Shanyewar ido (Central Retinal Artery Occlusion) da Arteritis na Lokaci¶

Ba zato ba tsammani, makanta mara zafi ko tsananin dimming na gani a cikin ido ɗaya wani lokaci ne mai mahimmancin neuro-ophthalmic vaskụla bugun jini na gaggawa na asibiti daidai da babban kwakwalwar ischemic. bugun jini. Lokacin da gudan jini, cholesterol crystal, ko autoimmune arterial kumburi yana toshe samar da jini zuwa ga ** retina ** (Central Retinal Artery Occlusion [CRAO] ko ** Branch Retinal Artery Occlusion [BRAO]) ko kuma ** kan jijiya na gani *** ( Na baya Ischemic Optic Neur Artitis) Arteritis]), Kwayoyin jijiya masu fama da yunwa sun fara mutuwa ba tare da juyewa ba a cikin mintuna 90 zuwa 240. Ko da baƙar fata a cikin ido ɗaya yana ɗaukar mintuna 2 zuwa 15 ne kawai sannan ya share gaba ɗaya (** Amaurosis Fugax**, harin ischemic na wucin gadi na retinal), har zuwa kashi 25 cikin ɗari na marasa lafiya sun riga sun sami ɓarna na ɓarna a cikin kwakwalwa a cikin kwakwalwar MRI ** kuma suna fuskantar haɗari nan da nan na kashe bugun jini na hemispheric ko makanta biyu. Calling emergency services immediately, transporting directly to a Designated Stroke Center (never waiting for a routine optometrist appointment), and starting immediate intravenous thrombolysis or high-dose intravenous corticosteroids within hours determines whether sight and brain function are saved.

Yi wannan yanzu¶

1. **Rufe ido daya a lokaci guda don tabbatar da ko baƙar fata na gani yana cikin ido DAYA (monocular) ko idanu biyu (binocular), sannan a rubuta ainihin lokacin da hangen nesa ya canza (lokacin "Last Known Well").
2. ** Baƙar fata kawai (idon hagu kawai KO idon dama kawai yayi duhu/rasa rabin lokacin da ɗayan ido ya rufe):** Yana nuna toshewar jijiya ** a gaban ɗigon gani ** (Central retinal artery Occlusion, Retinal artery Occlusion, Ophthalmic artery Occlusion, ko Giant Neur Arteritis).
3. Rashin rabin filin binocular (idon hagu DA idon dama ba zai iya ganin gefen hagu ko gefen dama na dakin): Yana nuna bugun bugun kwakwalwar lobe na occipital (homonymous hemianopia)** a bayan fage na gani.
4. ** Allon kowane majiyyaci mai shekaru 50 ko sama da haka nan da nan don "Giant Cell Arteritis (Temporal Arteritis) Red Flag Triad":** Tambayi mara lafiya a yanzu:
5. "Shin kin sami sabon ciwon kai, ciwon haikali, ko kuma fatar kanki mai laushi lokacin da kike shafa gashin kanki ko kina hutawa a kan matashin kai?"
6. "Shin ciwon baki, harshenki, ko fuskarki ko ciwon ciki, ko ciwon ciki, ko gajiya bayan tauna abinci na minti daya (ciwon baki)?"
7. "Shin kina da taurin kai, ciwon kafaɗa ko hips da safe (polymyalgia rheumatica), gajiya da ba a bayyana ba, gumi na dare, ko gajeriyar hangen nesa biyu ko hangen nesa mai duhu?"
8. Idan KOWANE amsar YES ce a cikin balagagge mai shekaru \(\ge 50\rubutu{shekaru}\): Ku gaya wa ma'aikatan lafiya da ma'aikatan jinya na gaggawa na gaggawa nan da nan cewa ku yi zargin ** Arteritic Ischemic Optic Neuropathy daga Giant Cell Arteritis** don haka suna gudanar da ** high-dose intravenous methylprednisolone) ($ 500\ttext) nan da nan, $ 100 mg don jiran rubutun nan da nan. gwaje-gwaje ko biopsy** don ceton idon ɗan adam.
9. Kira lambar gaggawa ta gida nan da nan kuma nemi jigilar zuwa Asibitin Cibiyar Ciwon Jiji da Ƙwaƙwalwa tare da Sashen Gaggawa. Buga lamba 911 a Amurka da Kanada, 112 a cikin Tarayyar Turai, 999 a Burtaniya, ko duba duka. lambobin gaggawa. A fayyace a fili: "Majiyyaci yana da hasarar hangen nesa ba zato ba tsammani a cikin ido ɗaya; muna zargin cutar ciwon ido (Central Retinal Artery Occlusion) ko Giant Cell Arteritis."
10. ** Sanya majiyyaci daidai lokacin da ake jiran motar asibiti:**
11. Ga wadanda ake zargin ba jijiya CRAO / Embolic Ido Stroke (babu ciwon kai ko ciwon zuciya mai tsanani): Kwanta mara lafiya ** gaba daya a kwance a bayansu (kwankwasa, \(0\rubutu{digiri}\))** tare da mitsitsike kai. Kwance kwance yana ƙara matsa lamba na jijiya mai ƙarfi zuwa jijiyoyi na ido da na tsakiya na ido, yana taimakawa tura jini ya wuce guda ɗaya ko ta cikin ƙananan tasoshin haɗin gwiwa na cilioretinal.
12. Idan majiyyaci yana da gajeriyar numfashi ko kuma wanda ake zargin zubar jini a kwakwalwa: Daukaka kai kadan zuwa \(15\rubutu{zuwa}30\rubutu{digiri}\).
13. Bincika alamun bugun jini mai saurin bugun kwakwalwa a lokaci guda da alamun gargaɗin rarrabawar carotid. Bincika faɗuwar fuska, raunin hannu, ko magana maras kyau (duba bugun jini jagora). Idan ƙaramin majiyyaci (ƙasa da shekaru 50) ya sami hasarar hangen nesa kwatsam guda ɗaya tare da ** sabon ciwo a gefe ɗaya na wuyansa ko fuska da fatar ido mai ɗan faɗuwa tare da ƙaramin almajiri a wancan gefen (Ciwon Horner)*
14. Kada a danna ko tausa ƙwallon ido, KADA ku shaƙa a cikin jakar takarda, kuma ku kiyaye marasa lafiya Babu wani abu da Baki (NPO) Yayin da tsofaffin littattafan likitanci suka ambata tausa mai ƙarfi na ido ko jakunkuna na sake numfashi, ** Ƙungiyar Zuciya ta Amurka (AHA)** tana ba da shawara game da rashin horar da masu kallon ido ko matsawar ido ko hypercarbia, yana iya haifar da jinkirin bugun jini ko fa'ida, yana iya haifar da sifiri na gaggawa. bugun jini-center thrombolysis.

