Syndrome ya koyiba subclavien mpe dissection ya artérie vertébrale: Syncope tango ya kosala ngalasisi ya loboko moko, >20 mmHg Inter-Arm BP Gap, mpe AVC ya Manipulation Cervical¶

Syndrome ya moyibi ya subclavien (SSS) mpe Disection ya artérie cervical / vertébrale (VAD) ezali ba urgences vasculaires mibale ya critique ya circulation postérieure (système artériel vertebrobasilaire) oyo ekataka flux ya makila na tiche ya cerveau, cérébelle, mpe ba lobes occipitales, ebimisaka kizunguzungu ya mbalakaka oyo ebalukaka (vertigo), komona mbala mibale (diplopie), koloba malamu te (dysarthrie), mpasi ya komela (dysphagie), kozanga kotɛngatɛnga (ataxie), to kosila mayele ya mbalakaka (syncope). Na Syndrome ya koyiba subclavien, blocage makasi na origine ya artérie subclavienne (mingi mingi na gauche) esalaka que kosala ngalasisi ya loboko oyo ezo toma e emela makila sima na se ya artérie vertébrale mosika na tronche ya cerveau, emonisaka diagnostic monene koleka 15 à 20 mmHg différence ya tansion systolique entre maboko mibale (mpe e déclenchaka pasi ya ntolo ya koyiba coronaire-subclavien na ba maladi oyo bazali na greffe ya bypass cardiaque ya artérie mammaire interne gauche [LIMA]. Na Disection ya artérie vertébrale, manipulation ya nkingo chiropractique ya vitesse makasi, kozoka na fimbu, hyperextension ya yoga, to kosukosu ya mobulu epasoli revêtement ya kati ya artérie vertébrale na kati ya mikuwa ya nkingo, etelemi lokola ntina ya liboso ya AVC ya circulation postérieure (syndrome médullaire latérale ya Wallenberg) na mikóló oyo bazali na nse ya mbula 45, mpe pene na ntango nyonso ebandaka na likebisi kingo ya nsima ya ngámbo moko to mpasi ya motó ya occipital. Soki moto moko azwi vertigo ya mbalakaka, amoni mbala mibale, alɛmbi ntango azali kosala mosala ya lobɔkɔ, to bilembo ya misisa ya bɔɔngɔ nsima ya mpasi ya nkingo, benga esika ofandi banimero ya mbalakaka (911 na États-Unis mpe na Canada, 112 na Union européenne mobimba, 999 na Royaume-Uni) mbala moko. Ntango ozali kozela basali ya lisalisi ya liboso, talelá malako oyo etali yango na ntina na koyeba AVC mpe eyano, . attaque ischémique transitoire (TIA) mpe likama ya AVC ya ngonga 24, mpe dissection ya aorte mpe aneurisme oyo epasuka.

Ba AVC ya circulation postérieure mpe ba TIA ezali notoirement kozanga na ba outils standard ya dépistage ya AVC lokola "FAST" (Elongi, Lobɔkɔ, Elobeli, Tango), oyo etali mingi circulation carotide antérieure. Tango nionso mobeli azali ko présenter na kizunguzungu aigu, débalancement, to évanouillage, ko vérifier tansion bilatérale ya loboko mpe kosala test ya "5 Ds ya Ischémie ya Circulation Postérieure" (Kzunguzungu, Diplopie, Dysarthrie, Dysphagie, mpe Dystaxie/Drop attacks) ekoki kobikisa tronche ya cerveau mpe bomoi na ye.

