Septic Cavernous Sinus Thrombosis: "Haɗarin Fuskar Alwatika na Fuskar" Boils, Sphenoid/Ethmoid Sinusitis, Farko na Shida-Nerve Palsy, da Proptosis Bilateral¶

** Ciwon thrombosis na sinusCST** wani bala'i ne, mai barazanar rayuwa na gaggawa na neurovascular wanda wani kamuwa da cutar jini (septic thrombus) ya taso a cikin ** cavernous sinuses , wasu dakunan da ke cike da jini da jini suna zaune kai tsaye a gindin kwakwalwa a kowane bangare na pituitary gland.sella turcica) da kuma sphenoid sinus. Domin jijin fuskaangular vein da jiyoyin gani na sama da na kasa masu zubar da tsakiyar fuskar dan adam da kwasfayen ido 100% ba su da ruwa (ba su da sifili guda daya), kwayoyin cuta daga ** matsewar tafasa ko kurajen fuska a cikin "Danger Triangle na Fuskar"** (daga bakin gada zuwa gada) ethmoid sinus infection**, wani orbital cellulitis, ko kuma ** kumburin hakori na gaba** na iya gudana a baya.retrograde) kai tsaye cikin kwanyar. Idan wani mai ciwon sinus na kwanan nan, tafasar hanci, ko cellulitis na fuska ya tasowa ** matsanancin ciwon kai a bayan ido, zazzabi, kumburi ko kumburin ido.proptosis), rashin iya juyar da ido waje zuwa kunne (sixth cranial nerve palsy yana haifar da hangen nesa biyu), faɗuwar fatar ido (ptosis), ko kumburin ido wanda ke tsalle daga ido daya zuwa idanu biyu a cikin awanni 24 zuwa 48**, kira yankin ku. lambobin gaggawa (911 a Amurka da Kanada, 112 a fadin Tarayyar Turai, 999 a Birtaniya, ko 000 a Ostiraliya) nan da nan. Yayin jiran jigilar asibiti, duba jagorar abokanmu akan orbital cellulitis da hatsarori na fuska mai haɗari triangle cututtuka, m coalescent mastoiditis da sigmoid sinus thrombosis, kuma cutar sankarau da cutar sankarau.

Me yasa ake iya ganewa ta musamman a gefen gado idan kun san abin da za ku gwada? Domin ba kamar kowane tsarin da ke jikin ɗan adam ba, **cavernous sinus yana da jijiya.the internal carotid arteryda kuma jijiyar cranial (Cranial Nerve VI, the abducens nerve) yana gudana kai tsaye ta tsakiyar magudanar jininsa mai venous *, yayin da wasu jijiyoyi guda huɗu (CN III, CN IV, CN \(\text{V}_1\), and CN \(\text{V}_2\)) ke gudana a cikin bangon gefenta na waje. Bugu da kari, ana haxa sinuses na kogo na hagu da dama a fadin tsakiyar layi ta hanyar intercavernous venous sinuses. Sakamakon haka, CST na septic yana samar da na yau da kullun, wanda ba a iya fahimta ** sa hannu na asibiti mai mataki biyu : 1. ** Na Farko (Early Hours): Warewa ** Ciwon Gashin Gashin Ƙarya (Ipsilateral Lateral Gaze Palsy)Cranial Nerve VI Palsy: rashin iya juyar da idon da abin ya shafa waje wajen haikalin) tare da ciwon kai mai zurfi na retro-orbital da goshin goshi/numbness na corneal (CN V1). 2. Na biyu (Within 24 to 48 HoursAlamar Pathognomonic): Yaduwan kumburin fatar ido, balloon conjunctival (chemosis), kumburin ido (proptosis), da kuma daskarewar motsin ido (ophthalmoplegia) zuwa KISHIYAR (contralateral) ido, mai da matsalar ido mai gefe daya zuwa masifu na bilateral.

