hoore mum.

Fuɗɗoode ƴeewtaama¶

• Fedde Ameriknaare Ɓernde (AHA) e Fedde Ameriknaare Ɓoornugol (ASA, Amerik): 2023 Kuulal ngam ƴellitde ñawɓe wonduɓe e ƴiiƴam gonɗam e nder ɓalndu (Hoh et al., Ɓoornugol).
• Fedde toppitiinde cellal ɓalli (NCS): Laabi toppitiiɗi safaara ɓuuɓɗo e ƴiiƴam gonɗam e nder ɓalndu (Toppitagol ƴiiƴam, Treggiari et al., 2023).
• Koldaa Ameriknaajo Cafrooɓe Emergency (ACEP, Dental Dowlaaji Amerik): Politik kilinik: Geɗe teeŋtuɗe e ƴeewndo e njuɓɓudi ñawɓe mawɓe arooɓe e departemaa Emergency wonduɓe e ñawu nguu (Annals of Emergency Médecine, tabitingol ruletta OCThead waktuuji 6).
• Duɗal ngenndiwal toppitiingal cellal e toppitagol (NICE, Royaume-Uni): Ƴiiƴam gonɗam e nder ɓalndu (Subarachnoïde) sabu ƴiiƴam ruppitɗam: ƴeewndo e njuɓɓudi (Kuulal NICE NG228).
• Duɗal wiɗto opitaal Ottawa (Kanadaa): Kuulal ƴiiƴam gonngal e nder Ottawa ngam ƴeewde ñawu nguu (Perry e woɗɓe, JAMA / CMAJ).

Ardiiɓe jokkondirɓe¶

• Anndinde stroke (FAST) e jaabawol e nder sahaa ɓuuɓɗo
• Ñawu iskemiik (TIA / mini-stroke) e haɓaade mboros oo ko yaawi
• Emergency hipertension vs urgence : so tawii ƴiiƴam ina ɓura 180/120
• Seppooji e ɓuuɓri ballal gadanal
• Ardotooɗo wuurtinde ɓernde e ƴiiƴam (CPR) e AED