Sala boye sikoyo¶

1. Benga mbala moko nimero ya urgence ya esika ofandi mpo na vertigo nyonso ya mbalakaka oyo esanganami na komona mbala mibale, koloba malamu te, kolɛmba elongi, mokakatano ya komela, kozanga likoki ya kotambola, to kolɛmba nzoto. Benga 911 na États-Unis mpe na Canada, 112 na Union européenne mobimba, 999 na Royaume-Uni, 000 na Australie, to tuna na répertoire na biso ya banimero ya mbalakaka. Soki moto yango azwaki mpasi ya motó ya makasi, ya ngámbo moko ya nsima ya nkingo to ya nse ya mokuwa nsima ya kobongisa nkingo na chiropratique, kosalela mindoki ya masaje na nkingo, kokutana na masano, to kotombola kilo, yebisa mbala moko motindiki ete: "Suspected Vertébral Arterie Dissection and posterior circulation stroke within the thrombolyse window."
2. Tika mbala moko ngalasisi nionso to mouvement ya likolo ya loboko oyo ezo bela pe lalisa mutu. Na Syndrome ya koyiba subclavien, contraction nionso ya muscle ya loboko oyo ezo bela (mingimingi loboko ya gauche tango ya ko peinture, ko scrubber, kotombola, to ko manivelle) ekitisaka résistance vasculaire na loboko pe e siphoner makila mingi sima libanda ya tronche ya cerveau. Kopema loboko na ngambo ya moto etelemisaka mbala moko moyibi ya métabolisme mpe ezongisaka koleka ya artérie basilaire liboso na cerveau.
3. Meka tansion na maboko MIBALE mpe vérifier ba pulsations nionso mibale ya poignet (radial) na mbala moko. Bokeseni ya tansion systolique ya monene koleka 15 à 20 mmHg kati na maboko ya droite na gauche, elongo na pulse radiale ya bolembu, retardé, to absent mpe malili na loboko ya kotanga na se, ezali elembo ya bedside ya ** subclavian proximal sténose artérielle**, artérite Takayasu, to dissection aiguë ya aortique Type A.
4. Bomba nkingo na alignment neutre, confortable mpe JAMAIS ko tourner, kotanda, kosala massage, to ko manipuler nkingo oyo ezali kosala pasi. Soki dissection ya artérie vertébrale to carotide ezali, coagulation ya makila (hématome intramural mpe thrombus intraluminal) ezali kokangama na ndenge ya précarious na mur artériel oyo epasuka na kati ya colonne vertébrale cervical. Kobaluka to kopasola lisusu nkingo ekoki kokata embolus mbala moko na artérie basilaire, kosala syndrome locked-in oyo ebomaka to infarctus ya tronce ya cerveau.
5. Kobatela mobeli strictement nil na monoko (eloko ya kolia, komela, to komela te, ata aspirine to mayi ya monoko te). Ezala dissection ya artérie vertébrale (AVC médullaire latéral ya Wallenberg) mpe ischémie basilaire e paralyser ba nerfs crâniens ya libwa mpe ya zomi (nerfs glossopharyngés mpe vagus) oyo etambwisaka reflexe ya gag mpe ya komela (dysphagie neurogène). Kopesa mai to bankisi ya aspirine oyo emɛlaka ekoki kosala ete moto akɔta nokinoki na mimpululu mpe oyo ekoki koboma moto.
6. Tala minute exacte ba symptômes neurologiques ebandaki (ntango "Last Known Well") mpe senga Angiogramme ya CT (CTA) ya Mutu na Ntolo na lopitalo. Ba CT scans ya mutu ya pamba sans contraste ezangaka koleka 70 à 85 pour cent ya ba AVC ya liboso ya trouche ya cerveau mpe ya cerveau mpo na ba artifacts ya mikuwa ya base ya crâne. Esengeli osala spécifiquement CT Angiogramme (CTA) ya mutu na kingo kobanda na arc aortique tee na vertex (to MRI pondérable à diffusion + MRA) mpo na komona na makanisi dissection ya artérie vertébrale to occlusion subclavienne.

Nzete ya mokano : triage ya syncope ya exercice ya loboko, >20 mmHg ya écart ya BP entre bras, mpe vertigo ya mpasi ya kingo¶

flowchart TD
    Start["Vertigo aigu, Syncope, Diplopie, Dysarthrie, Ataxie, to Faiblesse / Claudication ya loboko unilatérale"] --> BPCheck["Vérification ya mbala moko pembeni ya mbeto: Benga 911 / 112 / 999, Pema Maboko Mibale, Meka Tansion na Maboko MIBALE ya Droite na Gauche, Vérifier ba Puls Radiaux Bilatéraux"]

    BPCheck --> GapCheck{"Ezali na Différence ya tansion systolique entre bras >= 15 à 20 mmHg?"}

    GapCheck -->|"OUI: >= 15-20 mmHg Esika ya BP kati na maboko + Pulse radiale retardé/faible"| ChestPainCheck{"Ezali na Pasi ya Ntolo/mokɔngɔ oyo ezali kopasola na mbalakaka TO Konyata Angina na Mobɛli oyo asali Bypass ya motema ya LIMA liboso?"}

    ChestPainCheck -->|"OUI + Kopasola Pasi ya Ntolo/Mokɔngɔ"| AorticDissection["Dissection aortique aiguë ya Type A oyo ekanisami oyo epanzani na artérie subclavienne: Aortogramme ya CT ya mbala moko, IV Beta-Blocker (Esmolol/Labetalol na HR < 60, SBP 100-120 na loboko ya LIBOSO), Chirurgie Cardiothoracique d’urgence"]

    ChestPainCheck -->|"OUI + Angina Na tango ya Exercice ya loboko ya gauche na Mobeli ya CABG ya liboso"| CoronarySteal["Syndrome ya koyiba coronaire-subclavien (Flux rétrograde likolo ya greffe LIMA mosika na artérie coronaire LAD): Kotika kosala makasi na loboko, Duplex & CTA ya urgence, Angioplastie subclavienne endovasculaire & Stent"]