Yi wannan yanzu¶

1. Yi gwajin ido na 30-na biyu "Gwajin Duban Idon Hantsi" (Testing Cranial Nerve VI) da "Duba Alamar Ido Biyu" nan take. Ka ce majiyyaci ya riƙe kansa kuma ya bi yatsa a hankali zuwa hagu mai nisa da dama mai nisa:
2. ** Tuta ta FarkoCN VI Abducens Palsy):** Shin ido daya ya kasa juyowa waje zuwa kunne?abduction deficit), sa majiyyaci ya ga hotuna guda biyu na gefe-da-gefe (** a kwance diplopia **) lokacin kallon wannan gefen?
3. ** Babban Tutar Jaja (CN III & IV + Bilateral Spread):** Shin fatar ido tana faduwa (ptosis), almajiri ya fadi kuma ya kasa kasala, idon ya daskare a tsakiyar matsayi (cikakken ophthalmoplegia na waje), ko kumburi/janye ya fara bayyana a na biyu (kishiyar) ido*?
4. ** Kira 911 / 112 / 999 nan da nan idan wani kumburin fuska, sinusitis, ko jajayen ido yana tare da KOWANE Sinus na Cavernous ko Orbital Red Flag:**
5. ** hangen nesa biyu (diplopia), mai raɗaɗi ko ƙuntataccen motsin ido, ko faɗuwar fatar ido.**
6. ** Proptosis (kumburi na ido)** ko chemosis (jelly-like translucent kumburin farin conjunctiva balloon fita a kan ƙananan fatar ido).
7. Rashin hangen nesa, duhun hangen nesa, ko asarar jajayen launi (afferent pupillary defect).
8. Ciwon raɗaɗi, raɗaɗi, ko zafi a gaban goshi, fatar ido na sama, ko hanci, ko kuma kunci na sama (Cranial Nerve V1 / V2 trigeminal sensory deficit).
9. Mummunan ciwon kai na baya-orbital ko na gaba, taurin wuya, photophobia, rudani, rashin jin daɗi, ko zazzaɓi mai tsauri "picket-shing" (39.5°C+ / 103°F+) tare da girgiza (rigors).
10. Kada a taɓa matsi, pop, maɗaukaki, ko sarrafa pimple, furuncle (tafasa), ko gashin hanci da ke cikin "Danger Triangle na Fuskar." Triangle mai haɗari yana gudana daga ** gada ta hanci (glabella) ƙasa zuwa kusurwoyin hagu da dama na leɓe na sama (oral commissures**, ciki har da rigar hanci (cikin hanci) da philtrum. Matsar da mai ciwon Staphylococcus aureus a cikin wannan yanki yana tilastawa ƙwayoyin cuta da ƙwayoyin cuta na micro-thrombi a baya ta hanyar angular mara amfani da jijiyoyin ido kai tsaye zuwa sinus na kogo.
11. • Idan aka tafasa ko kumbura hanci vestibule infection (nasal furunculosis) yana cikin Triangle mai haɗari ba tare da alamun jijiya ba:* a shafa ** tsaftataccen damfara mai dumi** a hankali don 15 minutes 3 to 4 times daily ba tare da dannawa ko matsewa ba, wanke hannu da sabulu, sannan a ga likita da sauri don ** Mupirocin Intranasal2%) maganin shafawa** da ** maganin rigakafi na baka na maganin staphylococcal** (cephalexin, dicloxacillin, doxycycline, or TMP-SMX).
12. ** A kiyaye majiyyaci zuwa Sashen Gaggawa na asibiti sosai NPO (babu wani abu da baki: sifili abinci, ruwan sifili).** Marasa lafiya da septic cavernous sinus thrombosis sakamakon m sphenoid / ethmoid sinusitis, hakori ƙurji, ko orbital subperiosteal abscess akai-akai bukatar ** gaggawa endoscopic sphenoidotomy / ethmoidectomy tiyata a cikin sa'o'i na magudanar ruwa.
13. **Daga kan gadon ko shimfida zuwa 30 to 45 degrees a lokacin sufuri ** don rage intracranial da intra-orbital venous cunkoso yayin da ake ajiye wuyansa a cikin tsaka-tsaki, matsayi mara kyau don haka ciki na jugular venous outflow ba shi da kariya.

Bishiyar yanke shawara: Triaging Fuskar Haɗarin Fuskar Cututtukan Triangle, sinusitis, da kumburin ido¶

flowchart TD
    Trigger["Marasa lafiya Tare da Kumburi na Tsakiya / Hanci ko Tafasa ('Haɗarin Triangle'), Cutar Cutar Ethmoid/Sphenoid Sinusitis, Cellulitis na Ido, ko Cutar Haƙori na Sama"] --> NeuroCheck{"Mataki na 1: Allon don Cavernous Sinus & Orbital Red Flags: Ƙuntatawa / Ciwon Ido Motsi (Musamman Wajen Gaze CN VI), Biyu Vision, Buga Ido (Proptosis), Goshi / Kunci Numbness (CN V1 / V2), Ciwon kai na Retro-Orbital, Babban Zazzabi, ko Kumburi?"}

    NeuroCheck -->|"Ee ga KOWANE Jajayen Tuta (Musamman Alamomin Ido na Biyu ko Ƙunƙarar Jijiya)"| CSTCode["WANDA AKE ZATON SEPIC COVERNUS SINUS THROMBOSIS (KO ORBITAL APEX SYNDROME): Kira 911/112/999 Nan da nan -> Ci gaba da Matsayin Matsayi 30-45 Digiri -> Tsananin NPO don Tiya"]

    NeuroCheck -->|"BABU Cranial Nerve Palsy ko Yaduwa Biyu, AMMA Ido Daya Yana Da Jajayen Kumburan Idanun"| CheckOrbital{"Mataki na 2: Bambance Bayan-Septal (Orbital) Cellulitis vs. Pre-Septal (Periorbital) Cellulitis: Shin Akwai Jin zafi akan Motsa Ido, Proptosis, Chemosis, ko Rage gani?"}

