Disama dia mu mêsu (dikanga dia mushipa wa tshiadi tshia munkatshi) ne disama dia mushipa wa tshitupa tshîpi¶

Bufofo bua tshimpitshimpi, kabuyi ne kanyinganyinga anyi dijimija dia mêsu dikole mu dîsu dimue didi disama dia lukasa dia mijilu ya mu mêsu didi difuanangane ne dia buongo budi kabuyi buenda bimpe tshipupu. Padi tshipupu tshia mashi, tshiamu tshia cholestérol, anyi disama dia mu mishipa ya auto-immune dipangisha mashi bua kuya ku retine (Central Retinal Artery Occlusion [CRAO] anyi Branch Retinal Artery Occlusion [BRAO]) anyi mutu wa muonji wa optique (**I schemique optique [**ION] Giant Cell Arteritis [GCA / Temporal Arteritis]), selile ya mijilu idi kayiyi ne oxygène idi ituadija kufua kayiyi mua kupingana mu minite 90 too ne ku 240. Nansha mudi difiika dia dîsu dimue dienza anu minite 2 too ne ku 15 ne pashishe dijika dionso (Amaurosis Fugax, tshipupu tshia tshitupa tshîpi tshia dîsu), bantu batue ku 25 pa lukama badi kale ne disama dia mu lungenyi didi kadiyi diumvuika pa MRI wa buongo ne badi ne njiwu ya lukasa ya disama dia tshiadi didi dipangisha anyi dipanga dia mêsu. Kubikila diakamue bena mudimu ba diambuluisha dia lukasa, kuya nende buludiludi ku Centre Designated Stroke (kuindila nansha kakese bua kumonangana ne munganga wa mêsu), ne kutuadija diakamue dienza dia thrombolyse mu mishipa anyi corticosteroïdes ya bungi mu mishipa mu mêba makese bidi bileja ni mudimu wa dimona ne wa buongo udi mua kusungidibua.

Enza nunku mpindieu¶

1. Fuika dîsu dimue ku dimue bua kujadika ni dipanga dia kumona didi mu dîsu dimue (monocular) anyi mu mêsu onso abidi (binocular), ne funda minite menemene uvua tshimuenenu tshishintuluke (tshikondo tshia "Last Known Well"). Bisumbu bia disama dia stroke bia mu lupitadi ne baminganga ba mitu badi dijinga ne minite menemene idibu batuadije kubala bimanyinu bia disama dia tshiadi tshia mu lupitadi bua kubala 4.5h wetu wa tshiadi tshia munda mua tshiadi.**.
2. Dijika dia dîsu dimue (anu dîsu dia bakaji anyi anu dîsu dia balume ke didi difiike/kadiyi ne tshitupa padi dîsu dikuabu dibuikila): Didi dileja dikanga dia mashi kumpala kua tshitupa tshia mêsu (Dikanga dia mashi a mu tshiadi tshia munkatshi, Dikanga dia mashi a mu tshiadi tshia mu tshiadi, Dikanga dia mashi a mu mêsu, anyi Celltic gitis Neuropathy).
3. Dijimija dia tshitupa tshia tshimuenekelu tshia binocular (dîsu dia bakaji ne dîsu dia balume kabiena mua kumona luseke lua dia bakaji anyi lua dia balume lua nzubu to): Didi dileja tshipupu tshia mu buongo tshia mu tshitupa tshia ku tshiadi (hemianopia wa muomumue) panyima pa tshitupa tshia mêsu.
4. Ela mubedi yense udi ne bidimu 50 anyi kupita apu diakamue bua "Giant Cell Arteritis (Temporal Arteritis) Red Flag Triad": Ebeja mubedi mpindieu:
5. "Ukadiku mupete mutu mupiamupia, mu tshiadi, anyi dikoba dia mutu ditekete paudi usukula nsuki anyi paudi uikisha pa tshilamba tshia kulala anyi?"
6. "Mushiku webe, ludimi luebe, anyi mpala udi usama, usama, anyi utshioka panyima pa wewe mumane kutafuna biakudia munkatshi mua minite umue (jaw claudication) anyi?"
7. "Ukadiku ne makaya anyi tshifuka tshikole, tshisama mu dinda (polymyalgie rheumatica), ditshioka didi kadiyi diumvuika, tuishi butuku, anyi bikondo bikese bia dimona dia misangu ibidi anyi dinyanguka dia dimona dia tshiamu tshia nzembu anyi?"
8. Bikala diandamuna nansha dimue didi Eyowa kudi muntu mukulumpe wa bidimu \(\ge 50\text{ bidimu}\): Ambila baminganga ne munganga wa mu nzubu wa lupitadi diakamue ne: udi wela meji ne: udi ne disama dia Arteritic Ischemic Optic Neuropathy from Giant Cell Arteritis nunku bobu bakupeshe methylpred intravenous dose wa bungi (\(50\to 101 to }1,000\text{ mg}\) IV) diakamue kumpala kua kuindila mateta a mashi anyi biopsie bua kusungila dîsu dikuabu.
9. Bikila nimero ya lukasa lukasa ya muaba unudi ne ulombe bua kuya ku lupitadi lua tshimpitshimpi ludi ne tshibambalu tshia malu a njiwu. Ela 911 mu États-Unis ne mu Canada, 112 mu Union européenne mujima, 999 mu Royaume-Uni, anyi tangila bionso nomba ya tshimpitshimpi. Amba patoke ne: "Mubedi udi ne dijimija dia dimona dia tshimpitshimpi mu dîsu dimue kadiyi ne kanyinganyinga; tudi tuela meji ne: udi ne disama dia AVC (Central Retinal Artery Occlusion) anyi Giant Cell Arteritis."
10. Teka mubedi muaba muimpe paudi muindile ambulanse:
11. Bua disama dia non-arteritic CRAO / Embolic Eye Stroke (kakuyi disama dia ku mutu anyi disama dia mutshima dikole): Lala mubedi mupuwe mujima pa mukolo (mulala panshi, \(0\text{ degrees}\)) ne mutu wende mupuwe. Kulala panshi kudi kuvudija bukole bua mashi adi apita mu mishipa ya mêsu ne ya munkatshi mua mêsu, kuambuluisha bua kupitshisha mashi mu tshitupa tshia mashi anyi kupitshila mu mishipa mikese ya cilioretinal.
12. Bikala mubedi ne dipanga dia mupuya anyi udi wela meji ne: udi ne disama dia mashi mu buongo: Bandisha mutu kakese too ne ku \(15\text{ too ne ku }30\text{ degrees}\).
13. Tangila bimanyinu bia tshipupu tshia mu bongolo tshia FAST ne bimanyinu bia didimuija dia dikosolola dia mifuba. Tangila bimanyinu bia dinyanguka dia mpala, diboko ditekete, anyi ngakuilu mubi (tangila mulombodi wa tshipupu). Shi mubedi nsonga (muinshi mua bidimu 50) mupeta dijimija dia dîsu dimue mu tshimpitshimpi pamue ne disama dipiadipia ku luseke lumue lua nshingu anyi mpala ne tshilamba tshia dîsu tshidi tshipueka kakese ne mulongi mukese ku luseke alu (disama dia Horner) kunyima kua disama dia mu nshingu, dienza dia mudimu wa tshitupa tshia mubidi, dibandisha dia bintu binene anyi disama dia tshiadi tshia munda, ** Ditapulula**.
14. Kufinyi anyi kulenga tshitupa tshia dîsu ne tshikisu, KUENA mupuya mu tshibombi tshia mabeji, ne kulama mubedi kayi ne tshintu ku mishiku (NPO). Nansha mudi mikanda ya kale ya malu a luondapu itela dilengeja dia dîsu dia bukole anyi dipuekesha dia mu tshibombi tshia mabeji, American Heart Association (AHA) udi ufila mibelu bua kubenga kuenza mudimu ne dikuma dia dîsu dia tshianana anyi hyperbios diakalenga dijadika, didi mua kunyanga dîsu anyi kuenza bua mutshima ikale ne disama dia ischémie, ne kuenza bua disama dia stroke-centre thrombolyse dia lukasa.