    ChestPainCheck -->|"NO Pasi ya ntolo: Claudication ya loboko + Vertigo/Syncope Tango ozali kosala ngalasisi ya loboko moko"| SubclavianSteal["Syndrome classique ya koyiba subclavien (Flux ya artérie vertébrale rétrograde): Ultrason duplex (Forme d’onde de lapin -> flux rétrograde) + Arche CTA, Stenting endovasculaire to Bypass carotid-Subclavien"]

    GapCheck -->|"NO (< 10-15 mmHg Gap): Ba Puls Bilatéraux Normales"| NeckPainCheck{"Ezali na Pasi ya kingo ya sima / ya occipital unilatérale, Manipulation/Traumatisme/Yoga ya kingo oyo euti kosalema, to bilembo ya médullaire latéraux (Syndrome ya corner, koganga, Perte sensorielle croisée)?"}

    NeckPainCheck -->|"OUI: Ba soupçons makasi mpo na dissection ya artérie vertébrale (VAD) ."| VADProtocol["Dissection ya artérie vertébrale oyo ekanisami & AVC ya sima (Syndrome ya Wallenberg): Neutre ya kingo, NPO ya makasi, CTA ya mbala moko ya mutu & nkingo + IRM/MRA ya cerveau, Thrombolyse IV (tPA/TNK soki < 4.5h) Elandami na Antiplaquette (Aspirine/DAPT) to Anticoagulation pendant 3-6 Mois"]

    NeckPainCheck -->|"NO Pasi ya nkingo: Syndrome vestibulaire aigu ya peto"| HINTSCheck["Sala Examen ya CONSEILS côté ya mbeto (Ipulse ya mutu, Nystagme, Test ya Skew) + Vérification ya marche pona ko exclure AVC ya Cerebelle / AICA / PICA vs. Neurite Vestibulaire"]

Eteni ya 1: Syndrome ya moyibi ya subclavien (SSS) mpe koyiba ya coronaire-Subclavien¶

Mecanisme anatomique: ndenge oyo lobɔkɔ na yo ya mwasi eyibaka makila na mokuwa na yo ya bɔɔngɔ (mpe na motema na yo) .¶

Na momeseno, makila oyo ezali na oxygène oyo ebimaka na arc aortique ya motema ekɔtaka na artérie subclavienne gauche (mpe na ngambo ya mobali, tronco brachiocéphalique [innominate] oyo ekabwani na artérie carotide commune droite mpe artérie subclavienne droite). Kaka mwa ba centimètres sima ya kobima na arc aortique, artérie subclavienne ebimisaka etape na yango ya liboso ya monene oyo emati: Artérie vertébrale, oyo emata na mikuwa ya nkingo na kati ya mokuwa ya motó mpe esanganaka na molongani na yango uta na ngambo mosusu mpo na kosala Artérie Basilaire oyo epesaka tronche ya cerveau, cerveau, mpe cerveau ya sima.

Nini esalemaka soki plaque atherosclérose makasi (to artérite Takayasu na basi oyo bazali na nse ya mbula 40, compression ya sortie thoracique, to fibrose ya rayonnement) ekangaka segment proximal ya artérie subclavienne AVANT décollage ya artérie vertébrale? 1. Po na nini côté gauche ezo affecter mbala 3 à 4 fois (75% à 85% ya ba cas): Artérie subclavienne gauche ezo brancher na arc aortique na angle aigu, turbulent oyo e favorisaka makasi accumulation ya plaque atherosclérose na ostium na yango. 2. The Pressure Drop & Retrograde Siphon: Na se ya blocage subclavian proximal, tansion na kati ya artérie sous-clavienne ekiti makasi (ndakisa, na 90/60 mmHg na loboko ya mwasi pendant que loboko ya mobali etanga 140/85 mmHg, 50 mmHg ya écart ya tansion inter-arm). 3. Moyibi ya moboko oyo euti na ngalasisi: Tango nyonso oyo loboko ya mwasi ezali kopema na kimia, misisa ya collatérale ekoki kosala ete mobɛli azala na bilembo te (Phénomène ya koyiba subclavien). Kasi, na ntango oyo mobɛli azali kosala ngalasisi na lobɔkɔ na ye ya mwasi, na ndakisa kosimba lobɔkɔ na ye likoló mpo na kopakola langi na plafɔ, kosukola maninisa, kotombola kilo to kobɛta mai, misisa ya lobɔkɔ oyo ezali kosala ngalasisi ebimisaka biloko oyo ekómisaka misisa ya misisa ya nzoto na esika yango (adénosine, oxyde nitrique, lactate), mpe yango ekitisaka résistance vasculaire na lobɔkɔ ya mwasi. Makila elandaka nzela oyo ezali na résistance moke: makila esopanaka LISUSU na artérie vertébrale droite oyo ezali malamu na kati ya crâne, ebalusaka U-turn ya makasi na jonction vertebrobasilaire, mpe ekendeke mbangu NA SIMA (retrograde) NA SE ya artérie vertébrale gauche na loboko ya mwasi, ezongisaka nzala ya tronche cérébrale mpe cerveau ya oxygène.