Bishiyar yanke shawara ta gaggawa: Rasa hangen nesa mara zafi kwatsam & Arteritis na ɗan lokaci¶

Yi amfani da wannan taswirar hanyar asibiti don rarraba asarar hangen nesa na monocular vs. binocular ischemic asarar da kunna ainihin bugun jini na asibiti ko ka'idar steroid a cikin mintuna.

flowchart TD
    Start["Asarar hangen nesa mara raɗaɗi kwatsam,<br/>Baƙaƙewar Filin Kayayyakin gani, ko Dimming Mai Raɗaɗi"] --> CoverTest{"Rufe Kowani Ido Daban-daban:<br/>An Rasa Hani A Ido DAYA ko Ido Biyu?"}

    CoverTest -->|"IDANUN BIYU GUDA BIYU suna rasa daidai guda<br/> Rabin Hagu ko Rabin hangen dama"| Occipital["HOMONYMOUS HEMIANOPIA <br/>(Acute Posterior / Occipital Brain Stroke): <br/>Kira 911 / 112 / 999 Nan da nan don Cibiyar Shanyewar Jiki"]

    CoverTest -->|"IDO DAYA KAWAI (Rashin hangen nesa guda daya):<br/>Launi yana cikin Retina, Optic Nerve, <br/> ko Ipsilateral Carotid/Ophthalmic artery"| AgeCheck{"Duba Age & Giant Cell Arteritis <br/>(Tsarin Ciwon Jiki) Jajayen Tuta:<br/>Shin Shekarun Marasa lafiya >= Shekaru 50 TARE DA<br/> Ciwon Kan Haikali, Tausayin Kan Kan Kai, <br/> Ciwon Jaw Lokacin Tauna, Ko Taurin kafada?"}