    CheckOrbital -->|"Ee: Ciwo Tare da Motsin Ido, Proptosis, ko Canjin hangen nesa"| OrbitalCell["POST-SEPTAL (ORBITAL) CELLULITIS (Magangangangangangangangan Kai Tsaye zuwa Ciwon Sinus Thrombosis): Jeka Nan da nan zuwa Sashen Gaggawa na Asibiti don Magungunan rigakafi na IV & Sabanin Orbit/Sinus CT"]

    CheckOrbital -->|"A'a: Janyewar Ido Na Sama kawai; Cikakkun motsin ido mara radadi, hangen nesa na al'ada, Babu zazzabi/ciwon kai"| PreSeptal["Pre-Septal (Periorbital) Cellulitis ko Ƙunƙarar Fuskar Fuskar Wuta: Neman Kulawar Jiki na Rana ɗaya don Magungunan Baki/IV; KADA KA TSAYA TAFIYA; Sake Duba Motsin Ido Kowane Sa'o'i 4"]

    CSTCode --> HospitalCST["Nan da nan Asibitin Neurovascular & ENT Bundle: 1. Al'adun Jini + STAT Meningeal-Kashi IV Vancomycin + IV Ceftriaxone / Cefepime + IV Metronidazole, 2. Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwaƙwalwa . Anticoagulation (Da zarar an cire zubar jini), 4. Emergent Endoscopic Sphenoid/Ethmoid Sinus ko Magudanar Ruwa."]

Sashe na 1: Halittar Halittar Halittar “Haɗari Triangle” da Gine-ginen Ciki na Kogon Sinus¶

Fahimtar sifofi guda biyu na jikin mutum, (1) babbar hanyar venous ** mara ƙarfi daga hanci zuwa gindin kwanyar ** da (2) ** taswirar ɓangaren jijiyoyi na cranial a cikin sinus na cavernous **, yana bayyana kowace alama ɗaya da majiyyaci ke tasowa.

1. Hanyoyi 3 Masu Shiga Hannun Hannu Zuwa cikin Kogon Sinus¶

Me yasa cavernous sinus shine tsakiyar tsakiyar venous crossroad na saman fuska, idanu, kunnuwa, da kwakwalwa? 1. Hanyar Gaba (Daga "Danger Triangle na Fuskar" & Ido Socket): - Zana triangle daga ** kusurwoyin baki (labial commissures*** har zuwa ** gadar hanci (nasion/glabella). - Jinin jini daga lebba na sama, philtrum, tip na hanci, da na hanci vestibule yana magudawa zuwa cikin jijin fuska -> angular vein (a kusurwar ciki na ido), wanda ke yin fitsari kai tsaye tare da ** mafi girma na ophthalmic vein.SOV* da ** mara kyau na ophthalmic vein (IOV)**. - Saboda wadannan jijiyoyin suna da ** bawul bawul , thrombophlebitis septic yana yaduwa kai tsaye zuwa baya ta hanyar fissure na orbital zuwa gaban sinus na kogo. 2. ** Hanyar Matsakaici (Daga Sphenoid da Ethmoid Sinuses: Dalilin #1 Na Zamani): - A zamanin maganin rigakafi na zamani, ** m sphenoid sinusitis da na baya ethmoid sinusitis *** lissafin over 50 to 60 percent na duk cututtukan cututtukan sinus thrombosis na septic cavernous. - Sinuses na kogo na hagu da dama suna zaune an goge kai tsaye da bangon kasusuwan kasusuwa na gefen takarda na sphenoid sinus (often less than 0.5 mm thick, with natural bony dehiscent gaps). Kamuwa da cuta yana ratsa kai tsaye ta cikin siraren kashi ko kuma ta hanyar ƴan ƙaramin valve ** diploic and essary veins. 3. ** Hanyoyi na kasa da na baya (Daga Hakora na Sama da Kashin Mastoid):* - Ƙunƙarar haƙori na babban muƙamuƙi (maxillary molars/incisorsTafiya zuwa sama ta hanyar ** pterygoid venous plexus ** ta cikin foramen ovale / lacerum zuwa cikin kasan sinus na cavernous, yayin da cututtukan kunne / mastoid (** petrous apicitis / Gradenigo syndrome*) suna tafiya gaba tare da ** babba da ƙananan petrosal sinuses **.

2. Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwaƙwalwa: Me ya sa Cranial Nerve VI Ya Kasa Farko¶

========================================================================
       CORONAL CROSS-SECTION OF THE CAVERNOUS SINUS (SKULL BASE)
========================================================================

                 [ OPTIC CHIASM & PITUITARY GLAND ]
                                 ||
        +------------------------++------------------------+
        |  LATERAL WALL          ||                        |
        |  (Dura Mater):         ||                        |
        |                        ||                        |
        |  * [ CN III ]          ||                        |
        |    (Oculomotor)        ||    [ SPHENOID ]        |
        |  * [ CN IV ]           ||    [  SINUS   ]        |
        |    (Trochlear)         ||    (Separated by       |
        |                        ||     <0.5 mm bone)     |
        |         [ INTERNAL ]   ||                        |
        |         [ CAROTID  ]   ||                        |
        |         [ ARTERY   ]   ||                        |
        |              |         ||                        |
        |  * [ CN V1 ] v         ||                        |
        |    (Ophthalmic)  ===> [ CN VI (ABDUCENS) ]       |
        |  * [ CN V2 ]          (Runs FREE inside the      |
        |    (Maxillary)         center of the venous      |
        |                        blood pool -> HIT FIRST) |
        +--------------------------------------------------+
             ||                                      ||
             ++===[ INTERCAVERNOUS VENOUS SINUSES ]==++
             (Connects Left & Right Cavernous Sinuses ->
              Causes BILATERAL Eye Spread in 24 to 48 Hours)
========================================================================