ANATOMY OF LEFT SUBCLAVIAN STEAL & CORONARY-SUBCLAVIAN STEAL SYNDROME

                 [ BASILAR ARTERY ] (Brainstem & Cerebellum Starved of Blood)
                      /      \
  Normal Upward      /        \   RETROGRADE "STEAL" FLOW (Blood sucked
  Forward Flow      /          \  DOWNWARD out of the brain into the left arm)
         |         /            \         |
         |        /              \        v
  [ Right Vertebral ]          [ Left Vertebral Artery ]
         |                                |
         |                                v
  [ Right Subclavian ]   [99% BLOCK]--[ Left Subclavian Artery ] ---> [ EXERCISING ]
         |               (Proximal)       |                           [  LEFT ARM  ]
         |                  |             |                           (Low Resistance
  =======+==================+=============|=======                     Siphon Sink)
  [               AORTIC ARCH             |      ]
                                          |  RETROGRADE CORONARY STEAL
                                          |  (In patients with a prior LIMA-to-LAD
                                          |   heart bypass, blood is sucked UP the
                                          +-- LIMA graft AWAY from the heart muscle)

Variante oyo ebomaka: Syndrome ya koyiba coronaire-subclavien (CSSS) na ba malades ya bypass cardiaque¶

Na lipaso ya motema, conduit ya standard ya or oyo esalelamaka mpo na ko contourner artérie coronaire Left Anterior Descending (LAD) oyo ekangami ("mosali mwasi oyo mobali akufá") ezali Artérie Mammaire interne gauche (LIMA), oyo etikali ekangami na origine naturelle na yango na na se ya artérie subclavienne gauche kaka distal na artérie vertébrale. - Soki mobɛli oyo asali liboso Greffe ya bypass ya artérie coronaire LIMA-à-LAD (CABG) azwi blocage makasi na artérie subclavienne gauche proximale na ye, kosala ngalasisi ya loboko na ye ya mwasi amemaka makila na sima UP greffe ya bypass ya LIMA mosika na mur ya liboso ya motema oyo ezali kobeta na loboko ya mwasi. - Signature clinique ya moyibi ya coronaire-Subclavien: Tango nionso mobeli asalelaka loboko na ye ya gauche, azuaka pasi ya ntolo ya angina ya konyata, pema mokuse, elevation/dépression ya segment ST, arrhythmies ventriculaire, to crise cardiaque. Yango wana ba cardiologues basengeli ntango nyonso komeka tansiɔ na maboko MIBALE yambo ya kosala lipaso ya CABG mpe na mobeli nyonso ya bypass oyo azali ko présenter na mpasi ya ntolo oyo ezongaka mbala na mbala.

Ba 3 Grades ya Moyibi ya Subclavien na Ultrason Doppler Duplex (mpe Test ya Manchette ya Hypérémie)¶

Na ultrasons Duplex Doppler ya flux ya couleur ya kingo, ba spécialistes vasculaires ba classifier moyibi ya subclavien na 3 grades hémodynamiques selon forme ya mbonge ya artérie vertébrale: - Grade 1 (Pre-Steal / Occult Steal - "Bunny Waveform"): Débit antegrade (avant) ekobaka na cycle cardiaque mobimba, kasi ezali na notch ya décélération ya vitesse ya mid-systolic ya makasi oyo epesaka Doppler oyo ezali ko tracer silhouette incontestable ya lapin crouchant (forme ya mbonge ya "lapin lapin"). - Grade 2 (Partial / Intermittent / Alternating Steal): Débit bidirectionnel : makila ezo kende na sima (retrograde) na se ya artérie vertébrale na tango ya sommet systole (ntango pression na loboko ekiti par rapport na cerveau) pe ezo couler avant (antegrade) na tango ya diastole. - Grade 3 (Complete / Permanent Steal): Continuous 100% retrograde (return) écoulement na se ya artérie vertébrale na cycle cardiaque mobimba. - Momekano ya manchette ya provocation ya hyperémie réactive: Na ba malades oyo bazali na koyiba ya Grade 1 to Grade 2, sonographe a gonfler manchette ya tansion na loboko oyo ezo affecter na 20 mmHg likolo ya pression systolique pendant 3 à 5 minutes tango mobeli azali kofina boule, sima a défler noki manchette. Vasodilation réactive ya mbalakaka na loboko ebongoli mbala moko "forme ya mbonge ya lapin" ya Grade 1 na franch écoulement rétrograde ya Grade 3.