    AgeCheck -->|"YES (Shekaru>= 50 + KOWANE Alamar GCA, <br/>ko Rashin hangen nesa na Chalky/Altitudinal): <br/> SUSUPECT GIANT CELL ARTERITIS<br/>(Arteritic AION ko Arteritic CRAO)"| GCAProtocol["NAN 'KA CECE IDO NA BIYU' PROTOCOL: <br/>1. Kira 911 / 112 / 999 -> Sashen Gaggawa YANZU<br/>2. Gudanar da Stat High-Dose IV Methylprednisolone <br/> (500 zuwa 1,000 MG IV/rana x 3 days) NAN TAKE<br/> (KADA KA jinkirta steroids don ESR/CRP labs ko biopsy) <br/>3. oda Stat ESR, CRP, Platelets + Ultrasound/Biopsy na ɗan lokaci"]

    AgeCheck -->|"BABU Alamomin GCA <br/>(ko Mara lafiya A Ƙasar Shekara 50)"| DurationCheck{"Shin hangen nesa ya koma 100% na al'ada <br/> A cikin 2 zuwa 15 Minutes,<br/>ko hangen nesa HAR YANZU Duhu/Bace?"}

    DurationCheck -->|"Hangen Ya Koma Gabaɗaya a cikin Minti 2 zuwa 15 <br/>('Taga Shade Ya Janye & An ɗaga sama'):<br/>AMAUROSIS FUGAX (Retinal TIA)"| TIAProtocol["MATSALAR GAGGAWA:<br/>1. KADA ku zauna a gida (Haɗarin bugun jini a cikin 24-72h) <br/>2. Je zuwa Wurin Gaggawa na Cibiyar bugun jini YANZU<br/>3. Yana buƙatar ƙididdiga Brain MRI (DWI), Carotid CTA/Ultrasound, <br/> ECG/Holter don AFib, Dual Antiplatelet, & Statin"]

    DurationCheck -->|"Hangen Ya Ci Gaba Da Duhu (Kammala Baƙi) <br/> Ko Bangaren Sama/Kasa Ya Bace: <br/> MATSALAR TSAKIYA KO BRANCH RETINAL <br/> ARTERY OCCLUSION (CRAO / BRAO)"| CRAOProtocol["CUTE CUTAR BUGA ('CODE STROKE'): <br/>1. Kira 911 / 112 / 999 -> Cibiyar Bugawa da aka Ƙayya YANZU<br/>2. Sanya mai haƙuri FLAT a baya (digiri 0) don haɓaka turare <br/>3. Lura ainihin minti na farawa (< 4.5 hour IV tPA taga) <br/>4. Idan ciwon wuya + ƙaramin ɗalibi/rufin faɗuwa -> Duba Rarraba Carotid"]

Pathophysiology: Yadda samar da jinin ido biyu ke aiki da dalilin da yasa mintuna ke da mahimmanci¶

Ana kawo ido ne ta hanyar ** ophthalmic artery **, wanda shine babban reshe na farko daga internal carotid artery daidai lokacin da yake shiga cikin kwanyar daga wuya. Domin jijiyoyin ido suna reshe kai tsaye daga jijiyar carotid na ciki, duk wani abu da ke faruwa a jijiyoyi na ido shine taga kai tsaye zuwa cikin jijiyoyin kwakwalwa da zuciya.

A cikin kwas ɗin ido, jijiya na ophthalmic ta rabu zuwa ** tsarin jijiyoyin jini guda biyu daban-daban* waɗanda ke ciyar da nau'ikan nau'ikan retina da jijiyar gani:

1. Tsarin Tsarin Jijiyoyin Gaji (CRA) (Ciyar da Ciki)
2. Jijiya ta tsakiya ta huda tsakiyar jijiyar gani da reshe a saman saman ciki na retina zuwa hudu (mafi girma na ɗan lokaci, na ɗan lokaci, mafi girman hanci, da ƙananan rassan hanci).
3. Yana da ** ƙarshen jijiya ta jiki ** tare da haɗin haɗin kai mara nauyi a cikin kashi 70 zuwa 85 na mutane.
4. (Anatomical bangaran: Kimanin ** 15 zuwa 30 bisa dari na mutane ** an haife su da wani ƙarin kayan haɗi mai suna cilioretinal artery yana fitowa daga bugun jini na choroidal wanda ke ciyar da tsakiya macula. tsira.)
5. ** Tsarin Gajeran Ciliary Arteries (SPCAs) (Yana Ciyar da Kan Jijiya Na gani & Fitar Jijiya):**
6. Manyan kututtukan ciliary guda biyu zuwa uku sun kasu zuwa 10 zuwa 20 kankanin ** gajeriyar jijiyoyin ciliary arteries ** wadanda ke samar da zoben jijiyoyin jini a kusa da kan jijiyar gani kuma suna ciyar da ** choroid ** (wanda ke ciyar da sandunan photoreceptor na waje da cones, gami da tsakiyar fovea).
7. ** Me yasa Giant Cell Arteritis ke son Shortan Ciliary Arteries: *** Lamina na ciki na gajeriyar jijiyoyin ciliary arteries da jijiyoyi na wucin gadi shine makasudin # 1 na harin giant-cell na autoimmune a cikin ** Arteritis na wucin gadi ***, yana bayanin dalilin da yasa Giant Cell Arteritis ke haifar da rauni na gani na gani. Neuropathy [A-AION] ***) a cikin 80 bisa dari na lokuta na gani da ** Arteritic CRAO ** a cikin 10 zuwa 15 bisa dari.