Mutshi wa dipangadika dia tshimpitshimpi: dijimija dia tshimuenenu tshia tshimpitshimpi ne disama dia mishipa ya tshitupa tshîpi¶

Ingidija tshikandakanda etshi tshia luondapu bua kusungula dijimija dia tshimuenekelu tshia monocular ne tshia binocular ischémique ne kuenza mudimu ne protocole wa stroke wa lupitadi anyi wa steroïde mu minite mikese.

flowchart TD
    Start["Dijimija dia tshimuenenu dia tshimpitshimpi kadiyi ne kanyinganyinga,<br/>Dijimija dia tshimuenenu, anyi dijimija dia tshitupa tshîpi"] --> CoverTest{"Buikila dîsu dionso pa nkayadi:<br/>Dimona didi dijimina mu dîsu dimue anyi mu mêsu onso abidi?"}

    CoverTest -->|"MESU onso abidi adi ajimija tshimuenekelu tshia muomumue<br/>Tshitupa tshia ku dia bakaji anyi tshia ku dia balume"| Occipital["HOMONYMOUS HEMIANOPIA<br/>(Acute Posterior / Occipital Brain Stroke):<br/>Bikila 911 / 112 / 999 diakamue bua nzubu wa tshipupu"]

    CoverTest -->|"DISU DIMUE ANYI (Dijimija dia dimona dia mêsu umue):<br/>Disama didi mu Retina, Nerve Optique,<br/>anyi Ipsilateral Carotid/Ophthalmic Artery"| AgeCheck{"Tangila bidimu ne disama dia mishipa minene<br/>(Disama dia tshitupa tshîpi) Bimanyinu bikunze:<br/>Bidimu bia mubedi >= Bidimu 50 NE<br/>Mutu usama ku ntempelo, Disama dia mu mutu,<br/>Disama dia mu tshiadi padibu batafuna, anyi Dikasa dikola anyi?"}

    AgeCheck -->|"EYOWA (Bidimu >= 50 + Tshimanyinu tshionso tshia GCA,<br/>anyi dijimija dia tshimuenenu tshia muulu):<br/>KUELA BIDIMU BIDI BIA GIANT CELL ARTERITIS<br/>(Arteritic AION anyi Arteritic CRAO)"| GCAProtocol["MUKENDE WA 'KUSUMIJA DISU DIBIDI' WA LUMUE:<br/>1. Bikila 911 / 112 / 999 -> Tshibambalu tshia malu a tshimpitshimpi lelu<br/>2. Ufile Stat High-Dose IV Methylprednisolone<br/> (500 to 1,000 mg IV/day x 3 days) DIAMUE<br/> (Kulekedi steroids bua ESR/CRP labs anyi biopsy)<br/>3. ESR, CRP, Plaketes + Temporal Ultrasound/Biopsy"]