Traitement définitif ya Syndrome ya koyiba subclavien symptomatique¶

• Phénomène ya koyiba subclavien asymptomatique (écoulement rétrograde incidental na échographie to écart ya BP sans claudication ya loboko, TIA/syncope vertebrobasilaire, to koyiba coronaire): Traité na ndenge ya conservateur na thérapie médicale optimale (Aspirine 75-100 mg chaque jour, statin ya intensité makasi lokola atorvastatine 40-80 mg to rosuvastatin 20-40 mg, kotika komela likaya, mpe komeka tansion na bozindo na loboko oyo etangami mingi te mpo ete hypertension ezanga te to ezwama malamu te).
• Syndrome ya koyiba subclavien symptomatique to koyiba coronaire-subclavien: Esengaka revascularisation:
• Angioplastie transluminale percutanée endovasculaire de première ligne (PTA) mpe Stentage expandable na ballon ya artérie subclavienne proximale (succès technique > 95%, ntango ya kozanga mosala ya moke).
• Bipass chirurgicale extra-anatomique (** Bypass carotid-à-Subclavien** kosalela greffe prothétique PTFE/Dacron, Transposition subclavienne-carotide, to ** Bypass axillo-Axillaire**) mpo na ba occlusions totales chroniques ya segment milayi oyo ekoki kokatisama na endovasculaire te.

Eteni ya 2: Dissection ya artérie vertébrale (VAD) mpe AVC médullaire latéral ya Wallenberg¶

Alors que Subclavian Steal ezuaka mingi mingi ba grands adultes (âge > 55) na atherosclérose, Dissection ya artérie vertébrale (VAD) (elongo na dissection carotide interne) ezali bobele 2% ya ba AVC ischémiques nionso na mobimba, nzokande epesaka 15 kino 25% ya ba AVC nionso na bilenge mpe mikóló ya mibu ya katikati oyo bazali na nse ya mibu 45.

Pourquoi Segment V3 na C1-C2 epasuki na tango ya manipulation ya kingo, sports, to traumatisme ya mike¶

Artérie vertébrale ekabolami na 4 segments anatomiques (V1 à V4): - V1 (Préforaminal): Ebandeli uta na artérie subclavienne kino na foramen transversale C6. - V2 (Foraminal): Emati semba likolo na nzela ya mabulu ya mikuwa (foramine transversale) ya C6 na nzela ya C2 vertèbres cervical. - V3 (Boucle Extradural / Atlantoaxial - ZONE YA DANGER): Abimi na mokuwa ya C2, esalaka boucle horizontale ya 90 degrés ya makasi mpe kogumbama mosusu ya vertical zingazinga ya vertèbre C1 (atlas), mpe etɔbɔlaka dura mater na foramen magnum. Lokola 50 % ya kobaluka nyonso ya motó ya moto (kobalusa nsuki na yo na lobɔkɔ ya mwasi to na lobɔkɔ ya mobali) esalemaka na litonga atlantoaxial C1-C2, eteni ya V3 esalemaka na nguya makasi ya kotandama mpe ya kokatakata na ntango ya kobaluka mpe ya hyperextension. - V4 (Intradural / Intracranial): Ekoti na crâne, ebimisaka Artérie cérébelle inférieure postérieure (PICA), mpe esangani na artérie vertébrale opposée mpo na kosala Artérie Basilar.

Ba déclencheur oyo emonanaka mingi mpe ba vulnérabilités ya tissus connexes sous-jacents¶

1. Ba déclencheur ya kingo mécanique (Mbala mingi na ndenge ya kokamwa):
2. Manipulation ya colonne vertébrale cervicale ya vitesse makasi (Chiropratique / osteopathique neck Thrusts): Liloba ya siansi ya Association américaine du cœur / Association américaine des AVC (AHA/ASA) emonisi boyokani makasi ya épidémiologique kati na traitement manipulatif ya cervix na dissection ya artérie vertébrale ya segment V3 na bilenge oyo bakómi mikóló.
3. Sports, Exercise & Activités ya mokolo na mokolo: Ba crashes ya mituka ya whiplash, ba balancements ya golf, ba serves ya tennis, natation, levage ya poids ya kilo na likolo, ba headstands/hyperextension ya yoga ("syndrome ya AVC ya salon de beauté" tango ozali ko incliner nkingo na sima na lavabo ya kosukola suki ya salon), ba montagne russes, to kosalela munduki ya massage percussive na nkingo.
4. Kosukosu na mobulu, Koswa, Kosanza, to Kopusama na kobota.
5. Artériopathies sous-jacentes (Ezali na 15% kino 50% ya ba Dissections "Spontanées"):
6. Dysplasie fibromusculaire (FMD) ("kobima ya "string-of-perles" ya ba artéries rénale mpe ya cervix; ezali na 15% kino 20% ya ba dissections spontanées ya artérie cervicale), Syndrome vasculaire Ehlers-Danlos (Type IV - COL3A1), Syndrome ya Marfan, Loeys-Dietz Syndrome, mpe Osteogénèse Imperfecta.