Agogon Tsira na Retinal Ischemic (Me yasa Minti 90 zuwa 240 shine Ƙofar)¶

Gwaje-gwajen neuro-ophthalmology na al'ada (Hayreh et al.) da gwajin bugun jini na ɗan adam sun kafa ainihin agogon rayuwa na ƙwayoyin ganglion na retinal lokacin da aka kulle jijiyar retinal ta tsakiya: - ** Minti 0 zuwa 90 na cikakken rufewa:** Nama na retina ya cika da mamaki (ischemic penumbra), amma cikakke ko kusa da cikakken farfadowa na iya yiwuwa idan jini ya dawo nan da nan. - ** Minti 90 zuwa 240 (awanni 1.5 zuwa 4):** Ci gaba, rauni mai rauni na Layer ganglion cell na retinal na ciki yana faruwa; ɓangarorin murmurewa har yanzu yana yiwuwa tare da maimaita gaggawa. - Bayan mintuna 240 (awanni 4+) na cikakken rufewa:** Maɗaukaki, necrosis na retina na ciki yana faruwa, yana barin babban asarar gani na dindindin (yawanci ** kirga yatsu [CF], ** motsin hannu [HM], ko * hasashe haske [LP]** kawai) sai dai idan an sami babban jijiya mai cike da ƙwayar cuta.

Cikakken kwatancen manyan abubuwan gaggawa na ido na ischemic guda 5¶

Yi amfani da wannan tebur na asibiti don bambance embolic CRAO, reshe na reshe na jijiyoyi na retinal, amaurosis fugax, arteritic optic neuropathy (Giant Cell Arteritis), da kuma wadanda ba arteritic optic neuropathy:

Sharadi na 1: Tsaya da Reshe na Rushewar Jiji na Jiji (CRAO & BRAO)¶

Me yasa Ƙungiyar Zuciya ta Amurka ta ba da umarnin "Code Stroke" don CRAO¶

A tarihi, majinyatan da suka rasa gani a ido daya sun fara zuwa wurin likitan ido ko asibitin ido, inda aka shafe sa'o'i ko kwanaki ana duban ido kafin kowa ya duba jijiyoyin kwakwalwar sa ko wuyansa. A cikin 2021, Ƙungiyar Zuciya ta Amurka (AHA)** da ** American Stroke Association (ASA)** sun ba da sanarwar Bayanin Kimiyya da ke canza kulawar CRAO a duniya: 1. CRAO shi ne Mugun ciwon Ischemic: Saboda kwayar cutar kwayar cutar kwayar cutar kwayar cutar mahaifa wani bangare ne na tsarin juyayi na tsakiya kuma ana ciyar da ita ta hanyar carotid artery na ciki, rufewar jijiyar retinal ta tsakiya a zahiri shine ** ischemic bugun jini na retina**. 2. ** 1 a cikin 4 marasa lafiya na CRAO suna da bugun jini na Brain na Juzu'i Yanzu:** Nazarin-nauyin kwakwalwa na MRI (DWI) ya tabbatar da cewa ** 19 zuwa 25 bisa dari na marasa lafiya da ke gabatarwa tare da CRAO ko BRAO suna da bugun jini na ischemic na lokaci guda a cikin kwakwalwar kwakwalwar kwakwalwar kwakwalwa *** wanda ya haifar da bugun zuciya ko da bugun zuciya. mara lafiya ba shi da raunin hannu ko matsalar magana. 3. ** Window Thrombolysis na Jiki ($ le 4.5 rubutu {Sa'o'i}$): ** Lokacin da mara lafiya da ba arteritic CRAO ya isa a ** Zayyana Cibiyar bugun jini ** a cikin ** 4.5 hours ** na farkon bayyanar cututtuka, bayan kai tsaye ba kwatankwacin shugaban CT ya kawar da zubar da jini na kwakwalwa da labs na iya kawar da Giant neurolm Arteritis. plasminogen activator (alteplase ko tenecteplase)**. Binciken meta-bincike na asibiti ya nuna cewa thrombolysis na IV da aka bayar a cikin sa'o'i 4.5 yana haɓaka ƙimar farfadowar gani mai ma'ana idan aka kwatanta da lura da ra'ayin mazan jiya.