    AgeCheck -->|"KAKUENA Bimanyinu bia GCA<br/>(anyi mubedi udi ne bidimu muinshi mua 50)"| DurationCheck{"Tshimuenenu tshiakapingana ku 100% tshia pa tshibidilu<br/>Mu minite 2 too ne ku 15 anyi,<br/>anyi tshimuenenu tshitshidi anu tshifiike anyi?"}

    DurationCheck -->|"Dimona diakapingana dijima mu minite 2 too ne ku 15<br/>('Mudidishi mukoka panshi ne mubandisha'):<br/>AMAUROSIS FUGAX (Retinal TIA)"| TIAProtocol["AKUT RETINAL TIA EMERGENCY:<br/>1. KUSHALA kumbelu (Njiwu mikole ya disama dia tshiadi mu 24-72h)<br/>2. Enda mu nzubu wa tshimpitshimpi wa nzubu wa tshimpitshimpi udi musungula lelu<br/>3. Bidi bikengela stat MRI wa buongo (DWI), Carotid CTA/Ultrasound,<br/> ECG/Holter bua AFib, Dual Antiplatelets, & Statin"]

    DurationCheck -->|"Dimona didi dishala difiike (dijika dionso)<br/>anyi tshitupa tshia kuulu anyi tshia kuinshi tshidi tshijimina:<br/>USPECT CENTRAL OR BRANCH RETINAL<br/>ARTERY OCCLUSION (CRAO / BRAO)"| CRAOProtocol["CUTE OCULAR STROKE ('CODE STROKE'):<br/>1. Bikila 911 / 112 / 999 -> Designated Stroke Center NOW<br/>2. Lala mubedi mu nshingu (0 degrés) bua kukolesha dibuela dia mashi<br/>3. Tangila minite milelela ya ntuadijilu (< 4.5 heur IV tPA window)<br/>4. Shi nshingu udi ne kanyinganyinga + muana mukese/tshibuikidiji tshidi tshipueka -> Tangila dikosolola dia tshiadi"]

Pathophysiology: Mushindu udi mashi abidi a dîsu enza mudimu ne bua tshinyi minite idi ne mushinga¶

Dîsu didi dipeta kudi mushipa wa mêsu, udi ditamba dinene dia kumpala dia mushipa wa munda wa tshiadi anu padiye ubuela mu tshifu ufumina ku nshingu. Bu mudi mushipa wa mêsu upatuka buludiludi ku mushipa wa munda wa carotide, tshintu tshionso tshidi tshienzeka mu mishipa ya dîsu tshidi dididishi dia buludiludi mu mishipa ya buongo ne ya mutshima.

Munda mua tshitupa tshia dîsu, mushipa wa mêsu udi utapuluka mu mishipa ibidi mishilangane idi ifila biakudia ku bitupa bishilangane bia retina ne nerve optique:

1. Mushipa wa munda mua mêsu (CRA) (udi udisha tshitupa tshia munda tshia mêsu):
2. Mushipa wa munkatshi wa retina udi utobola munkatshi mua muonji wa mêsu ne udi upitshila mu tshitupa tshia munda tshia retina mu bitupa binayi (tshikondo tshia kuulu, tshia kuinshi tshia tshikondo, tshia kuulu tshia mu mishiku, ne tshia kuinshi tshia mu mishiku).
3. I mushipa wa ku ndekelu kua mubidi udi kayi ne malanda mu bantu 70 too ne ku 85 pa lukama.
4. (Dishilangana dia mubidi: Bantu batue ku 15 too ne ku 30 pa lukama batu baledibua ne tshintu tshikuabu tshidibu babikila ne: mushipa wa cilioretinal udi ufumina ku tshitupa tshia mashi tshidi tshidisha macula wa munkatshi. Mu mubedi wa diakalenga udi ne mushipa wa cilioretinal udi ne disama dia CRAO, *mushipa wende wa cilioretinal udi uya*mutoke, kadi udi umueneka bu mutoke 20/20 tshikena kumona tshia dibala tshia munkatshi tshidi tshishal*.
5. Tshiamu tshia mishipa mikese ya panyima (SPCAs) (tshidi tshidisha mutu wa tshiamu tshia mêsu ne tshia pambelu tshia mêsu):
6. Mishipa ibidi anyi isatu ya kunyima idi itapuluka mu 10 anyi 20 mikese mishipa mikese ya kunyima idi yenza tshijengu tshia mishipa tshidi tshinyunguluka mutu wa muonji wa mêsu ne idisha choroïde (udi udisha mionji ya pambelu ya photorecepteur ne cones, kusangisha ne fovea wa munkatshi).
7. Bua tshinyi Giant Cell Arteritis udi munange mishipa mikese ya panyima: Lamina wa munda wa mishipa mikese ya panyima ne mishipa ya tshitupa tshîpi ke tshipatshila tshia kumpala tshia dibunda dia selile minene ya auto-immune mu Temporal Arteritis, bidi biumvuija bua tshinyi Giant Cell Arteritis udi ukebesha dinyanguka dia mijilu ya mu mutu (Arterite Anteriorique Neuropathy [A-AION]) mu 80 pa lukama ya bilumbu bia kumona ne Arteritic CRAO mu 10 too ne ku 15 pa lukama.

