Spinal Epidural Hematoma and Abscess vs Post-Epidural Headache: Te mamae o muri me te Paralysis Nga Kara Whero¶

Whai muri i te whakawhanautanga o te whakawhanau, te whakamoanatanga o te tuara, te werohanga lumbar diagnostic (te paopao), te werohanga steroid epidural ranei, ka pa te mamae o nga turoro i te waahi o te ngira, he mahunga tawhito ** i muri i te werohanga i muri i te roanga o te tuara ("wet-tap" spinal headache)** na te hekenga puhoi o te wai cerebrospinal (CSF) ka puta te mate nui o te upoko o te upoko i te wa e noho ana15 meneti. Heoi, e rua nga aitua ohorere, neurosurgical ka taea te patu i te mokowhiti epidural i muri i te mahi a te tuara (i nga turoro e tango ana i te whakaheke toto, e mate ana ranei i te mate huakita toto): (1) Spinal Epidural Hematoma (SEH), i reira ka pakaru te uaua epidural i te toto ki roto i te uaua o te kirikiri me te Epid i roto i nga haora. Abscess (SEA), ka toro atu te pute o te nana huakita (Staphylococcus aureus) ki roto i te tuara i roto i nga ra. Na te mea he ngongo kikokore te kirikiri o te tangata me te kore he ruma mo te roha, ka werohia te toto o te ira tuara e te toronga toto o te taurakira, me te kore e taea te whakahoki paraplegia or quadriplegia mena ka mahia e nga tohunga neurosurgeon he ohorere ** decompressive laminectomy i roto i te 8 ki te 12 haora o te timatanga o te ngoikoretanga. Mena ka tupu te tangata kua pangia e te epidural, i te pao tuara, i werohia te tuara, i te horopeta whakaheke toto, i te mate hou ranei ka tupu ** te mamae o te tuara waenga waenga, te mamae o te hiko-hiko e pupuhi ana i nga waewae, i te taha o nga riu, te ngongo o te hiku/papa (whakarerenga o te nohoanga), te uaua ki te mimi, te taumaha/ngoikore o nga waewae**, waea atu ki to rohe. tau ohorere tonu. I a koe e tatari ana ki te kawe waka tūroro, arotakehia nga aratohu e pa ana te mate o te cauda equina me te kōpeketanga o te taurakira, te whakaheke toto subarachnoid me te mahunga o te whatitiri, a te pupuri mimi whakapeka me te kore e kaha ki te mimi.

Na te mea he maha nga wa ka pohehe nga nēhi whakaora whanau me nga whanau ki te kopeketanga o te taurakira i muri i te mahi epidural mo te "mamae tonu o te rongoa epidural" me te "mamae o te papa pelvic i muri i te whanautanga," ko o ture haumaru tino nui e rua ko Te Ture Whakaora Motuka Epidural 4-ki-6-Hora (ko te tangata kua mutu te kaha o tona waewae i roto i nga haora**4 kua kore e mutu te kaha o te waewae **4 kua kore e mutu te kaha o te waewae **4 kua hoki mai te kaha o tona waewae i muri i te rongo ** ka tangohia ranei, ka hoki mai ano te ngongo o te waewae *i muri i te * ka mau, me tere ohorere te Spine MRI) me te Te 15-Minute Flat-Lie Headache Test (ko te mahunga ka KORE e tino pai ake i te wa e takoto papatahi ana, ehara i te mamae o te tuara ngawari me te arotake mo te cerebral venous sinus thrombosis, subdural hematoma, meningitis ranei).