Menene "Cherry-Red Spot" akan jarrabawar ido?¶

Lokacin da likitan gaggawa ko likitan ido ya kalli ido tare da CRAO ta amfani da ophthalmoscope ko kyamarar fundus a cikin sa'o'i na harin: - Yadudduka na ciki na retina (wanda aka katange jijiya na retinal na tsakiya) yana kumbura tare da ruwan ciki (** edema cytotoxic ), yana juya ** farar fata mara kyau. - Duk da haka, mataccen bullseye na macula ( foveola ***) takarda ce-baƙi kuma ya ƙunshi ** babu matakan ganglion na ciki na ciki , ana ciyar da shi gabaɗaya ta tushen ** choroid (wanda ake ciyar da shi ta ciliary arteries na baya). - Because the bright red vascular choroid shines right through the thin transparent center while surrounded by a halo of milky-white infarcted retina, it creates the classic "Cherry-Red Spot" of Central Retinal Artery Occlusion.

Why you must NOT rely on home "Ocular Massage" or "Paper-Bag Breathing"¶

Older textbooks suggested pressing forcefully on the closed eyeball (digital ocular massage) or breathing into a brown paper bag (carbogen therapy) for CRAO. - Modern Clinical Verdict (AHA & AAO): Both practices are discouraged for bystanders. Forceful eyeball pressing can rupture an eye with recent surgery, worsen a retinal detachment, or trigger a vagal bradycardia reflex (oculocardiac reflex). Breathing into a paper bag causes systemic hypoxia in older patients without improving retinal survival. The single effective pre-hospital action is laying the patient flat on their back and calling 911 / 112 / 999 for immediate Stroke Center transport.

Special Cause in Adults Under Age 50: Internal Carotid Artery Dissection¶

If a younger adult (aged 20 to 50) develops sudden monocular vision loss or amaurosis fugax, ask if they have neck pain, a one-sided headache, or facial ache, and check their eyelids and pupils in dim light: - A tear in the inner lining of the internal carotid artery in the neck (Internal Carotid Artery Dissection), often triggered by neck whiplash, yoga hyperextension, chiropractic manipulation, heavy lifting, or violent coughing, stretches the sympathetic nerve fibers wrapped around the outside of the carotid artery wall. - This produces ipsilateral Horner Syndrome (a slightly drooping upper eyelid [ptosis] and a smaller constricted pupil [miosis] on the same side as the neck pain) alongside retinal or cerebral emboli. Immediate CT angiography (CTA) of the head and neck in the emergency department confirms the dissection.

Condition 2: Amaurosis Fugax (Transient Monocular Vision Loss / Retinal TIA)¶

Why "vision returning to normal in 5 minutes" is still a 911 / 112 / 999 emergency¶

Amaurosis fugax ("fleeting darkness") occurs when a fragment of cholesterol (a Hollenhorst plaque) or a platelet-fibrin micro-clot breaks loose from a plaque in the internal carotid artery of the neck (or from the heart in atrial fibrillation), lodges briefly in the central retinal artery, and then breaks apart within 2 to 15 minutes: - Patients describe it as "a dark window shade pulling smoothly down over ONE eye" until the eye is gray or black, lasting 3 to 10 minutes, and then lifting back up until vision is 100 percent normal. - The Trap: Because vision returns to normal after 5 minutes with zero pain, many people brush it off as eye strain or a migraine and stay home. - The Reality: Amaurosis fugax is a Retinal Transient Ischemic Attack (TIA). Without emergency hospital evaluation, dual antiplatelet therapy (aspirin + clopidogrel), high-intensity statin therapy, and urgent carotid endarterectomy or stenting (if carotid narrowing is \(70\%\text{ to }99\%\)), the next clot that breaks off hours later can plug the middle cerebral artery, causing permanent paralysis and loss of speech.