Duba da kyau ga zanen jikin mutum a sama: - An kiyaye shi a cikin bangon bangon bangon fibrous na waje ** (daga sama zuwa kasa) jijiyoyi guda hudu: 1. ** Jijiya Cranial III (Oculomotor Nerve): Yana ɗaga fatar ido na sama (levator palpebrae), yana takura wa almajiri (parasympathetic fibers), kuma yana motsa ido zuwa sama, ƙasa, da ciki. 2. Cranial Nerve IV (Trochlear Nerve): Yana matsar da ido ƙasa da ciki (superior oblique muscle). 3. Cranial Jijiya \(\rubutu{V}_1\) (Ophthalmic Division of Trigeminal Nerve): Yana ba da hankali ga kuryar ido, fatar ido na sama, da goshi, da gadar hanci. 4. Cranial Jijiya \(\rubutu{V}_2\) (Maxillary Division of Trigeminal Nerve): Yana ba da jin daɗi ga fatar ido na ƙasa, kunci, gefen hanci, da na sama / lebe. - Mai shawagi ba tare da kariya ba a tsakiyar ɗakin jini na venous ** (kai tsaye tare da ** jijiya carotid na ciki ** da plexus na jijiya mai tausayi) yana zaune ** Cranial Nerve VI (Abducens Nerve, wanda ke sarrafa ** tsokar dubura ta gefe* ( tsokar da ke juya kwallon ido waje zuwa kunne). - Sakamakon Asibiti: Lokacin da maƙarƙashiya da ɗigon jini suka fara shiga cikin sinus na kogo, Cranial Nerve VI (Abducens) ana wanke shi kai tsaye a cikin thrombus mai cutar da farko, yana haifar da ** keɓaɓɓen palsy na gefe.inability to turn the eye outward** sa'o'i kafin jini ya faɗaɗa isa don damfara ** CN III, IV, \(\rubutu{V}_1\), da \(\rubutu{V}_2\)** akan bangon waje (wanda daga baya ya haifar da ** cikakken daskararre ido.total ophthalmoplegia, ** rufaffiyar murfi [ptosis, almajiri dila.mydriasis]* daga CN III parasympathetics ko ** matsananciyar almajiri [miosis]** idan aka fara buga tausayin carotid, da kuma ** ciwon goshi/kunci**).

3. Me Yasa Cutar Ke Tsallawa Idon Kishiyar A Cikin Sa'o'i 24 zuwa 48 (The Intercavernous Bridge)¶

A cikin sauki orbital cellulitis (cututtukan da ke cikin kwas ɗin ido ɗaya), alamun suna tsayawa sosai a ** ido ɗaya.unilateral)** saboda ƙwanƙarar ido guda biyu suna raba su da kogon hancin ethmoid. - Sabanin haka, hagu da dama ** sinuses na cavernous ** suna haɗuwa kai tsaye tare a kan tudun pituitary kamar matakan tsani ta ** na gaba da na baya (madauwari) sinuses**. - A cikin awanni 24 zuwa 48 na toshe sinus guda ɗaya, thrombus septic yana yaduwa kai tsaye a kan gadar intercavernous zuwa ** kishiyar.contralateral) cavernous sinus , yana haifar da sauran idon majiyyaci ya fara kwatsam ** edema na periorbital, chemosis, protosis, da cranial nerve III/IV/VI palsies. ** Ci gaba na gaba daga unilateral zuwa proptosis na biyu da ophthalmoplegia a cikin mara lafiya mai fama da ciwon ciki shine pathognomonic don thrombosis na cavernous sinus thrombosis har sai an tabbatar da haka.

Sashe na 2: Bambance-bambancen Ciwon Ciwon Ciwon Ciki daga Orbital Cellulitis, Pre-Septal Cellulitis, da Carotid-Cavernous Fistula¶

Yi amfani da wannan tebur kwatankwacin asibiti don bambance CST septic daga mimic guda uku mafi kusa:

Sashe na 3: Ƙananan ƙwayoyin cuta masu haddasawa da kuma dalilin da yasa bugun jini na Carotid na ciki zai iya faruwa¶