Dîba dia kupanduka dia disama dia tshiadi (Bua tshinyi minite 90 too ne ku 240 ke tshibangidilu)¶

Malongesha a kale a nyama ya nsongo (Hayreh et al.) ne mateta a tshiadi tshia bantu adi aleja dîba dia muoyo dia selile ya ganglion ya retinal padibu bakanga mushipa wa munkatshi wa retinal: - 0 to 90 minutes of complete occlusion: Tissue wa retinal udi mupangile (penumbra ischémique), kadi dipingana dia tshimuenekelu dijima anyi pabuipi ne dijima didi mua kuenzeka pikala mashi apingana diakamue. - Minutu 90 too ne ku 240 (mêba 1,5 too ne ku 4): Disama dia tshitupa tshia munda tshia tshitupa tshia mubidi tshidi tshienzeka; diondopangana dia tshitupa didi anu mua kuenzeka ne dipingaja dia mashi mu tshimpitshimpi. - Panyima pa minite 240 (mêba 4+) a dikanga dijima: Difua dinene dia tshitupa tshia munda tshia dîsu didi dienzeka, dishiya dijimija dia mêsu dia kashidi (pa tshibidilu kubala minu [CF], dienda dia bianza [HM], anyi dimona dia butoke [LP] anu) anu padiku anyi dikanga dia mushipa wa cilin anyi anyi dijika dijima penumbra.

Difuanyikija dia malu 5 manene a disama dia tshiadi tshia mêsu¶

Ingidija tshibambalu etshi tshia luondapu bua kusunguluja CRAO wa embolique, dikanga dia mishipa ya retinal ya matamba, amaurose fugax, disama dia mishipa ya mu mishipa (Giant Cell Arteritis), ne disama dia mu mishipa idi kayiyi ya mu mishipa:

Bualu 1: Dikanga dia mushipa wa munkatshi ne wa matamba (CRAO & BRAO)¶

Bua tshinyi tshisumbu tshia bena Amerika tshia muoyo tshidi tshilomba "Code Stroke" bua CRAO¶

Mu malu a kale, babedi bavua bajimija dimona ku dîsu dimue bavua baya kumpala kudi munganga wa mêsu anyi ku lupitadi lua dîsu, muaba uvuabu bapitshisha mêba anyi matuku a bungi benza mateta a mêsu kumpala kua muntu nansha umue kutangila buongo anyi mijilu ya mu nshingu. Mu 2021, American Heart Association (AHA) ne American Stroke Association (ASA) bakapatula mukenji wa malu a sianse udi ushintulula luondapu lua CRAO pa buloba bujima: 1. CRAO i tshipupu tshikole: Bu mudi retina muikale tshitupa tshia tshitupa tshia munda tshia mubidi ne udi udishibua kudi mushipa wa munda wa carotide, dikanga dia mushipa wa munkatshi wa retina didi bushuwa tshipupu tshia ischémie tshia retina. 2. 1 pa 4 babedi ba CRAO udi ne disama dia tshiadi tshia mu buongo tshidi katshiyi tshiumvuika mpindieu: Bimanyinu bia diffusion-weighted brain MRI (DWI) bidi bileja ne: 19 too ne ku 25 pa lukama ba babedi badi ne CRAO anyi BRAO badi ne disama dia tshiadi tshia mu buongo tshia musangu umue mu tshitupa tshia buongo tshidi tshifumina ku ditshibuka dia mutshima umue plaque anyi nzubu wa muoyo, nansha padi mubedi kayi ne butekete bua diboko anyi lutatu lua kuakula. 3. Intravenous Thrombolysis Window (\(\le 4.5\text{ Hours}\)): Padi mubedi udi ne CRAO udi kayi ne disama dia tshiadi ufika ku Centre Designated Stroke mu mêba 4.5 a ntuadijilu wa bimanyinu, kunyima kua CT wa mutu udi kayi ne tshiamu tshia nzembu udi uleja ne: mashi adi apatuka mu buongo ne udi uleja ne: udi ne disama dia CRAO ne disama dia mijilu idi kayiyi ne mijilu baminganga ba mesu badi mua kufila tshiamu tshia plasminogène tshidi tshienza mudimu mu mishipa (alteplase anyi tenecteplase). Bimanyinu bia mu lupitadi bidi bileja ne: IV thrombolysis muenza mu mêba 4,5 udi uvudija bikole bungi bua dilengejibua dia mêsu dia mushinga padibu babifuanyikija ne dimona dia mu mushindu wa tshimpitshimpi.