Mahia tenei inaianei¶

1. **Waea wawe ki to nama whawhati tata ki te mea ka haere tahi te mamae o muri, kaki ranei me te ngoikore o te waewae, te ngongo o te waewae, te ngongo o te hiku, te kore ranei e kaha ki te mimi. tau ohorere. Kia marama te korero: "E whakapaetia ana he hematoma epidural spinal acute or spinal epidural abscess: te mamae nui o te tuara waenga me te ngoikore o te waewae hou / pohehe / te pupuri mimi i muri i te epidural / spinal tap / i runga i nga whakaheke toto. Me tere tonu te MRI Spine me te Neurosurgery."
2. Whakamahia te 15-Minute Flat-Lie Test ki te wehewehe i te Maehe o te Mahunga o muri-Dural mai i te Intracranial or Spinal Catastrophe. Mena ko te tohu tuatahi ko te mahunga nui i muri i te werohanga epidural, lumbar puncture ranei, me takoto te manawanui 100 paiheneti ki runga i tona tuara kaore he urunga mo te 15 ki te 30 meneti:
3. Ko te Mahunga o te Mahunga o te Mahunga Whakamuri-Dural ("Wet Tap"): Ka pai ake te mahunga o mua-occipital me te kaki o te kaki 80 ki te 100 ōrau i roto i te 15 ki te 30 meneti o te takoto papa, ka hoki mai i roto i te 15 meneti o te noho, o te tu ranei.
4. Haka Whero (Intracranial Subdural Hematoma, Cerebral Venous Thrombosis, Meningitis, Preeclampsia ranei): Ka pupuhi tonu te mahunga me te tino kaha ahakoa e takoto papatahi ana, ka oho te turoro i te moe, ka pa mai ano he whatitiri 1-tuarua, ka haere tahi ranei me te kirikaa, te rangirua, te ngoikoretanga, te ngoikoretanga o tetahi taha. Waea wawetia 911.
5. Tirohia te "4-Hour Epidural Wear-Off Clock" me te whakamatautau i te neke haere o nga waewae. I muri i te whakamutua, i te toia ranei o te ngongo ngongo epidural, me pai haere tonu te whakamaarama me te ngoikore o te rohe i roto i te 4 ki te 6 haora. Tonoa te manawanui ki (1) Hikina ia waewae tika mai i te moenga, (2) Whakapikoa nga turi e rua, me (3) Toia nga waewae e rua ki runga ki tona ihu ka pana ki raro ano he pene hau. Mena kei te taumaha tonu tetahi, e rua ranei nga waewae, he ngoikore, he ngongo ranei kua hipa i te 4 ki te 6 haora, mena ka ngaro ohorere te kaha o te waewae o te manawanui ka taea te hikoi i mua ("biphasic motor block return"), tono mo te Ohotata katoa Whole-Spine MRI.
6. Kia mau tonu nga rongoa angiangi toto me nga rongoa antiplatelet (KAUA e tango i te horopeta o muri mai o te apixaban, rivaroxaban, enoxaparin/Lovenox, warfarin, clopidogrel, aspirin ranei). Mena kei te whakaheke toto te hematoma epidural spinal i roto i te hiku, ka tango i tetahi atu horopeta o te anticoagulant he tere ake te tere o te whakaora i te hauora, ** ka tere ake te whakaora o te mate ki te hōhipera. idarucizumab, 4-factor PCC, protamine sulfate ranei **) i mua i te whakahekenga neurosurgical.
7. Kia takoto te manawanui me te takoto tonu i runga i te moenga, me te whakakaha i te NPO (kaore he mea ma te waha) mena he haki whero kei reira. Mena kei reira he hematoma epidural epidural, he puku puku ranei, ka haere tika te manawanui mai i te matawai MRI ki te ruma whakahaere mo te mate whawhati tata whawhati tata me te laminectomy decompressive; Ko te noho kau o te puku ka aukati i te wawata i te wa o te intubation. (Mehemea he anake te mahunga o te mahunga i muri i te werohanga o te tuuroro me te kore o te tohu neurological, te haki whero ranei o muri, ka takoto tapapa, ka inu i te wai-a-waha me te kawheine i te wa e whakarite ana i te tapa toto epidural me te Anesthesia).
8. Pitihia marietia (tap) te waenganui o te tuara ka tirohia te mahana o te tinana. I roto i te Spinal Epidural Abscess, ka paopao ma te kotahi maihao ki runga i nga tukanga porowhita i waenganui o te tuara ka kitea te tino ataahua, te tohu ** te ngawari o te rohe waenga** i runga tonu i te vertebrae pangia, ahakoa kare ano te turoro i te kirika 0pid** KORE kirikaa nga turoro i te whakaaturanga tuatahi).

Rakau whakatau: te mamae i muri i te epidural, te mamae o te tuara, te mahunga, me te whakamatautau paralysis¶

flowchart TD
    Start["Te mamae nui o te tuara/kaki, te mamae o te mahunga ranei i muri mai i te epidural, te werohanga o te lumbar, te wero i te tuara, te whakaheke toto, te mate ranei."] --> CheckSymptom{"Hipanga 1: Ko te Amuamu Tuatahi kei muri / Waewae / Tongi Puke, He Mauiui Mahunga ranei?"}

    CheckSymptom -->|"Te mamae o te tuara, te kaki ranei, te ngongo/ngoikore o te Waewae, te mamae o te pupuhi, te pupuri ranei i te kopu."| CheckCordRedFlags{"Hipanga 2: Tirohia nga Kara Whero Ko te Kopeketanga Tauira Iwi: 1. Te ngoikore o te waewae, te taumahatanga ranei (neke atu i te 4 haora i muri i te wehenga o te epidural, ka hoki mai ranei i muri i te kakahu), 2. Te paheketanga o te nohoanga (te papa/papa), 3. Te kore e kaha ki te mimi, ki te kore ranei e kaha ki te mimi, 4. Te mamae o te tuara waenga me te mamae o te radicular?"}