1. Wadanne kwayoyin cuta ne ke haifar da Septic Cavernous Sinus Thrombosis?¶

Domin septic CST yana fitowa daga ko dai fatar hancin vestibule/ leben samaDanger Triangle), da paranasal sinuses, ko hakora, empirical jiyya dole ne nan da nan a kai farmaki hudu pathogens: - Staphylococcus aureus60% to 70% na dukkan lamuran: #1 Gabaɗaya Pathogen): An ƙididdige su da kusan 100% na lokuta da suka taso daga furuncles na hanci, matsewar fuska da pimples, da rauni na fata, da babban rabo na sphenoid/ethmoid sinusitis m. Al'umma-samuwa da kiwon lafiya mai alaƙa da Methicillin-Resistant Staphylococcus aureus (MRSA yana ƙara zama gama gari, yana mai da ** empiric Vancomycin intravenous (ko Linezolid/Daptomycin) tilas daga Minti 1**. - Streptococcus Nau'o'i (15% to 20%: Streptococcus pneumoniae, S. pyogenes, da kuma Streptococcus anginosus/milleri group): Na kowa a cikin sinusogenic da otogenic lokuta. - Maƙarƙashiyar Anaerobes na baka & Sinus (10% to 15%: Fusobacterium necrophorum, Bacteroides, Prevotella, Peptostreptococcus): Na kowa a lokacin da kamuwa da cuta ya samo asali daga kumburin odontogenic (hakori), na kullum sphenoid sinusitis, ko Lemierre-kamar thrombophlebitis. - ** Angioinvasive Fungi a cikin masu ciwon sukari / marasa lafiya marasa lafiya (* Mucor / Rhizopus* [Mucormycosis] da Aspergillus fumigatus):** - ** MATAKIYAR JAN TUTA:** A cikin kowane majiyyaci mai ** rashin kulawa da ciwon sukari mellitus (especially Diabetic Ketoacidosis / DKA), neutropenia, cutar sankarar bargo, dashen gabobin jiki mai ƙarfi, corticosteroids masu girma, ko maganin deferoxamine ** wanda ke gabatar da sinusitis, baƙar fata necrotic eschar a kan turbinates na hanci ko bakin wuya, da thrombosis sinus cavernous, wanda ake zargi ** Rhino-Orbital-Cerebral Mucormycosis (ROCM*, wanda ke buƙatar gaggawa ** Liposomal Amphotericin B5 to 10 mg/kg/day) da gaggawar cirewar tiyata.

2. Ciwon Ciwon Jiji (Carotid Arty)Mycotic Aneurysm and Ischemic Stroke)¶

Ka tuna cewa ** na ciki carotid artery (ICA, babban jijiya da ke ba da jini zuwa gaban kashi biyu bisa uku na kwakwalwa, ta ratsa kai tsaye ta tsakiyar sinus na kogon da ake wanka da magudanar jini da gudan jini. - Bacterial mamayewa da tsananin kumburi na carotid arterial bango (infectious arteritiszai iya haifar da ** vasospasm, carotid kunkuntar.stenosis, Septic carotid occlusion, ko wani cavernous carotid mycotic aneurysm , yana haifar da ** m hemispheric ischemic bugun jini (kwatsam gurbacewar hannu ko kafa da aphasia) har zuwa 10 to 15 percent na marasa lafiya. - Bugu da kari, necrosis na makwabta ** pituitary gland shine yake.sella turcica* na iya haifar da m, mai barazanar rai ** rashin wadatar adrenal na biyu (pituitary apoplexy / hypocortisolism*, yana haifar da raguwar hauhawar jini wanda kawai ke amsawa ga ** damuwa-kashi hydrocortisone na cikin jini (100 mg IV STAT).

Sashe na 4: Matsayin Gwanayen Ganewar Asibiti (MRI/MRV + Contrast CT) da Tabbataccen Magani¶

Lokacin da majiyyaci ya isa Sashen Gaggawa tare da thrombosis na sinus da ake zargin septic cavernous sinus thrombosis, rayuwa ba tare da makanta na dindindin ko bugun jini ya dogara da aiwatar da ayyukan asibiti guda huɗu a layi daya a cikin sa'a ta farko:

1. Nan take Meningeal-Dose Broad-Spectrum Antibiotics (Cikin Ciki). < 60 Minutes)¶

Bayan zana nau'i biyu na al'adun aerobic da anaerobic (waɗanda suke da inganci a ciki 70% na m septic CST lokuta), likitoci nan da nan suna gudanar da tsakanin-tsarin-jijiya-tsarin shiga-tsakiyar-tsakiyar-manigeal) maganin rigakafi na intravenous: - Kashi na 1 (Anti-MRSA / Anti-Staphylococcal Coverage): Vancomycin na Jiki15 to 20 mg/kg IV every 8 to 12 hours, da a 25-30 mg/kg loading kashi nufin trough 15-20 mcg/mL* KO ** Linezolid na Jiki600 mg IV every 12 hours*** (wanda ke samun mafi girman CSF da ƙwayoyin nama na kwakwalwa idan an hana vancomycin). (Idan al'adu daga baya sun tabbatar da methicillin-mai saurin kamuwa da S. aureus [MSSA], kunkuntar zuwa babban kashi IV Nafcillin ko Oxacillin 2 g IV every 4 hours). - Kashi na 2 (Cephalosporin na uku ko na huɗu don Pneumococcus & Gram-Negatives): Ceftriaxone na Jiki2 grams IV every 12 hours: cikakken meningeal biyu-dosing) KO ** Cefepime na Jiki (2 grams IV every 8 hours*** (idan Pseudomonas ko bayyanar lafiyar jiki ana zargin). - Kashi na 3 (Anaerobic Brain/Sinus Shiga): Metronidazole na Jiki500 mg IV every 6 to 8 hours). * (A madadin, ** Meropenem na Jiki 2 grams IV every 8 hours + Vancomycin** ya ƙunshi duka nau'ikan ƙwayoyin cuta guda uku a cikin tsarin magunguna biyu). - Lokacin Farkon IV: Mafi ƙarancin ** 3 zuwa 4 makonni ** na maganin rigakafi na ciki (wanda aka ƙara zuwa makonni 6 zuwa 8 ** idan tare da gaba / sphenoid kashi osteomyelitis ko intracranial kwakwalwa / epidural abscess).