"Tshitupa tshikunze" pa tshikebelu tshia mêsu ntshinyi?¶

Padi munganga wa mpukapuka anyi munganga wa mêsu utangila mu dîsu ne CRAO ku diambuluisha dia ophthalmoscope anyi tshiamu tshia foto tshia muinshi mua dîsu mu mêba makese kunyima kua dibunda: - Bitupa bia munda bia retina (bidi bidia kudi mushipa wa retina wa munkatshi udi mubuikila) bidi bivula ne mayi a munda mua selile (cytotoxic edema), bilua mutoke wa mabele. - Ino, bullseye wa munkatshi mua macula (foveola) udi mutekete bu dibeji ne kena ne bipese bia ganglion bia munda bia retina, udi udishibua anu kudi choroïde udi muinshi (udibu badisha kudi mishipa ya ciliaire ya panyima idi kayiyi minyanguke). - Bualu bua choroïde vasculaire mutoke udi ukenka mu tshitupa tshikese tshia munkatshi tshidi tshimueneka patoke padiye munyunguluka kudi tshimuenekelu tshia retina mutoke bu mabele, udi wenza "Cherry-Red Spot" wa Centre Retinal Artery Occlusion.

Bua tshinyi kuena ne bua kueyemena "Massage wa mêsu" anyi "Dipuya dia mu tshibombi tshia mabeji" ku nzubu to.¶

Mikanda ya kale ivua ileja ne: mbimpe kufina bikole pa disu dikanga (masage ocular numérique) anyi kuela mupuya mu tshibombi tshia dibeji dia nsukadi (therapie de carbone) bua CRAO. - Dipangadika dia malu a luondapu dia matuku etu aa (AHA & AAO): Midimu yonso ibidi eyi mipangile bua bantu badi bamona malu aa. Kufina dîsu ku bukole kudi mua kutshibula dîsu ne dipanda dia matuku mashale aa, kunyangakaja dinyanguka dia dîsu, anyi kufikisha ku reflex vagal bradycardia (reflex oculocardiac). Kuela mupuya mu tshibombi tshia mabeji kudi kufikisha ku dipanga dia oxygène mu mubidi kudi babedi bakulumpe kakuyi kulengeja muoyo wa retina. Tshintu tshimuepele tshia kuenza kumpala kua kuya mu lupitadi nkulala mubedi panshi ne kubikila 911 / 112 / 999 bua kuya nende diakamue ku Stroke Center.

Tshilumbu tshia pa buatshi kudi bantu bakole badi ne bidimu muinshi mua 50: Dikosolola dia mishipa ya munda mua tshiadi¶

Shi nsonga (wa myaka 20 to ne ku 50) mupeta dijimija dia tshimuenekelu tshia tshimpitshimpi anyi amaurosis fugax, umuebeje ni udi ne disama dia mu nshingu, mutu usama ku luseke lumue, anyi mpala usama, ne utangile mêsu ende ne mêsu ende mu butoke bukese: - Ditapuluka dia munda mua mushipa wa mu nshingu (Internal Carotid Artery Dissection), misangu ya bungi didi difumina ku dikuma dia mu nshingu, dikola dia bungi dia yoga, dienza dia mudimu wa tshiamu tshia mitaku, dibandisha dia bintu bikole, anyi dikokola dia tshikisu, didi dilengeja mijilu ya luse idi minyunguluke pambelu pa mushipa wa mu nshingu. - Ebi bidi bipatuisha ipsilateral Horner Syndrome (tshitupa tshia mêsu tshidi tshipueka kakese [ptosis] ne tshitupa tshikese tshia mêsu tshidi tshipueka [miosis] ku luseke lumue ne disama dia mu nshingu) pamue ne emboli wa retine anyi wa buongo. Tshiamu tshia CT (CTA) tshia mutu ne tshia nshingu mu tshibambalu tshia malu a mpukapuka tshidi tshijadika dipanda.

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

Bua tshinyi "tshimuenenu tshidi tshipingana ku tshilelela mu minite 5" tshitshidi anu tshilumbu tshia 911 / 112 / 999¶

Amaurosis fugax ("fleeting darkness") udi wenzeka padi tshitupa tshia cholesterol (a Hollenhorst plaque) anyi platelet-fibrin micro-clot tshipatuka ku plaque mu mushipa wa munda wa carotide wa mu nshingu (anyi ku mutshima mu fibrillation atriale), tshisomba mu tshitupa tshîpi mu mushipa wa munda ne wa tshitupa tshia munda tshia mu tshiadi, ne pashishe kupatuka Minutu 2 too ne ku 15: - Babedi badi bamba ne: "tshimuenekelu tshia dididishi tshifiike tshidi tshikoka panshi bimpe pa dîsu dimue" too ne padi dîsu dilua dikunze anyi difiike, dienza minite 3 anyi 10, ne pashishe dipingana too ne padi dimona dilua diakane 100 pa lukama. - Buteyi: Bualu dimona didi dipingana ku tshilelela kunyima kua minite 5 kakuyi kanyinganyinga, bantu ba bungi badi badimona bu disama dia mêsu anyi disama dia mutu ne bashala kumbelu. - Bulelela: Amaurosis fugax i Retinal Transient Ischemic Attack (TIA). Padiku kakuyi dikonkonona dia lukasa dia mu lupitadi, buondapi bua antiplatelet ibidi (aspirine + clopidogrel), buondapi bua statin bua bukole bua bungi, ne dipanda dia mu tshiadi anyi diteka dia stent (bikala dipueka dia mu tshiadi dikale \(70\%\text{ too ne ku }99\%\)), tshitupa tshidi tshilonda tshidi tshipatuka mêba a bungi pashishe tshidi mua kunyangakaja mushipa wa buongo, **** bidi bifikisha ku dipanga dia lungenyi dia kashidi ne dijimija dia ngakuilu.