    CheckCordRedFlags -->|"ĀE ki TĒTAHI Haki Whero (Otirā me te Epidural/LP o na tata nei, he Whakapai Toto ranei)"| CheckFeverRisk{"Hipanga 3: Te Whakaoho Tere (Miti ki nga Haora) ki te Whakaaetanga Subacute (Nga Ra) me te Morearea Mate (IV Whakamahinga Taakaro, Mate huka, kiri whewhe, Mahi Tuira)?"}

    CheckFeverRisk -->|"Te mamae o te tuara e rite ana ki te Naipi ohorere, ka tere te ngoikore i roto i nga meneti ki nga haora (Whakatangohia te Catheter i muri i te Epidural, te Whakamahi Anticoagulant ranei)"| SEH["HEMATOMA EPIDURAL HEMATOMA (SEH): Waea wawetia 911 / 112 / 999; Puritia nga Whakapai Toto, NPO Tino, Stat Spine MRI + Anticoagulant Reversal + Decompressive Laminectomy I roto i te 8 ki te 12 haora"]

    CheckFeverRisk -->|"Kei te ahu whakamua te mamae o te tuara o waenganui i nga ra + te kirika/mao, te ESR/CRP teitei ranei + te mamae o te pupuhi ira"| SEA["TE PUTANGA EPIDURAL EPIDURAL HUARANGA (SEA): Waea wawetia nga ratonga ohorere; Stat Gadolinium-Whakarei MRI Katoa-Spine + Nga Ahurea Toto + IV Vancomycin & Ceftriaxone/Cefepime + Ko te Whakahekenga Whakahekenga"]

    CheckSymptom -->|"Te mamae o te Mahunga (Postpartum, Post-Lumbar Puncture, Post-Epidural ranei)"| FlatTest{"Hipanga 4: Mahi i te 15-Minute Flat-Lie Test: Ma te Takoto 100% Flat me te kore he urunga ka awhina i te 80% ki te 100% o te mamae o te mahunga i roto i te 15 ki te 30 meneti?"}

    FlatTest -->|"AE: Te Maehe Maehe Turanga (Kua Kare Ina Papatahi, Tino Nui I Roto I te 15 Mineti o te Noho/Tu) + Te kaki o te kaki / Tinnitus / Photophobia, ZERO Neuro Deficits or Fever"| PDPH["POST-DURAL PUNCTURE HEADACHE ('WET TAP' CSF Leak): Lie Flat, Hydrate, Oral Caffeine (200 ki te 300 mg), Acetaminophen/NSAIDs; Whakapa atu ki te Anesthesiology mo te Paa Toto Epidural Autologous (90% ki te 98% Rere Whakaoranga)"]

    FlatTest -->|"KORE: Ka mau tonu te mamae o te Mahunga Ina Takoto Ana, Ka Pahekeheke te Waitiriki, Te Kirikaa, Ka mau, Te BP Teitei, Nga Huringa Matakite, Te ngoikoretanga o te ringaringa/waewae."| IntracranialRedFlag["TE WHAKAMAHI KI TE ORARAA (Subdural Hematoma, Cerebral Venous Sinus Thrombosis, Bacterial Meningitis, Postpartum Preeclampsia ranei): Waea wawe ki te 911 mo te Brain CT/MRV"]

Tikanga 1: Te Mahunga o te Mahunga o te Mahunga o muri-Dural ("Papa Makuku") me te pakarutanga o te CSF ka huri hei Hematoma Subdural¶

I te wa o te whakamatautautanga whanga lumbar (tapa tuakoi) ranei whakamoana tuakoi, ka werohia e te ngira iti te kiriuhi uaua e karapoti ana i te wai o te tuara (te dura mater me te membrane arachnoid). I te wa o te mahi epidural, epidural steroid werohanga ranei, e whai ana te kai-whakamaori mate ki te whakamutu i te *waho noa o te roa i roto i te waahi epidural, ma te whakamahi i te **17-mehua, 18-mehua Tuohy ngira **; i roto i te 0.5 ki te 1.5 paiheneti o nga tuunga whakarorohara, ka werohia e te ngira whanui (te catheter ngawari ranei) te dura (he "tap makuku" pokanoa).

1. Pathophysiology: He aha te rerenga o te CSF ka pa te mamae o te upoko¶

Ka tere te roro pakeke ki roto i te 150 milliliters (5 hekere) o te wai cerebrospinal (CSF). Ka rere tonu te CSF i roto i te kohao o te lumbar dura ki roto i nga kopa ngohe o te tuara o raro tere atu i te choroid plexus o te roro ka whakaputa wai hou (-20 mL/hour), ka heke katoa te rōrahi CSF intracranial (incranial hypotension). - Te ngohe o te roro me te tohenga meningeal: I te wa ka noho te manawanui ki runga, ka tu ake ranei, ka kumea te roro ki raro ma te maha mirimita i roto i te angaanga (caudal brain sag). Na te mea karekau he mamae mamae o te parenchyma o te roro, ka puta te mamae mai i te roro ngohe e kumea ana i runga i nga ** kiriuhi tairongo mamae, nga nerve cranial (CN V, IX, me X), me te piri i nga uaua roro** kua mau ki runga o te angaanga. - Whakautua Monro-Kellie venous engorgement: Na te mea he pouaka maro kati te angaanga (te kaupapa Monro-Kellie), ka heke te rōrahi o te CSF, ko nga uaua me nga sinuses venous i roto i te angaanga me te tuara o runga kaokao ka pupuhi ki te toto ki te whakakii i te korehau, ka puta te pehanga vascular o te manawanui i roto i nga meneti.