2. Babban Neuroimaging (Contrast Brain MRI with MR Venography + Thin-Slice Sinus/Orbit CT)¶

Bambance-bambancen kai CT scans ya ɓace har zuwa 30% to 50% na farkon cavernous sinus thromboses. - ** Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwaƙwalwa na MR (Mr Venography).MRV** shine mafi girman ma'aunin zinare na bincike ***: yana hango kai tsaye ** faɗaɗawa da kumburin gefen bangon cavernous sinus , ** siginar kwararar venous / ciko lahani a cikin sinus cavernous , ** dilation da thrombosis na babban ophthalmic vein.SOV, haɓakawa na ƙwanƙwasa, da ƙunshewar jijiyar carotid na ciki na ciki. - ** Babban Yanke Bakin Ciki (1 mmKwatankwacin CT na Orbits da Paranasal Sinuses (CT Venography / CTV): Anyi nan da nan tare da MRI don taswirar ƙasusuwan kasusuwa na ** sphenoid da ethmoid sinuses ** da jagorar magudanar ruwa na endoscopic.

3. AnticoagulationIntravenous Unfractionated Heparin ko LMWH)¶

Ya kamata ku ba da magungunan jini (anticoagulation) ga majiyyaci da magungunan gudan jini a cikin kogon sinus? - ** Ijma'in Asibiti na Yanzu (AHA/ASA Cerebral Venous Thrombosis Guidelines & Cochrane Reviews):** Da zarar neuroimaging (CT/MRI) ya keɓance babban zubar jini na cikin ciki ko fashewar carotid mycotic aneurysm, ** anticoagulation na farko tare da Heparin Unfractionated Intravenous.UFH: wanda aka fi so da farko saboda ana iya kashe shi kuma a juya shi tare da protamine a cikin mintuna kafin a fara aikin sinus) ko Heparin Low-Molecular-Weight (Enoxaparin 1 mg/kg SC every 12 hours*** yana dakatar da yaduwar jini a cikin sinus na intercavernous zuwa cikin kishiyar ido kuma yana inganta shigar da kwayoyin cuta a cikin thrombus, yana rage yawan mace-mace.from -30% down to < 10-15%) da makanta na jijiyoyi na dindindin. Yawanci ana ci gaba da maganin jijiyoyi har tsawon makonni 6 zuwa watanni 3** har sai an dawo da jini.

4. Kula da Tushen tiyata na gaggawa (Endoscopic Sphenoidotomy / Ethmoidectomy ko magudanar ruwa)¶

Magungunan rigakafi da heparin ba za su iya bakara rufaffiyar kasusuwa sphenoid sinus cike da matsewar mujiya ba. Idan hoton CT ya gano ** m sphenoid / ethmoid sinusitis, wani orbital subperiosteal abscess, ko ciwon hakori / fuska , wani ** likitan ilimin likitancin likita (likitan ENT) ko ** Likitan baka & Maxillofacial Surgen** yana daukar mara lafiya cikin gaggawa zuwa dakin tiyata don ** Sinadarin Surgery.FESS: m endoscopic sphenoidotomy da ethmoidectomy)** ko magudanar ruwa. (Lura: Likitoci suna zubar da asalin sinus na farko ko tushen fuska; ba sa yanke kai tsaye cikin ɗakin sinus ɗin kansa).

Lambobin gaggawa na yanki da nau'in jijiyoyin jini¶

Wanda ake zargin septic cavernous sinus thrombosis yana buƙatar jigilar motar asibiti nan da nan zuwa Sashen Gaggawa na Gaggawa na Babban Asibitin da aka sanye da 24-hour MRI / MRV, Neurosurgery, Neurology, Ophthalmology, da Otolaryngology (ENT) Surgery ***:

• Amurka da Kanada: Kiran kira 911 nan take. An gudanar da shi a ƙarƙashin ** Ƙungiyar Zuciya ta Amirka / Ƙungiyar Ƙwararrun Ƙwararrun Ƙwararrun Amirka (AHA/ASABayanin Kimiyya game da Bincike da Gudanar da Ciwon Ciwon Jiki (Cerebral Venous Thrombosis)CVT**, Cutar Cututtuka ta Amurka (IDSA*, da kuma ** AAO-HNS *** jagororin.
• United Kingdom: Danna 999 ko kuma a garzaya da gaggawa zuwa babban asibiti mai gaggawa ** Sashen GaggawaA&E** tare da kiran waya ENT, Ido, da Neurology/Neurosurgery. Gudanarwa a ƙarƙashin ** Ƙungiyar Ƙwararrun Ƙwararrun Turai (ESO) / NICE Cerebral Venous Sinus Thrombosis Guidelines ** da ** ENT UK *** ka'idojin.
• ** Tarayyar Turai:** Kiran Kira 112. Gudanarwa a ƙarƙashin ** Ƙungiyar Ƙwararrun Ƙwararrun Turai (ESO) Sharuɗɗa don Ganewa da Maganin Ciwon Ciwon Ciwon Ciwon Jiki**.
• ** Ostiraliya da New Zealand:** Kiran kira 000 a Ostiraliya ko 111 a New Zealand. An gudanar da shi a ƙarƙashin ** Stroke Foundation / ANZAN ** da ** Jagororin warkewa: Kwayoyin cuta (Septic Venous Sinus Thrombosis)**.
• ** Asiya-Pacific:** Kiran kira 119 (Japan, Koriya ta Kudu), 995 (Singapore), ko 112/108 (Indiya). Nemi canja wuri nan da nan zuwa babban aikin neurosurgical da cibiyar ENT.

Tambayoyin da ake yawan yi¶

Menene "Haɗarin Fuskar Triangle," kuma me yasa matsi pimple a wurin zai iya haifar da gudan jini na kwakwalwa?¶

"Haɗarin Fuskar Fuskar" shi ne yankin triangular da ke gudana daga gadar hanci zuwa kusurwar hagu da dama na bakinka, gami da hancinka, hancinka, da lebbanka na sama. Ba kamar jijiyoyi a cikin sauran jikinka waɗanda ke da bawul ɗin hanya ɗaya don kiyaye jini yana gudana zuwa zuciyarka kawai, jijiya ta fuska (jijiya mai kusurwa) da manyan jijiyoyin ido da na ƙasa a kusa da idanunka ba su da bawul. Lokacin da kuka matse ko busa wani tafasa mai zurfi ko pimple (yawanci kamuwa da Staphylococcus aureus) a cikin hanci ko babba lebe, kumburin kewaye yana toshe magudanar ruwa na al'ada, kuma matsa lamba yana tura jini da ƙwayoyin cuta a baya ta cikin jijiyoyin ido kai tsaye zuwa cikin sinus na cavernous a gindin kwakwalwa.

Me yasa rashin iya juyar da ido ɗaya waje ("lalacewar jijiya na shida") shine alamar gargaɗin farko na thrombosis na sinus na cavernous?¶

Jijiyoyin cranial guda biyar suna wucewa ta cikin sinus na cavernous akan hanyarsu zuwa ido da fuska: Cranial Nerves III, IV, V1, da V2 suna ɓoye cikin aminci a cikin bangon bangon waje mai ƙarfi na sinus, yayin da Cranial Nerve VI (jijiya abducens, wanda ke sarrafa tsokar da ke juyar da ƙwallon ido zuwa waje gaba ɗaya ta wurin tafki na gaba). na ciki carotid artery. Lokacin da kwayoyin cuta da gudan jini suka fara shiga cikin sinus na kogo, Cranial Nerve VI shine ainihin jijiya na farko da aka wanke da muji da matsa lamba. Majinyacin da ke da ciwon sinus ko ciwon fuska kuma ba zato ba tsammani ya fara hangen nesa biyu a kwance saboda ido ɗaya ba zai iya juyowa waje yana buƙatar gaggawa na rigakafi na MRI/MRV da IV nan da nan.

Ta yaya likitoci suka bambanta tsakanin cellulitis na orbital da cavernous sinus thrombosis?¶

Duk da yake yanayin biyu na iya haifar da ja, kumbura, kumburin ido (proptosis), zazzabi, da zafi ko ƙuntata motsin ido, alamu guda uku suna nuna musamman ga thrombosis na sinus na cavernous: (1) Yaduwa ta biyu: saboda sinuses na hagu da na dama suna haɗuwa a tsakiyar layi ta hanyar intercavernous veins, kumburi da gurɓataccen ido tsalle daga cikin ido na farko zuwa 4 hours. (2) Ƙunƙarar jijiya na Trigeminal: pinching ko sauƙi taɓa goshin majiyyaci (CN V1) ko babba kunci (CN V2) yana nuna rashin jin daɗi ko hasara na ƙwanƙwasa ƙibta; da (3) Mummunan cutar cututtukan jijiya, gami da ciwon kai mai raɗaɗi a bayan idanuwa, taurin wuya, ɗalibi mai faɗuwa/ sluggish, da cikakkiyar motsin ido da aka daskare daidai da kumburin fatar ido.