How to tell Amaurosis Fugax apart from a benign Visual Migraine Aura or Papilledema¶

Condition 3: Giant Cell Arteritis (GCA / Temporal Arteritis) in Adults Aged 50 and Older¶

Why Giant Cell Arteritis is the most preventable cause of bilateral total blindness¶

Giant Cell Arteritis (GCA), also known as Temporal Arteritis, is an autoimmune granulomatous vasculitis of medium and large arteries that occurs exclusively in adults aged 50 years and older (peaking between ages 70 and 85).

In GCA, immune T-cells and giant cells infiltrate the wall of extracranial branches of the carotid and vertebral arteries: - The artery wall swells inward (intimal hyperplasia) until the central channel clots shut. - When this inflammatory occlusion strikes the short posterior ciliary arteries or central retinal artery, the optic nerve head dies of sudden oxygen starvation (Arteritic Anterior Ischemic Optic Neuropathy [A-AION]), leaving the eye completely dark in over 50 percent of cases. - Agogon "Idon Zumunci": Da zarar ido na farko ya rasa hangen nesa daga GCA, wannan ido na farko da kyar yake murmurewa sosai. **Duk da haka, idan an jinkirta maganin corticosteroid mai girma, kashi 30 zuwa 50 na marasa lafiya suna fama da irin wannan hari a cikin ido na BIYU (sauran) a cikin sa'o'i 24 zuwa kwanaki 7, yana barin su makanta na dindindin a idanun biyu. (sabawa rarrabawar aortic).

Cikakkun Lissafin Alamar Jan Tuta don Giant Cell Arteritis (Shekaru \(\ge 50\))¶

Domin ** kashi 20 cikin 100 na marasa lafiya da ke da hasarar gani daga GCA suna da "GCA gaɓoɓin"** (ƙananan ciwon kai, tare da muƙamuƙi mara hankali ko alamu na tsarin), duba kowane abu akan wannan jerin a kowane babba sama da 50 tare da canjin gani:

• 1. Jaw Claudication (Mafi Specific Symptom of GCA, present in - 50%): Tambayi majiyyaci: *"Lokacin da kuke tauna abinci mai taushi kamar nama ko gurasa mai ɗanɗano na tsawon mintuna 1 zuwa 2, shin tsokoki na muƙamuƙi ko harshenku sun fara ciwo, murƙushewa, ko jin gajiya don haka dole ne ku daina taunawa kuma ku huta? arteritis, wanda ke haifar da ischemia tsoka tsoka.
• 2. Ciwon Ciwon Ciwon Kan Sabon Farowa (Yana cikin kashi 70% zuwa 80%): Wani sabon buguwa, ban sha'awa, ko ƙona ciwon daya ko duka biyu ** temples **, goshi, ko bayan kai a cikin babban mutum.
• 3. Taushin Kwankwasiyya da Jijin Jiji na Jiki na Al'ada: Wanke gashin kai, dora kai akan matashin kai, ko sanya gilashin ido yana jin zafi a fatar kai. Gudun yatsa a hankali akan jini na wucin gadi (a gaban kunne da sama da haikalin) yana nuna bugun jini mai kauri, nodular, taushi mai laushi** mai rauni ko rashi.
• 4. Alamomin Gargaɗi na Kayayyakin Kayayyakin Ƙawance: Taƙaitaccen ɓacin rai na mintuna 5 (amaurosis fugax) ko mai wucewa diplopia (hangen nesa biyu, wanda ke cikin kashi 10% zuwa 15%) wanda ischemia na tsokar ido ke haifarwa.
• 5. Polymyalgia Rheumatica (PMR) da Alamomin Tsarin Mulki (Yanzu a cikin 40% zuwa 50%): Taurin safiya da raɗaɗi a duka biyun ** kafadu, wuyansa, da kwatangwalo** yana dawwama fiye da mintuna 45 bayan farkawa, tare da ** ƙananan zazzabi, gumi na dare, anorexia, ko asarar nauyi ba da gangan ba ***.