2. Nga Tohu Haumanu o te Mahunga o te Mahunga o te Mahunga o muri-Dural (PDPH)¶

1. Wā: Ka timata 12 ki te 72 haora i muri i te werohanga lumbar, te epidural ranei (90 ōrau i roto i te 3 ra, tata katoa i roto i te 5 ra).
2. ** Tauira Orthostatic (Turanga) Tino:** Ka rongo te manawanui he tino pai, he 80 ki te 100 paiheneti kaore he mamae i te wa e takoto kau ana i runga tuara, engari i roto i te 15 meneti i te noho tika, i te tu ranei, ka pa te mahunga kino, puhoi, pupuhi, he rite ranei ki te mahunga ki runga ** i nga taha e rua o te rae me te tuara o te mahunga, ki te taha o mua me te tuara o te mahunga pakihiwi.
3. ** Nga Tohu Taonga VI & VIII:** Na te mea ka totoro te roro o te roro i te ono o nga nerve cranial (abducens nerve) me te whakaheke i te wai mai i te puku o roto o te taringa ma te aawa o te korokoro, he maha nga wa ka rongohia e nga turoro ** te rongo maru ("taringa i raro i te wai"), te reo iti o te tangi o te tangi, te pouri, te ahua o te tangi, te pouri, te ahua o te ahua o te ahua o te ahua o te ahua o te ahua. whakakitenga**.

3. Te Whakawhitinga Morearea: I te wa e haea ai e te "Hemaoma Mahunga Mokowhiti" he "Hematoma Turoro Intracranial"¶

4. Te maimoatanga tino mo te PDPH: He aha te Autologous Epidural Blood Patch (EBP) ko te Paerewa koura¶

• I nga haora 24 tuatahi o nga tohu o te waahi ngawari: Takoto i nga wa katoa ka timata te mahunga, inu i te nui o te wai-a-waha (ko te kaha o te nui o te wai i tua atu i te matewai kare e piki ake te hanga CSF, ahakoa ka nui haere te mamae o te matewai), tango ** kawhe-waha (200 to 300 mg kotahi, e rua ranei ia ra, kawheine konutai benzoate ranei 500 mg IV)** (e whakatiki ana i nga uaua intracranial kua pupuhi me te aukati i nga kaiwhakawhiwhi adenosine), me te acetaminophen me te ibuprofen. Ka taea hoki e nga paraka whakaeke iti rawa atu penei i te transnasal sphenopalatine ganglion (SPG) paraka te whakaora tere.
• Te rongoa Paerewa-Gold (Autologous Epidural Blood Patch): Mo nga mate mahunga o muri mai i te werohanga i muri i te roanga o te mamae (ina koa i muri mai i te paopao maku o te ngira epidural nui, he mahunga ranei kua roa atu i te 24 ki te 48 haora), ka mahia e nga tohunga anesthesiologist he Epidural Blood Patch. I raro i nga tikanga korekore, ka kumea e te kai-whakamaori te 15 ki te 20 miramira o te toto venous o te manawanui mai i o ratou ringa ka werohia ki roto i te waahi epidural lumbar i tetahi waahi ranei i raro iho i te waahi werohanga tuatahi. E rua nga merekara e mahia ana e tenei: (1) ko te nui o te toto ka kume tonu i te pukoro o te lumbar dural, ka pana CSF ki runga ki te mahunga me te whakaora i te mamae o te upoko ** i roto i nga meneti i runga i te tepu**, me (2) ka pupuhi te toto i runga i te roimata i roto i te dura ano he Band-Aid koiora, ka hiri i te pakaru i roto i te 85 ki te 98 paiheneti o nga turoro.

Tikanga 2: Spinal Epidural Hematoma (SEH) and the Anticoagulant / Catheter-Removal Trap¶

Ko te Spinal Epidural Hematoma (SEH) he kohinga whakapeka o te toto totika, toto venous ranei i roto i te mokowhiti epidural spinal e kokopi ana i te taurakira, cauda equina ranei.