Mushindu kayi wa kujingulula Amaurosis Fugax ne Aura wa Migraine anyi Papilledema¶

Disama 3: Disama dia mishipa minene (GCA / Disama dia mishipa ya tshitupa tshîpi) kudi bantu bakole badi ne bidimu 50 ne kupita apu¶

Bua tshinyi Giant Cell Arteritis ke tshintu tshidi mua kuepuka tshidi tshikebesha dipanga dia mêsu dia ku nseke yonso ibidi¶

Gant Cell Arteritis (GCA), udi kabidi mumanyike bu Temporal Arteritis, udi auto-immune granulomatous vasculitis wa mishipa ya munkatshi ne minene udi wenzeka anu kudi bantu bakole badi ne bidimu 50 ne kupita apu (udi ufika ku bidimu 70 ne 85).

Mu GCA, selile ya T idi ikuba mubidi ne selile minene idi ibuela mu tshimanu tshia matamba a pambelu pa mutu a mishipa ya mu tshiadi ne ya mu tshiadi: - Tshimanu tshia mishipa tshidi tshivula munda (hyperplasie intimal) too ne padi tshitupa tshia munkatshi tshijika. - Padi disama edi dikuata mishipa mikese ya kunyima anyi mishipa ya munkatshi mua mêsu, mutu wa muonji wa mêsu udi ufua bua nzala ya oxygène ya tshimpitshimpi (Arteritic Anterior Ischemic Optic Neuropathy [A-AION]), ne udi ushiya dîsu difiike bikole mu misangu mipite pa 50 pa lukama. - The "Fellow Eye" Clock: Padi dîsu dia kumpala dijimija dimona dia GCA, dîsu dia kumpala kaditu dipeta kabidi dimona dia mushinga mukole to. Kadi, pikala diondapangana dia corticosteroïde dia bungi dienzeja, babedi 30 too ne ku 50 pa lukama badi bapeta disama dia muomumue mu dîsu diabu dibidi (didi dishala) mu mêba 24 too ne matuku 7, bibashiya bafofo ku mêsu onso abidi. GCA udi kayi muondapibue udi kabidi mua kusama mishipa ya mu mikolo ne ya munda mua mutshima () ne stroke aorte thoracique (udi wenza dikosolola dia aorte).

Mulongo mujima wa bimanyinu bia tshipupu tshia Giant Cell Arteritis (Bidimu \(\ge 50\))¶

Bualu 20 pa lukama ya babedi badi kabayi bamona bimpe bua GCA badi ne "GCA wa tshisokomenu" (mutu mukese, ne anu nshingu mikese anyi bimanyinu bia mubidi), tangila tshintu tshionso tshidi mu liste eu kudi muntu mukulumpe yonso udi ne bidimu bipite pa 50 udi ne dishintuluka dia mêsu:

• 1. Disama dia tshiadi (Tshimanyinu tshinene tshia GCA, tshidi mu -50%): Ebeja mubedi ne: *"Paudi utafuna biakudia bidi ne mupuya bu mudi nyama anyi mampa adi ne mupuya munkatshi mua minite 1 anyi 2, misunyi ya tshiadi tshiebe anyi ludimi luebe ludiku lutuadija kusama, kutshioka, anyi kudiumvua mutshioke nunku udi ne bua kulekela kutafuna ne kuikisha bualu mishipa ya mpala ne idi ifila diambuluisha anyi?" mishipa ya kutafuna ne ludimi bidi bikese bua disama dia mishipa, bidi bifikisha ku disama dia mishipa didi difumina ku dibidija dia mubidi.
• 2. Disama dia mutu dipiadipia (didi mu 70% too ne ku 80%): Disama dipiadipia didi dikuma, dibungamija anyi diosha pa mutu pa tshimue anyi bionso bibidi tshitupa, pa mpala anyi panyima pa mutu kudi muntu mukulumpe.
• 3. Disama dia dikoba dia mutu ne mishipa ya tshitupa tshîpi idi kayiyi mimpe: Kusukula nsuki, kuikisha mutu pa tshilamba tshia kulala, anyi kuvuala makalashi a mêsu kudi kumvuija disama dia mutu. Kuela munu bitekete bitekete pa mushipa wa tshitupa tshia pa mutu (kumpala kua ditshi ne pa mutu pa ntempelo) kudi kuleja mushipa munene, wa nsongo, mutekete udi ne dikuma ditekete anyi kadiyiku.
• 4. Bimanyinu bia didimuija dia kumona: Bikondo bikese bia minite 5 bia dijimija dia mêsu (amaurosis fugax) anyi diplopia wa tshitupa tshîpi (dimona dia misangu ibidi, didiku mu 10% too ne ku 15%) difumina ku disama dia ischémie dia misunyi ya mêsu.
• 5. Polymyalgie Rheumatica (PMR) ne bimanyinu bia mubidi (bidi mu 40% too ne ku 50%): Dikolesha dia mu dinda ne disama dia mu dinda mu makaya, nshingu, ne tshifu didi dienza minite mipite pa 45 kunyima kua dijuka, dilondangana ne kapia kakese, tuishi tua butuku, kanyinganyinga, anyi dijimija dia kilo.