Yarjejeniyar Gaggawa na Asibiti don Wanda ake zargin Giant Arteritis¶

Bisa ga ka'idodin aikin haɗin gwiwa na asibiti na ** Kwalejin Rheumatology na Amurka (ACR) , Ƙungiyar Ƙungiyoyin Ƙungiyoyin Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararru (EULAR) 1. Fara Corticosteroids Masu Girma Mai Girma Nan da nan Kan Zato Na asibiti (Kafin Biopsy ko Labs ya dawo): - Idan WANI bayyanar cututtuka na gani ya kasance (rashin hangen nesa, amaurosis fugax, ko hangen nesa biyu): Gudanar da ** methylprednisolone na jini \(500\rubutu zuwa }1,000\rubutu{mg}\) IV a kowace rana don kwanaki 3 a jere, tare da babban kashi na baka prednisone ($ 1 yawanci $ 6 $ \(/text }80\rubutu{mg}\) kullum) da la'akari da tocilizumab. - Idan alamun GCA na cranial suna nan BA TARE da alamun gani ba tukuna: Fara ** prednisone na baka \(40\rubutu zuwa }60\rubutu{mg}\) kullum** nan take. 2. Kada Ka Taba Jinkirta Sisteroids Jiran Jini na Jijiyoyin Jiji na ɗan lokaci ko Ultrasound: Canje-canje masu kumburi da manyan ƙwayoyin da ke cikin bangon jijiya na wucin gadi na ci gaba da ci gaba har zuwa kwanaki 10 zuwa 14 bayan fara manyan ƙwayoyin steroids**, yayin da jinkirin steroids ta ko da awanni 12 na iya kashe majiyyaci ragowar ido. 3. An Bada Umarnin Gwajin Jini Nan da nan a cikin ER: Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP), da Complete Blood Count (CBC) (duba don amsawa thrombocytosis tare da platelets \(> 400,\)Ltext{000).

Daidaitaccen rubutun sadarwa na 911/112/999 da kuma bambancin asibiti¶

Saboda rashin raɗaɗin hangen nesa yana sa waje na ido yayi kama da kashi 100 na al'ada (farin sclera, bayyanannen cornea), ma'aikatan rarrabuwa a asibitocin gabaɗaya na iya yin la'akari da gaggawar sa sai dai idan kun yi amfani da ainihin bugun jini da kalmomin vasculitis:

• Don abin da ake zargi da rufewar jijiya ta tsakiya (CRAO) a cikin Awanni 4.5:

  "I need an emergency ambulance at [Exact Address]. The patient is a [Age]-year-old [male/female] who developed sudden, complete, painless blindness in the [left/right] eye at [Exact Minute of Onset]. According to American Heart Association guidelines, we suspect an acute Ocular Stroke (Central Retinal Artery Occlusion) and need immediate Code Stroke transport to a Designated Stroke Center within the Tagan thrombolysis na ciki na awa 4.5."

• Ga Wanda ake zargin Giant Cell Arteritis (Tsarin Arteritis) a cikin Baligi Mai Shekaru 50+:

  • "Matsalar gaggawa: wannan [Shekaru] mai shekaru yana da asarar hangen nesa kwatsam (ko hangen nesa biyu / dimming mai wucewa) a cikin ido (hagu / dama) tare da [sabon ciwon kai na haikali / ciwon kai / ciwon jaw yayin cin abinci]. (500 zuwa 1,000 MG IV) YANZU don hana makanta ta dindindin a cikin ido.

• Domin Magance Amaurosis Fugax (Retinal TIA):

  • "Mai haƙuri shine mai shekaru [Shekaru] wanda ya sami cikakkiyar baƙar fata mara zafi ('inuwa taga') a cikin [hagu / dama] ido na tsawon mintuna [Lambar] a [Lokaci] a yau. Ko da yake hangen nesa ya koma al'ada, wannan shine Amaurosis Fugax, wani m Retinal TIA, kuma yana buƙatar gaggawa na Stroke Center na gaggawa, ƙwaƙwalwar ƙwayar cuta, MRI, da kwakwalwa. "*

Tambayoyin da ake yawan yi¶

Me yasa waje na ido yayi kama da fari da al'ada yayin bugun jini (CRAO) ko arteritis na wucin gadi?¶

Tasoshin jini da ke sa saman ido yayi ja yayin ido mai ruwan hoda ko glaucoma su ne na waje conjunctival da episcleral tasoshin a gaban idon ido. A cikin tsakiyar Retinal Artery Occlusion da Giant Cell Arteritis, toshewar jijiya yana faruwa a zurfin bayan kwas ɗin ido a cikin ƙaramin jijiya na retinal na tsakiya ko gajeriyar jijiyar ciliary na baya wanda ke ciyar da retina da jijiyar gani, don haka gaban ido ya kasance gaba ɗaya fari kuma ba shi da zafi yayin da retina a ciki ke fama da yunwar iskar oxygen.