1. He aha te Tangohanga i te Epidural Catheter he rite tonu te morearea ki te whakauru¶

Ko te mea nui i whakakoia e te American Society of Regional Anesthesia and Pain Medicine (ASRA) nga aratohu ko ** tata ki te 50 paiheneti o nga hematomas epidural epidural katoa e pa ana ki te rewharewha KORE ka puta i te wa tuatahi ka whakaurua te ngira epidural, engari i nga ra i muri mai ka unuhia te catheter epidural kirihou ngawari**. - Ko te whakaheke i te catheter epidural mai i te tuara ka kutikutia he uaua iti i roto i te plexus venous o Batson. - Te Ture Whakatau Whakatau: I nga turoro i roto i te hohipera (pēnei i nga turoro orthopedic turi/hip whakakapi, nga turoro pokanga vascular/thoracic, nga turoro C-wahanga ranei e whiwhi ana i nga whakaheke toto prophylactic penei i te enoxaparin [Lovenox], te heparin kore-wahanga, te apixaban, te rivaroxaban ranei), ka kumea he toto ki waho i te rerenga toto i roto i te awheawhe angiangi. ka angiangi te toto i muri tata tonu i te toia o te catheter ki waho) ka aukati i taua uaua iti ki te toto. I roto i te 1 ki te 12 haora, ka whakakiia e te kohanga toto pehanga-nui te awaawa. - Tuhipoka mo te SEH Mahorahora: Ka puta ano nga hematomas epidural spinal kare he ngira tuara i roto i nga turoro e tango ana i nga whakaheke toto (warfarin, DOACs, rua antiplatelets) i muri i te riaka iti, te maremare, te hiki, te whawhe o te chiropractic.

2. Te Huringa Haumanu o te Hematoma Epidural Spinal¶

1. Te ahua o te maripi, te mamae o te tuara waenga, te mamae kaki ranei ("Spinal Stroke Pain") tika i te taumata o te toto, he maha tonu te haere tahi me te koi ** te mamae radicular e pupuhi ana i te uma / puku, i raro ranei i nga waewae e rua**.
2. Ka tere haere te ngaronga o te tairongo me te ngoikore o te motuka (i roto i te 30 meneti ki etahi haora): Te ngongo me te ngongo e piki ake ana nga waewae ki te raina whakapae motuhake i runga i te katua (te taumata rongo), te ngongo ranei o te papa, te ira, me te papa (te whakamohoatanga o te nohoanga), ka whai tere i te taumaha, te ngongo o nga waewae (parasisi kua oti te haere).)
3. Te pupuri i te mimi me te ngaronga o te whekau: Na te mea kei te noho whakaraerae nga muka motuhake o te sacral e whakahaere ana i te uaua detrusor bladder ki waho o te conus medullaris me te cauda equina, ko te kore e kaha ki te mimi (me te kore mamae e pupuhi ana mai i te tomi o te kopu) tetahi o nga tohu tuatahi o te pehanga taura.

Tikanga 3: Spinal Epidural Abscess (SEA) and the Classic 4-Stage Progression¶

Ko te Spinal Epidural Abscess (SEA) he mate huakita pyogenic (i puta mai i te 60 ki te 70 ōrau o ngā take e Staphylococcus aureus, tae atu ki te MRSA, whai muri ko Streptococcus, Escherichia coli, me Pseudomonas) kua mau i waenganui i te koiwi dura me te vertebral mater. Ka tae atu nga huakita ki te mokowhiti epidural tuawhenua ma te rere toto ranei (te purapura hematogenous mai i te whewhe kiri/cellulitis, te puku niho, te mate urinary tract, te catheter intravenous, te whakamahi tarukino werohia ranei) ma te toronga tika ranei mai i te catheter epidural, pokanga tuawhenua, he mate kōpae vertebral pātata ranei (discitis/osteomyelitis).

Ko nga wahanga haumanu e 4 e whai ana i te hiku o te kopu (Heusner's Stages)¶

Na te mea ka pakaru te kiri tuara epidural i te taurakira na roto i te whakakopeketanga miihini me te septic thrombophlebitis (te whakahekenga o nga uaua o te taurakira), ka taea e te manawanui te peke mai i te Waahanga 2, 3 ranei ki te paralysis o te Waahanga 4 e kore e taea te huri i roto i te haora kotahi:

• Stage 1 (Focal Midline Back or Neck Pain + Spine Percussion Tenderness): Te mamae nui, te kore e mutu, te mamae o te rohe, te mamae mamae ranei i waenganui o te tuara, te kaki ranei e kino ana i te wa e takoto ana i te po, ka haere tahi me te ngawari o te tohu ka paohia e te maihao nga tukanga spinous. (Tuhipoka: Karekau te kirika ki runga ki te 50 paiheneti o nga turoro o te Waahanga 1, na te mea he maha nga wa ka kitea he "uaua toia ki muri").
• Wāhanga 2 (Nerve Root Irritation / Radicular Shooting Pain): Hiko-ra, weranga, mamae pupuhi ranei e puta mai ana i te tuara ki raro i te waewae (sciatica), i raro i te ringa, i te takai i te ribcage, i te puku ranei (he maha nga wa e pohehehia ana he kowhatu, he kowhatu whatukuhu, he mamae o te gallbladder ranei).
• Wāhanga 3 (Waewaenga Moata moata, Ngaronga Ngaro, me te Tongi Tongi/Wha: Te taumaha o nga waewae, te tutukitanga o te hikoi, te takahanga o te waewae, te ngongo i raro i te whara, i te waahi noho ranei, me te te pupuri i te mimi whakapeka (i muri i te korenga o te rahi o te ngongo ngongo >100 to 200 mL). Koinei te matapihi whakaoranga whakamutunga.
• Wāhanga 4 (Kati Paralysis): Ka ngaro katoa te neke me te karekau i raro i te taumata o te puku. Kia roa ake te Waahi 4 i te 24 ki te 36 haora, karekau e taea te whakahoki mai i te hikoi e te waipara pokanoa.

Te rerekee i te Mahunga o te Mahunga o te Mahunga, te Hematoma Epidural Spinal, te Abscess Epidural Spinal, me te Meningitis¶

Whakamahia tenei ripanga whakataurite i te taha o te moenga kia tere te wehewehe i nga tohu pai i muri i te whakahaerenga mai i nga mahi pokanga me nga aitua hopuhopu:

Nga tikanga tātaritanga o te hohipera me nga tikanga neurosurgical¶

Ina tae mai te manawanui ki te tari whawhati tata me te whakapae he paheketanga o te taurakira, ka mahia e nga hohipera he ara neurosurgical tino nui mo te waa:

1. Ko te MRI Hikoi-katoa Inamata (KORE i nga hihi X, CT anake ranei): He mea noa nga hihi X-tuira i roto i te hematoma whakapeka me te puku moata, a ka ngaro nga karaehe rereke-kore o te CT ka ngaro nga kopa me te nana i roto i te awaawa. Ko te paerewa koura ko Emergent Magnetic Resonance Imaging (MRI) of the Whole Spine (me te gadolinium contrast for suspected abscess; non-contrast T1/T2 for hematoma), atahanga cervical, thoracic, and lumbosacral taumata ki te hopu i te 10 ki te 15 paiheneti te auau o nga whiu peke. (Mena ka whakakorehia e te kaiwhakatere te MRI, ka mahia te CT Myelography).
2. Te Matawai Irirangi Tongi Moenga (Post-Void Restual): Ka mahia e nga nēhi he ultrasound tongāmimi 30-hekona i muri tonu i te nganatanga o te manawanui ki te whakakore. He muri-kore-kore-roa te toenga (PVR) kua hipa 100 to 200 mL ka whakapumau i te pupuri i te pukupuku neurogenic mai i te taura, te cauda equina compression ranei, ka tere tonu te Foley catheterization.
3. Whakamuri Anticoagulant + Laminectomy Decompressive Putanga:
4. Mo te Spinal Epidural Hematoma (SEH): Ka huri tonu te whakaheke toto (4-factor PCC + IV huaora K mo te warfarin; andexanet alfa ranei 4-factor PCC mo te apixaban/rivaroxaban; idarucizumab mo te dabigatran; protamine sulfate ki te heparin/enoxaparin; platelets sulfate mo te heparin/enoxaparin; ** <100,000/uL), ka whai muri mai i te ** laminectomy decompressive me te wehe i te toka i roto <8 to 12 hours.
5. Mo te Spinal Epidural Abscess (SEA): E rua nga huinga ahua toto ka tuhia, ka timatahia nga patu paturopi IV empiric (IV vancomycin [15 to 20 mg/kg] PLUS IV cefepime [2 g q8h] ceftriaxone ranei [2 g q12h]), a ka mahia e nga taote neurosurgeon ** te laminectomy pokanga tere me te whakaheke pana** ka whai muri i te 4 ki te 8 wiki o nga patu paturopi kua tohua.

Nga nama ohorere a rohe me nga tikanga umanga¶

E whakapaetia ana he hematoma epidural epidural ranei, me tere tere te kawe waka tūroro ki te hōhipera tuatoru me 24-haora Emergency MRI me On-Call Neurosurgery / Orthopedic Spine Surgery:

• Te Hononga o Amerika me Kanata: Waea 911. Korero atu ki nga paramedics ki te kawe ki te hohipera nui me te ** 24/7 MRI me te Spine Surgery ** (te haere ki tetahi hohipera hapori iti kaore he MRI neke-po, he neurosurgery ranei ka pau nga haora utu nui i roto i te whakawhiti i waenga i nga hohipera i te matapihi paralysis 8-haora). Whakahaerehia i raro i American Society of Regional Anesthesia and Pain Medicine (ASRA) me ** Infectious Diseases Society of America (IDSA)** nga aratohu.
• United Kingdom: Waea 999 mo te waka tūroro tere ki te hōhipera tino nui Te Tari ohorere (A&E) me nga ratonga Spinal Surgery and MRI services (e whai ana i te GIRFT National Suspected Cauda Equina Syndrome & Spinal Cord Compression Pathway and **Association of Anesthetists / Obstetrics' Association of Anesthetists / Obstetrics]
• Uniana Pakeha: Waea 112. Whakahaerehia i raro i European Society of Anaesthesiology and Intensive Care (ESAIC) me European Society of Regional Anesthesia (ESRA) nga aratohu haumaru neuraxial.
• Ahitereiria me Aotearoa: Waea 000 i Ahitereiria, 111 ranei i Aotearoa. Ka whakahaerehia i raro i Australian and New Zealand College of Anesthetists (ANZCA) nga aratohu poraka neuraxial.
• India me Ahia-Kiwa: Waea 112 (ranei 108 i Inia), 995 i Singapore, 119 i Hapani me Korea ki te Tonga, 999 ranei i Malaysia me Hong Kong. Tonoa he pokapū tuatoru me te MRI 24-haora me te neurosurgery.

Pātai auau¶

Me pehea e mohio ai ahau he rerekee i waenga i te mahunga o te tuara "makuku-tap" i muri mai i te epidural me te mate o te roro kino i te toto, i te toto ranei?¶

Mahi i te 15-Minute Flat-Lie Test: he mahunga o muri ("wet-tap") te mahunga o te tuara na te iti o te pehanga wai o te tuara i te wa e tu ana, no reira ko te 100 paiheneti e takoto ana i runga i to tuara me te kore urunga ka marie te 80 ki te 100 paiheneti o te mahunga i roto i te 15 ki te 30 meneti, ka hoki mai te mahunga i roto i te 15 meneti e noho ana, e tu ana ranei. Ki te KORE e tino pai ake to mahunga i te wa e takoto papatahi ana, mena ka huri ohorere te mahunga i mua i te tuunga ahakoa e takoto ana, mena he toto toto teitei koe, he rereke te tirohanga, he rangirua, he hopu, he kirika, he ngoikore ranei o te ringa, o te waewae ranei, waea atu ki te 911 ki te whakakore i te hehemaoma subdural intracranial, cerebral venous me sinusitis premiositis, cerebral venous sinusitis.

Kia pehea te roa o oku waewae kia hoki mai ano te ngakau me te kaha i muri i te whakakorenga o te epidural whakawhānau?¶

I raro i nga aratohu haumaru anesthesiology o te ao (pēnei i te Obstetric Anesthetists' Association me nga tikanga ASRA), ka mutu te whaowhia epidural me te tango i te catheter, ka memeha haere tonu te rongoa rongoa o te rohe, me te 100 paiheneti hoki te kaha me te kaha o to waewae i roto i te 4 haora (kaore e roa ake i te 6 haora). Ki te kore e taea e koe te hiki ake o waewae tika i runga i te moenga i muri i te 4 haora, mena ka kaha te taumaha, ka ngongo ranei o waewae, ki te mea he ngongo koe i to hiku i te wa e muru ana koe, mena kua pai te mahi o ou waewae i mua ake nei, ka mutu ka ngenge, ka ngoikore ano, me tono mo te Spine MRI hei whakatau i te mate hematoma epidural spinal.

He aha te take ka puta he hematoma epidural epidural i muri i te mahi?¶

Kei roto i te mokowhiti epidural he tukutuku matotoru o nga uaua pakitara angiangi (Batson's plexus). Ko te whakaheke i te ngongo epidural kirihou ngawari mai i te tuara i te mutunga o te mahi, i muri ranei i te pokanga ka pakaru tetahi o aua uaua iti, e tata ana ki te haurua o nga hematoma epidural katoa. Mena kua whiwhi te manawanui i te horopeta o te toto angiangi (penei i te enoxaparin/Lovenox, heparin, apixaban, rivaroxaban ranei) tata rawa atu ki te wa e unuhia ai te catheter, he iti ranei nga platelets (pēnei i te mate HELLP syndrome), kaore e taea e taua uaua iti rakuraku te korowha, ka toto ki roto i te uaua o te hiku i roto i nga haora.

He aha te "papiri toto epidural" me te aha e kore ai koe e tuku i te mahunga o te tuara nui kia kore e rongoa mo nga wiki?¶

Ko te papaki toto epidural autologous he 15-meneti te mahi i te taha o te moenga e mahia ana e te tohunga kaiao ka toia te 15 ki te 20 mL o te toto parakore mai i to uaua ringa ka werohia ki roto i to tuara o muri o te waahi epidural hei hiri i te roimata i roto i te putea wai o te tuara. Ka rongoa e ia te 85 ki te 98 paiheneti o nga mahunga o muri i te werohanga tata tonu. I tua atu i te whakakore i te mamae mamae kia noho ai te whaea hou, te manawanui ranei ki runga ki te mahi, ma te hiri i te pakaru o te CSF kino ka tiaki i te roro: mena ka totohu te roro ki raro ki roto i te angaanga mo nga ra, wiki ranei mai i te turuturu kaore i rongoatia, ka taea e ia te totoro me te haehae i nga uaua piriti pakarukaru ki runga o te roro, ka puta he mate intracranial intracranial subdural.