Mukenji wa lupitadi lua tshimpitshimpi bua disama dia mishipa minene¶

Bilondeshile mikenji ya mudimu wa lupitadi wa American College of Rheumatology (ACR), European Alliance of Associations for Rheumatology (EULAR), ne British Society for Rheumatology (BSR): 1. Tuadija manga a corticosteroïdes a bungi diakamue paudi wela meji ne: udi ne disama (kumpala kua kuenza biopsie anyi kupingana mu laboratware): - Bikalaku bimanyinu bia kumona (dijimija dia mêsu, disama dia amaurosis fugax, anyi dimona dia misangu ibidi): Ufila methylprednisolone \(500\text{ ku }1,000\text{ mg}\) IV ku dituku mu matuku 3 malondangana, pashishe ufila dose munene wa dnis wa mukana (\(1\text{ mg/kg/dituku}\), pa tshibidilu \(60\text{ to }80\text{ mg}\) dituku dionso) ne dikonkonona dia tocilizumab. - Bikala bimanyinu bia GCA bia mu mutu kabiyi bimueneka: Tuadija prednisone wa ku mishiku \(40\text{ to }60\text{ mg}\) dituku dionso diakamue. 2. Kulekedi manga a steroïde nansha kakese bua kuindila bua kuenza biopsie anyi ultrasound: Mashintuluka a disama ne selile minene idi munda mua tshimanu tshia mushipa wa tshitupa tshîpi idi itungunuka munkatshi mua matuku 10 too ne ku 14 kunyima kua wewe mumane kutuadija kunua manga a steroïde a bungi, eku kulekela manga a steroïde nansha mêba 12 kudi mua kujimija dîsu dia mubedi didi dishala. 3. Dikonkonona dia mashi dilomba diakamue mu nzubu wa lupitadi: Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP), ne Complete Blood Count (CBC) (kukonkonona thrombocytosis udi ne plakete \(>400,000/mux\)).

Mukanda wa dimanyishangana wa 911 / 112 / 999 ne disungula dia lupitadi¶

Bu mudi dijimija dia dimona dia tshianana dienza bua pambelu pa dîsu dimueneke bu dia pa lukama 100 (sclera mutoke, cornée clair), bena mudimu ba triage mu lupitadi lua bantu bonso badi mua kupepeja mushinga wa bualu ebu pa kumbusha wewe muenze mudimu ne miaku ya stroke ne vasculite:

• Bua dielakana dia dikanga dia mushipa wa tshiadi (CRAO) mu meba 4.5:

  "Ndi dijinga ne ambulanse wa lukasa lukasa ku [Adrese mulelela]. Mubedi udi ne bidimu [mulume/mukaji] uvua mupete bufofo bua tshimpitshimpi, bujima, kabuyi ne kanyinganyinga mu dîsu dia [dia bakaji/dia balume] ku [Minutu milelela ya ntuadijilu]. Bilondeshile mikenji ya American Heart Association, tudi tuela meji ne: udi ne disama dia acute Sketral Sketeral Art Occlusion) ne udi dijinga ne dituma dia lukasa dia Code Stroke ku Designated Stroke Center mu tshikondo tshia 4.5-hour intravenous thrombolysis."

• Bua disama dia mishipa minene (disama dia mu mishipa ya tshitupa tshîpi) kudi muntu mukole udi ne bidimu 50+:

  "Triage wa tshimpitshimpi: mubedi wa bidimu [Age] udi ne dijimija dia tshimpitshimpi dia dimona [anyi dimona dia misangu ibidi / dijimija dia tshitupa tshîpi] mu dîsu dia [dia bakaji/dia balume] dilondangana ne [mutu mupiamupia wa ku ntempelo / disama dia mu mutu / disama dia mu tshiadi padiye utafuna biakudia]. Tudi tuela meji ne: Arteritic Ischemic Optic Neuropathy from Giant Cell Arteritis udi dijinga ne dikonkonona dia lukasa dia lukasa stat high-dose intravenous methylprednisolone (500 to 1,000 mg IV) RIGHT NOW bua kuepuka bufofo bua kashidi mu dîsu dikuabu."

• Bua disama dia Amaurosis Fugax (Retinal TIA):

  "Mubedi udi ne [Age]-year-year uvua mupeta disama dia dijima dia tshianana ('window shade') mu [left/right] dîsu divua dienze [Number] minite pa [Time] lelu. Nansha mudi tshimuenenu tshipingane ku tshilelela, eu udi Amaurosis Fugax, TIA wa Retinal wa tshimpitshimpi, ne udi dijinga ne dikonkonona dia lukasa dia Stroke, Centre wa buongo, MRI tshimfuanyi tshia mishipa, ne ECG."

Nkonko itubu bela misangu ya bungi¶

Bua tshinyi pambelu pa dîsu didi dimueneka ditoke dijima ne diakane mu tshikondo tshia stroke ocular (CRAO) anyi temporal arteritis?¶

Mishipa ya mashi idi yenza bua dîsu dimueneke dikunze mu tshikondo tshia dîsu dia rose anyi dia glaucome idi mishipa ya pa mutu ya conjonctival ne ya episcleral idi kumpala kua disu. Mu dikanga dia mishipa ya munkatshi mua dîsu ne disama dia mishipa ya selile minene, dikanga dia mishipa didi dienzeka munda menemene mua tshitupa tshia dîsu mu mushipa mukese wa dîsu anyi mu mishipa mikese ya panyima idi idisha retina ne nerve optique, nunku kumpala kua dîsu didi dishala ditoke dionso ne kadiyi ne kanyinganyinga padi retina munda mua nzala ya oxygène.