Menene ainihin dalilin #1 na septic cavernous sinus thrombosis a yau idan ba matsi da pimples ba?¶

Kafin a gano maganin rigakafi, matse fuska da tafasar hanci ("furuncles") a cikin Triangle mai haɗari shine babban abin da ke haifar da thrombosis na sinus na cavernous. A yau, ko da yake ciwon hanci har yanzu yana haifar da kashi 15 zuwa 25 na lokuta, dalilin #1 na zamani (wanda ke da alhakin fiye da kashi 50 zuwa 60 na lokuta) shine sinusitis na sphenoid na kwayan cuta da kuma ethmoid sinusitis. Saboda sinus na sphenoid yana zaune mai zurfi a bayan hanci wanda aka rabu da sinus na kogo ta bangon kashin da bai wuce 0.5 millimeters ba (wanda sau da yawa yana da gibin microscopic na halitta), kamuwa da sinus mai zurfi da ba a kula da shi ba zai iya rushewa kai tsaye zuwa cikin sinus na kogo.

Me yasa likitoci ke ba da magungunan jini (Heparin) don gudan jini mai cutar a cikin sinus na kogo?¶

A kallo na farko, ba da sirin jini a lokacin kamuwa da cuta yana sauti mai haɗari, wanda shine dalilin da ya sa likitoci suka fara yin gwajin CT da MRI don tabbatar da cewa babu zubar jini mai aiki a kwakwalwa. Da zarar an kawar da zubar da jini, heparin mara lahani (ko heparin mara nauyi mai nauyi) tare da babban maganin rigakafi na cikin jini yana taka muhimmiyar rawa ta ceton rai: yana dakatar da ɗigon jini daga yaduwa a cikin veins na intercavernous zuwa cikin sauran ido na majiyyaci ko baya zuwa cikin sauran motocin venous na kwakwalwa, yana hana bugun jini na cikin gida, yana hana bugun jini daga ciki, yana hana bugun jini daga ciki yana buɗe tashoshi na venous don haka maganin rigakafi na cikin jijiya na iya shiga cikin kamuwa da cuta.

Menene zan yi idan na sami ciwon zafi a cikin hancina ko kuma a kan leɓena na sama a yanzu?¶

Da farko, kiyaye hannuwanku daga shi: kada a matse, tsunkule, ɗauka, ko buga shi da allura. Aiwatar da rigar wanka mai tsabta, dumi, mai ɗanɗano a hankali a kan yankin na tsawon mintuna 15 sau uku zuwa huɗu a rana don ƙarfafa magudanar ruwa na zahiri ba tare da matsa lamba ba. Duba likita a wannan rana don sayan maganin mupirocin (2%) na hanci da maganin rigakafi na baka wanda ke rufe Staphylococcus aureus (da MRSA idan ya zama ruwan dare a cikin al'ummar ku). Idan ka kamu da wani zazzabi, yada ja zuwa kusurwar idonka na ciki, ciwon kai a bayan idonka, kumburin ido, ko hangen nesa biyu, kai tsaye zuwa sashin gaggawa na asibiti.

Tushen da jagorar hukuma¶

• American Heart Association / American Stroke Association (AHA/ASA, United States): Scientific Statement: Diagnosis and Management of Cerebral Venous Thrombosis (CVT) and Septic Cavernous Sinus Thrombosis (Stroke, contrast MRI/MRV diagnostic gold standard, broad-spectrum CNS-dose antibiotics, and early unfractionated/LMWH heparin anticoagulation).
• Cibiyoyin Cututtuka na Amurka (IDSA, Amurka): * Sharuɗɗan Ayyukan Kula da Lafiya don Ciwon Ciki na Ciki na Sinusitis da Cututtukan Fuska* (vancomycin na ciki na ciki tare da cephalosporin na uku/na huɗu da tsarin metronidazole).
• ** Ƙungiyar Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙasa (ESO)
• ** Cibiyar Nazarin Otolaryngology ta Amurka-Head da Neck Surgery (AAO-HNS, United States) & ENT UK:** * Matsalolin Rhinosinusitis (Sphenoid/Ethmoid Sinusitis, Chandler Classification of Orbital Complications Stage V Cavernous Sinus Thrombosis, and Endotopic Endoscopic)
• ** Academy of Ophthalmology na Amurka (AAO):** * Neuro-Ophthalmic Triage of Cavernous Sinus Syndrome (Keɓaɓɓen Jijiya na Farko na Cranial VI Abducens Palsy, Trigeminal V1/V2 Hypoesthesia, da Contralateral Intercavernous Spread)*.

Jagora masu alaƙa¶

• Orbital cellulitis, cavernous sinus thrombosis, da hatsarin triangle fuska cututtuka
• Mastoiditis mai tsanani na coalescent: kumburin kunnen pinna da sigmoid sinus thrombosis
• Cutar sankarau da ciwon sankarau da ciwon sankarau wanda ba ya barkewa
• Cutar sankara, erysipelas, lymphangitis ja streaking, da kumburi sepsis ci gaba.
• Bell's palsy vs. bugun fuskar faɗuwar faɗuwar fuska, tsayayyen goshi, da bugun ido