Ka taea e te tangata te pa ki te mate kirikaa ahakoa KARE ia he kirika?¶

Ae, ko te tatari mo te kirikaa te take tuatahi ka ngaro nga puku epidural tuara kia puta ra ano te pararutiki. Ko nga rangahau haumanu e whakaatu ana ko te 50 ki te 60 paiheneti anake o nga turoro kua whakapumauhia he mate kirikaa kua pa ki te kirikaa i to ratou taenga tuatahi ki te rūma whawhati tata, me te iti iho i te 15 paiheneti he "torutoru" katoa o te mamae o muri, kirikaa, me nga ngoikoretanga neurological i te wa kotahi. Engari, titiro mo te mamae nui, te tuara waenga rohe, te mamae kaki ranei e mamae ana i te paopaohia e te maihao, te pupuhi i te mamae o te nerve ki raro i nga waewae, i nga rara ranei, me nga mea morearea penei i te mate huka, te mate kiri tata, te tukanga niho, te werohanga tuara, te raina IV ranei, ka tono mo te whakamatautau toto ESR / CRP me te rereke MRI Spine.

He aha te mea tino nui te matapihi 8-ki-12-haora ina timata te ngoikore o te waewae, te pupuri ranei i te mimi?¶

Na te mea kare e taea e te wiwi vertebral te totoro, karekau e kowhao noa te kohanga toto epidural, te pute nana ranei, ka kuwha noa i te taurakira, ka kuru hoki i nga uaua-iti e whakaheke ana i te taurakira, ka pa mai te mate o te uaua (infarction) o te kiko. Ko nga raraunga neurosurgical e whakaatu ana mehemea ka whakatuwherahia e nga taote te tuara (decompressive laminectomy) me te tango i te pupuhi, te nana ranei i roto i nga haora 8 ki te 12 o te timatanga o te ngoikore o te waewae, ko te nuinga o nga turoro ka hoki mai ano te kaha o te hikoi me te whakahaere i te kopu; I te roanga o te pararutiki katoa neke atu i te 24 ki te 36 haora, ka mate tonu nga waahanga o te taurakira.

Nga puna me nga aratohu whai mana¶

• American Society of Regional Anesthesia and Pain Medicine (ASRA, United States): Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy: ASRA Evidence-Based Guidelines (Fifth Edition) (Regional Anesthesia & Pain Medicine, ture taima mo te whakaurunga epidural me te catheter mo te tangohanga o te catheter 4hours, me te tango i te motika epidural me te catheter 4hours. <8 to 12 hour matapihi laminectomy decompressive mo te hematoma epidural spinal).
• Te Roopu Mahi a te Motu-a-ao mo te Maehe o te Mahunga o te Mahunga o muri-Dural (ASRA, ESRA, OAA, SOAP, International): Aratohu Mahinga Haumanu I runga i nga Whakaaturanga mo te Maehe Maehe Pouamu (Regional Anesthesia & Pain Medicine / JAMA Network, te paearu tātaritanga tuunga, te haki toto whero subdural me te mate pukupuku o te roro. kawa).
• Obstetric Anesthetists' Association (OAA) & Association of Anesthetists (United Kingdom): Te Aratohu Haumaru: Neurological Monitoring Associated with Obstetric Neuraxial Block ("Whakaarahia Waewae Tika i te 4 Hours" te ture me te huarahi MRI tonu mo te paraka motuka roa, hoki mai ranei).
• Infectious Diseases Society of America (IDSA, United States): IDSA Clinical Practice Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis and Spinal Epidural Abscess in Pakeke (Clinical Infectious Diseases, Heusner staging, ESR/CRP screening, gadolinium-enhanced IV, and comed vanycinic IV tuatoru/wha-whakatupuranga cephalosporin).
• NHS Kia Tika Tuatahi (GIRFT) & Society of British Neurological Surgeons (SBNS, United Kingdom): National Suspected Cauda Equina Syndrome and Acute Spinal Cord Compression Emergency Pathway.

Nga kaiarahi e pa ana¶

• Ko te mate o Cauda equina me nga haki whero o te kopeke o te taurakira
• Te whakaheke toto o te subarachnoid, te mahunga whatitiri, me te pakaru o te roro
• Ko te mate o te Eclampsia, te mate HELLP, me te mate o te whanautanga
• Ko te mate pukupuku me te mate pukupuku mate pukupuku karekau he whakapouri
• Te mau tonu o te mimi, te kore e kaha ki te mimi, me te aukati i te catheter