Ndenge nini Dissection ya artérie vertébrale epesaka AVC: Syndrome médullaire latéral ya Wallenberg¶

Tango doublure ya kati (intima) ya artérie vertébrale epasuka, makila ya artérielle ya pression makasi etimolaka na mur musculaire, esala lumen ya lokuta / hématome intramurale. Yango e déclenchaka AVC na nzela ya ba mécanismes mibale: 1. Thromboembolisme artérie-à-artérie (85% ya ba cas): Ba facteurs ya coagulation ya makila e contacter collagène subendothélial exposé na esika ya déchirure, esala coagulation oyo epanzani pe ekangamaka Artérie cérébellaire inférieure postérieure (PICA), artérie vertébrale distal, to Artérie basilaire. 2. Occlusion hémodynamique ya Lumen (15% ya ba cas) to Hémorragie Subarachnoïde Intracrânienne (soki segment intracrânial V4 ya mur mince epasuka).

Elilingi ya kliniki ya kala ya Syndrome ya Wallenberg (Infarctus médulaire latéral) .¶

Ya liboso, 70 kino 80 % ya ba maladi bazwaka mpasi ya mbalakaka ya nkingo ya nsima na ngámbo moko mpe mpasi ya motó oyo ezali kobɛtabɛta na occipital (mokɔngɔ ya motó), oyo mbala mingi bakanisaka ete ezali misisa ya nkingo oyo ebendami to migraine na boumeli ya bangonga tii mikolo mingi (moyenne jours 1 à 4, jusqu’à 2 semaines) liboso ete AVC ebɛta. Tango coagulation e occluer artérie vertébrale ipsilatérale to PICA, e infarcter coin latérale ya médulla oblongata na cérébel inférieur, ebimisaka Syndrome de Wallenberg oyo ekoki kozala na congo te:

WALLENBERG LATERAL MEDULLARY SYNDROME (THE "CROSSED" BRAINSTEM STROKE)

  [ IPSILATERAL SIGNS (Same Side as the Torn Vertebral Artery & Neck Pain) ]
    * HORNER SYNDROME (Sympathetic tract): Drooping eyelid (Ptosis), Constricted
      pupil (Miosis), and Loss of facial sweating (Anhidrosis) on the SAME side.
    * FACIAL LOSS OF PAIN & TEMPERATURE (Spinal Trigeminal Nucleus CN V):
      Numbness to pinprick and heat/cold on the SAME side of the face.
    * ATAXIA & FALLING TO THE SAME SIDE (Inferior Cerebellar Peduncle / Cerebellum):
      Violent spinning Vertigo, Nystagmus, Nausea/Vomiting, and falling toward the lesion.
    * BULBAR PALSY (Nucleus Ambiguus CN IX & X): Hoarse voice (vocal cord paralysis),
      Loss of gag reflex, severe Dysphagia (cannot swallow), and intractable Hiccups.

  [ CONTRALATERAL SIGNS (Opposite Side of the Body Below the Neck) ]
    * CONTRALATERAL BODY LOSS OF PAIN & TEMPERATURE (Spinothalamic Tract):
      Cannot feel hot water or pinprick on the arm, trunk, and leg on the OPPOSITE side.
    *(Note: Motor strength in the arms and legs is often SPARED unless the stroke
      extends forward into the medial medulla or basilar artery)*

Tableau ya comparaison complète: Steal subclavian vs. Dissection ya artérie vertébrale vs. Vertigo bénign (BPPV / Neurite vestibulaire)¶

Traitement ya lopitalo ya Dissection ya Artérie Vertébrale: Thrombolyse, Essai CADISS (Antiplaquettes vs. Anticoagulation), mpe Keba na rupture ya V4¶