Mmunyi mundi mua kukonkonona kumbelu bikala tshimuenenu tshibi tshia tshimpitshimpi tshidi mu dîsu dimue (monocular) anyi mu mêsu onso abidi (binocular)?¶

Padi dîsu dimue dijimija dimona dia tshimpitshimpi anyi dipeta mundidimbi mufiike, buongo bua muntu budi butetaku bua kusangisha tshimfuanyi tshia pa tshibidilu tshia dîsu dimpe ne tshimfuanyi tshifiike tshia dîsu dibi, bidi bienza bua muntu adiumvue bu ne: mêsu onso abidi mmanyanguke anyi mmanyanguke. Misangu yonso ufuke dîsu diebe dia bakaji bimpe ne tshianza tshiebe bua kuteta dîsu diebe dia balume nkayadi, ne pashishe ufuke dîsu diebe dia balume bua kuteta dîsu diebe dia dia bakaji nkayadi; bualu ebu budi buleja diakamue ni difiika didi anu mu dîsu dimue anyi didi dikuata tshitupa tshia ku dia bakaji anyi tshia ku dia balume tshia mêsu onso abidi.

Bua tshinyi disama dia mu mishiku padibu batafuna biakudia (disama dia mu mishiku) ntshimanyinu tshinene tshia didimuija dia Giant Cell Arteritis?¶

Bishilangane na disama dia temporomandibular joint (TMJ), didi disama dîba diudi ukangula mukana anyi disuma tshintu tshikole, disama dia mu tshiadi mu Giant Cell Arteritis didi difumina ku disama dia auto-immune didi dipangisha mijilu idi ifila mashi ku misunya ne ludimi luebe lua kutafuna. Bu mudi mifuba kayiyi mua kupeta luya lua bungi padibu benza manaya a mubidi misangu ne misangu, mpala webe udi umvua bimpe paudi udia biakudia bia kumpala, udi umvua disama dikole anyi utshioka panyima pa wewe mumane kutafuna mu sekonde 60 anyi 90, ne udi umvua bimpe diakamue paudi ulekela kutafuna; kujingulula tshimanyishilu etshi ne kuya ku ER bua kupeta steroïdes kudi kupangisha difofo dia tshimpitshimpi.

Shi tshimuenenu tshianyi tshienda tshifiika mu dîsu dimue munkatshi mua minite itanu ne pashishe tshipingana bimpe, bua tshinyi tshiena mua kuindila bua kumona munganga wanyi wa mêsu lumingu ludi lulonda?¶

Dijimina dia dîsu dimue dia minite itanu (amaurosis fugax) didi diumvuija ne: mashi anyi tshiamu tshia cholestérol tshidi tshipatuka mu mushipa wa carotide mu nshingu webe anyi mu mutshima webe, tshikanga mushipa munene wa dîsu diebe, ne pashishe tshipatuka. Mubedi umue pa banayi badi ne disama dia mishipa ya mu mêsu badi kale ne bitupa bipiabipia bia disama dia tshiadi bidi kabiyi biumvuika pa MRI wa buongo, ne njiwu ya disama dia tshiadi tshikole tshidi tshipangisha muntu bua kuenza mudimu tshiendelele idi mipite bungi mu mêba 24 too ne ku 72 a kumpala kunyima kua tshilumbu atshi tshia didimuija, bidi bikengela kuya diakamue ku lupitadi lua Stroke Center.

Miaba mifumina¶

• American Heart Association (AHA) ne American Stroke Association (ASA, United States): Management of Central Retinal Artery Occlusion: A Scientific Statement from the American Heart Association (Mac Grory et al., Stroke 2021; establishing CRAO as a Code Stroke emergency, the \(xt\45\. dîba}\) IV protocole wa tPA, ne dikankamija dia ditanta dia masaji a mêsu a tshimpitshimpi).
• 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 \(500 to\xt{txt }1,000\text{ mg/day}\) bua dijimija dia mêsu kumpala kua dipima dia mashi anyi ultrason).
• British Society for Rheumatology (BSR, United Kingdom) and National Institute for Health and Care Excellence (NICE, United Kingdom): Guide on Diagnosis and Treatment of Giant Cell Arteritis ne NICE NG128: Stroke and Transient Ischemic Attack in Over 16s (amat pathway furx TIA).
• Tshilongelu tshia bena Amerike tshia malu a mêsu (AAO, États-Unis): Mushindu wa kuenza mudimu (PPP): Dikanga dia mishipa ya mêsu ne ya mêsu.
• Royal College of Ophthalmologists (RCOphth, United Kingdom): Ophthalmic Services Guidance: Management of Acute Retinal Arterial Occlusion and Giant Cell Arteritis.

Malu adi apetangana¶

• Dijimija dia tshimuenenu tshia tshimpitshimpi, ditapuluka dia retina, ne glaucome wa angle-closure wa tshimpitshimpi
• Dijingulula dia tshipupu (FAST) ne diandamuna dia tshimpitshimpi
• Disama dia cellulite dia mu mishiku, disama dia mêsu mavula, ne thrombose wa sinus cavernose
• Dikosolola dia aorte ne ditapa dia aneurysme wa aorte wa mu difu
• Dimanya dia disama dia mutshima ne diambuluisha dia kumpala