Ta yaya zan bincika a gida idan kwatsam hangen nesa yana cikin ido ɗaya (maɗaukaki) ko idanu biyu (binocular)?¶

Lokacin da ido daya ya rasa gani kwatsam ko ya fito da inuwa mai duhu, kwakwalwar dan Adam na kokarin hade hoton da aka saba daga ido mai kyau da duhun hoton da ba mummuna ba, wanda hakan kan sa mutum ya ji kamar idanuwan biyu sun yi shuhura ko suma. A koyaushe ka rufe idonka na hagu gaba daya da tafin hannunka don gwada idonka na dama shi kadai, sannan ka rufe idonka na dama don gwada idonka na hagu kadai; nan take wannan ya nuna ko baqin ido ya yi tsauri a cikin ido daya ko kuma ya shafi rabin idon biyu na hagu ko dama.

Me yasa ciwon jaw lokacin cin abinci (jaw claudication) shine alamar gargadi mafi mahimmanci na Giant Cell Arteritis?¶

Ba kamar haɗin gwiwa na temporomandibular (TMJ) ba, wanda ke cutar da lokacin da ka buɗe bakinka ko ka ciji wani abu mai wuya, ƙwayar jaw a cikin Giant Cell Arteritis yana haifar da kumburi na autoimmune yana rage arteries da ke ba da jini ga tsokoki da harshe. Domin tsokoki ba za su iya samun isasshiyar iskar oxygen ba yayin motsa jiki mai maimaitawa, muƙamuƙin ku yana jin daɗi a farkon cizon abinci, yana haifar da ciwo mai zurfi ko gajiya bayan taunawa na 60 zuwa 90 seconds, kuma yana jin daɗi da zarar kun daina tauna; gane wannan alamar kuma zuwa ER don maganin steroid yana hana makanta kwatsam.

Idan ganina ya yi duhu a ido daya na tsawon mintuna 5 sannan ya dawo daidai bisa dari, me ya sa ba zan iya jira kawai in ga likitan ido na mako mai zuwa ba?¶

Baƙin minti 5 mara zafi a cikin ido ɗaya (amaurosis fugax) yana nufin ɗigon jini ko crystal crystal ya balle daga ƙunƙuntaccen jijiya na carotid a wuyanka ko daga zuciyarka, ya toshe babban jijiyar idonka, sannan ya rabu. Har zuwa 1 a cikin 4 marasa lafiya tare da abubuwan da suka faru na artery na retinal sun riga sun sami sabon alamun bugun jini a kan kwakwalwar MRI, kuma hadarin daɗaɗɗen bugun jini na kwakwalwa ya kasance mafi girma a cikin sa'o'i 24 zuwa 72 na farko bayan wannan lamarin gargadi, yana buƙatar ziyartar Cibiyar Stroke na asibiti.

An duba tushe¶

• ** Ƙungiyar Zuciya ta Amirka (AHA) da 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 Ƙasar Amurka Massage ido mai ra'ayin mazan jiya).
• American College of Rheumatology (ACR, United States) and European Alliance of Associations for Rheumatology (EULAR): 2021 ACR/Vasculitis Foundation Guideline and EULAR Recommendations for the Management of Giant Cell Arteritis (immediate IV methylprednisolone \(500\text{ to }1,000\text{ mg/day}\) for visual loss prior to temporal artery biopsy ko duban dan tayi).
• ** Ƙungiyar Burtaniya don Rheumatology (BSR, United Kingdom) da Cibiyar Kula da Lafiya da Kulawa ta Kasa (NICE, United Kingdom):** *Jagora kan Bincike da Jiyya na Giant Cell Arteritis * da * NICE NG128: Harin Ischemic mai Gusau a Sama da 16s * (maurosis fugax) gaggawar TI.
• ** Kwalejin Ilimin Ido ta Amurka (AAO, Amurka):** Tsarin Ayyukan Da Aka Fi So (PPP): Rufewar Jiji da Jini.
• ** Kwalejin Royal na Likitan Ido (RCOphth, United Kingdom):** *Jagorancin Sabis na Ido: Gudanar da Ƙunƙarar Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararru.

Jagora masu alaƙa¶

• Rashin hangen nesa kwatsam, cirewar ido, da matsanancin glaucoma-ƙulli
• Ganewar bugun jini (FAST) da amsa gaggawa
• Orbital cellulitis, kumburin ido cututtuka, da cavernous sinus thrombosis
• Ragewar aortic da ruptured aortic aneurysm na ciki
• Gane ciwon zuciya da taimakon farko