1. Thérapie ya réperfusion aiguë (Na kati ya 4,5 à 24 heures sima ya début ya AVC):
2. Thrombolyse intraveineuse (Alteplase [tPA] to Tenecteplase [TNK]): Na se ya AHA/ASA Guidelines ya AVC ischémique aigu, dissection ya artérie cervical to vertébrale extracrânienne ezali SAFE mpe RECOMMANDÉ mpo na thrombolyse intraveineuse na kati ya 4,5 heures sima ya ebandeli ya bilembo (soki ezali na intracranial te hémorragie subarachnoïde na CT ya liboso ya motó).
3. Thrombectomie mécanique: Soki thrombus oyo euti na dissection ya artérie vertébrale e emboliser na kati mpe ekangami na Artérie Basilaire (AVC oyo ebomaka mingi na kisi, na... > 80% liwa soki basalisi yango te, epesaka quadriplegie mpe syndrome locked-in), thrombectomie mécanique endovasculaire ya urgence esalemaka kino heures 24 kobanda ebandeli.
4. Kopekisa AVC oyo ezongaka mbala na mbala: Thérapie antiplaquette contre Anticoagulation (Ba épreuves CADISS na TREAT-CAD):
5. Soki balongoli hémorragie aiguë, ba maladi oyo bazali na extracrânienne (segment V1, V2, to V3) dissection ya artérie vertébrale esengaka sanza 3 to 6 ya traitement antithrombotique mpo na kopekisa ba coagulation emboliser na déchirure intime brute tango artérie ezo bikisa yango moko.
6. Ba études cliniques randomisées ya repère (CADISS mpe TREAT-CAD) e prouvé que nionso mibale Térapie antiplaquettes (lokola Thérapie antiplaquette double [Aspirine + Clopidogrel] na boumeli ya mikolo 21 kino 90 elandami na antiplaquette unique, to monothérapie ya aspirine) mpe Anticoagulation thérapeutique (heparin esali pont na warfarine to direct anticoagulant orale) bazali na ba taux ya nse mpe oyo ekokani na statistique ya AVC oyo ezongaka mbala na mbala (pene na 1% kino 2%).
7. EXCEPTION CRITIQUE PONA DISSECTION INTRACRANIAL V4: Na bokeseni na ba segments ya kingo V1-V3, segment intracrânial V4 ya artérie vertébrale na kati ya crâne ezali na milieu ya papier mince mpe adventitie mpe ezali na lamine élastique ya libanda te. Yango wana, ba dissections intracrâniennes V4 ememaka risque makasi ya kobukana na mur ya libanda mpo na kosala Hémorragie subarachnoïde (SAH) oyo ebomaka. Yambo ya kobanda biloko oyo ekitisaka makila na dissection intracrânienne V4, minganga basalaka Angiogramme CT (mpe perforation lombaire soki esengeli) mpo na koboya pseudoaneurisme dissectant to makila ya subarachnoïde; ba dissections intracrâniennes V4 ruptures esengaka urgence stenting ya débit-diverter endovasculaire to trapping ya bobine.
8. Ntango ya kobikisa mpe bipekiseli ya mosala (Sanza 3 kino 6):
9. Koleka 70 kino 85% ya ba dissections ya artérie vertébrale sténotique ezongisaka na yango moko mpe ebikisaka efelo na yango ya kati na kati ya sanza 3 kino 6 (endimisami na kozongela CTA to MRA na sanza 3 kino 6).
10. Na tango ya kobika, ba malades basengeli koboya libela manipulation ya kingo chiropratique mpe koboya kotombola kilo ya kilo, masano ya contact, montagne russe, mpe hyperextension ya kingo ya makasi.

Ba numéros ya urgence régionale na ba protocoles ya AVC¶

• Etats-Unis na Canada: Benga 911. Ekambami na Association américaine du cardiaque / Association américaine de AVC (AHA/ASA) Guidelines mpo na gestion ya liboso ya ba malades oyo bazali na AVC ischémique aigu mpe AHA/ASA Déclaration scientifique sur les dissections d’artérie cervical.
• Union européenne na Royaume-Uni: Benga 112 na Europe mobimba to 999 na Royaume-Uni. Ekambami na Mabongisi ya Organisation européenne ya AVC (ESO) mpo na boyangeli bokati ya misisa ya libanda mpe ya kati ya motó mpe Mabongisi ya ESC mpo na koyeba mpe kosalisa maladi ya misisa ya périphérique (maladi ya misisa ya nse).
• Australie na Nouvelle-Zélande: Benga 000 na Australie to 111 na Nouvelle-Zélande. Ekambami na se ya Mabongisi ya clinique ya Fondation ya AVC mpo na boyangeli AVC.

Mituna oyo batunaka mingi¶

Ndenge nini kosala ngalasisi ya lobɔkɔ na ngai ya mwasi ekoki kosala ete nazala na kizunguzungu to nalɛmba nzoto na Syndrome ya koyiba subclavien?¶

Ntango misisa monene oyo ezali koleisa lobɔkɔ na yo ya mwasi (artérie subclavienne gauche proximale) ekómi moke mpenza LIBOSO ya esika ya etape ya artérie vertébrale gauche oyo emati tii na bɔɔngɔ na yo, pression na artérie ya lobɔkɔ na yo ya mwasi ekiti. Ntango kaka ozali kosala ngalasisi ya lobɔkɔ na yo ya mwasi, na ndakisa kotombola, kopangusa, to kosimba likoló ya motó, misisa ya lobɔkɔ na yo esɛngaka makila mosusu mpe epanzani misisa na yango, mpe yango esalaka ete vide oyo ezali na pression moke oyo ememaka mpenza makila na nsima na nse ya misisa na yo ya mokuwa ya mokɔngɔ na lobɔkɔ na yo ya mwasi na mokuwa na yo ya bɔɔngɔ mpe na cerveau mpo na koleisa lobɔkɔ na yo, mpe yango esalaka ete lobɔkɔ na yo ekóma na vertigo ya mbalakaka, omona mbala mibale, to olɛmba nzoto ntango kaka yo pemisa loboko na yo.

Bokeseni ya tansiɔ koleka 20 mmHg kati na lobɔkɔ na ngai ya mobali mpe ya mwasi elimboli nini?¶

Na momeseno, motango ya tansiɔ ya likoló (systolique) kati na lobɔkɔ na yo ya mobali mpe ya mwasi ekeseni na nse ya 10 mmHg. Bokeseni ya tansiɔ systolique oyo eumelaka ya 15 kino 20 mmHg to koleka elakisi bokiti to bokangami ya monene na artérie subclavienne to innominate oyo epesaka loboko ya kotanga na nse (mingi mingi Syndrome ya koyiba subclavien atherosclérotique, to artérite Takayasu na bilenge basi). Soki >20 mmHg ya bokeseni ya tansiɔ kati na mabɔkɔ ebimi na mbalakaka pembeni ya mpasi makasi ya ntolo to ya mokɔngɔ oyo ezali kopasola, ezali elembo ya drapeau rouge ya dissection aiguë ya aortique Type A.

Mpo na nini kobongisa nkingo na chiropratique to kobɛta fimbo makasi ekoki kosala ete elenge mokóló abɛla AVC na lititi ya bɔɔngɔ?¶

Mikuwa ya mokɔngɔ ematamaka na mabulu mikemike na mikuwa ya nkingo mpe esengeli kosala boucle moko ya makasi na degré 90 kati na mikuwa mibale ya likoló ya nkingo (C2 mpe C1) epai kuna 50 % ya kobaluka ya motó esalemaka. Kopusama ya nkingo oyo ebalukaka na vitesse makasi, kokweya na fimbu, to hyperextension makasi ekoki kotanda mpe kopasola revêtement ya kati ya artérie (Dissection d’artérie vertébrale). Makila oyo ekangamaka esalemaka na mpisoli mpe epasukaka na lititi ya bɔɔngɔ mpe na bɔɔngɔ, mpe epesaka AVC ya mopanzi ya Wallenberg, mbala mingi bangonga tii mikolo nsima ya elembo ya liboso ya likebisi ya mpasi ya nkingo ya nsima ya ngámbo moko mpe ya nse ya mokuwa ya motó.

Syndrome ya koyiba coronaire-Subclavien ezali nini na mutu oyo asali lipaso ya bypass cardiaque?¶

Na ntango ya lipaso ya contournement cardiaque (CABG), mbala mingi minganga ya lipaso basalelaka Artérie Mammaire Interne gauche (LIMA), oyo epanzani na artérie subclavienne gauche, mpo na koleisa makila oyo ezali na oxygène na liboso ya motema. Soki kokita ekómi na nsima na ebandeli ya artérie subclavienne gauche, kosala ngalasisi ya lobɔkɔ ya mwasi eyibaka makila na nsima na likoló ya greffe ya bypass LIMA mosika na misisa ya motema oyo ezali kobɛta, mpe yango ebimisaka mpasi ya ntolo oyo ezali konyata angina to crise cardiaque mbala nyonso oyo moto yango azali kosalela lobɔkɔ na ye ya mwasi.

Maziba mpe bokambi ya Leta¶

• Association américaine ya motema / Association américaine ya AVC (AHA/ASA, Etats-Unis): Liloba ya siansi mpo na bato ya mayele na makambo ya bokolongono: Dissections artérielles cervicales mpe association na thérapie manipulative cervicale (Biller J et al., AVC) mpe Mabongisi mpo na gestion ya liboso ya ba malades oyo bazali na AVC ischémique aigu.
• Organisation européenne ya AVC (ESO, Europe): Bokambami ya ESO mpo na gestion ya dissection ya artérie extracrânienne mpe intracrânienne (Debette S, Markus HS, et al., Journal européen ya AVC, 2021).
• Dissection ya artérie cervicale na étude ya AVC (CADISS) Ba enquêteurs ya épreuve (The Lancet Neurology, 2015 & JAMA Neurology, 2019): Thérapie antiplatelétique vs. Thérapie anticoagulation na dissection ya artérie cervicale.
• Société européenne ya cardiologie (ESC) & Société ya chirurgie vasculaire (SVS): Mabongisi ya diagnostic mpe traitement ya ba maladies artérielles périphériques: Sténose ya extrité supérieure mpe artérie subclavienne / Syndrome ya steal subclavien.

Ba guides oyo etali yango¶

• Koyeba AVC, test ya FAST, mpe eyano ya mbala moko
• Attaque ischémique transitoire (TIA) mpe likama ya AVC ya ngonga 24
• Dissection ya aortique mpe anévrisme aortique abdominal oyo epasuka
• Syncope na ba drapeaux rouges cardiogènes na exercice ya exercice
• Ba blessures ya moelle épinière na immobilisation ya kingo sans danger