Ọrịa coma

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Àtụ:Infobox medical condition (new) Amaghi onwe bu onudu ihe di omimi nke amagi onwe tere aka nke mmadu agaghi eteta, ghara izaghichi ihe mkpali nke ufu, ihe,na ura, na enweghi ezigbo iteta ura ma onaghi emeghari ahi. .[1] Onye ahu nwere ike inwe nsogbuiku ume na obaraT n'ihe enweghi ike nke ahu irusi oru ya ike. Ndi na no na Amaghi onwe ha na achosi nlekota anya nke ulo ogwu ike iji lekota ahu ike ha ma gbochie mgbagwoju anya dika mkpokata obara.

Ndi no na Amaghi onwe ha na nwekariComa patients exhibit a complete absence of wakefulness and are unable to consciously feel, speak or move.[2][3] Comas can be derived by natural causes, or can be medically induced.[4]

N'ụzọ ahụike, enwere ike ịkọwa coma dị ka enweghị ike ịgbaso iwu otu nzọụkwụ.[5][6] A pụkwara ịkọwa ya dị ka akara nke ≤ 8 na Glasgow Coma Scale (GCS) nke na-adịgide ≥ awa 6.[7] Maka onye ọrịa ka ọ mara, a ghaghị ịnọgide na-enwe ihe ndị metụtara ịmụrụ anya na ịmara ihe. Uche na-akọwa ogo nke ịma ihe, ebe ịma ihe na-emetụta akụkụ dị mma nke ọrụ ndị cortex na-eme, gụnyere ikike nghọta dị ka nlebara anya, nghọta, ncheta doro anya, asụsụ, ịrụ ọrụ, nhazi oge na oghere na ikpe ikpe eziokwu.[2][8] Site n'echiche nke ụbụrụ, a na-eme ka uche mara site na ịrụ ọrụ nke ụbụ ụbụrụ - ihe na-acha ntụ ntụ nke na-emepụta ụbụrụ dị n'èzí - na site na usoro reticular activating system (RAS), ihe dị n'ime ụbụrụ.[9]

Okwu 'coma', sitere na Grik κῶμα koma, nke pụtara ụra miri emi, ejirila ya mee ihe na Hippocratic corpus (Epidemica) na mgbe e mesịrị site na Galen (narị afọ nke abụọ AD). N'ikpeazụ, a naghị eji ya eme ihe n'akwụkwọ ndị a ma ama ruo n'etiti narị afọ nke iri na asaa. A na-ahụkwa okwu ahụ na Thomas Willis' (1621-1675) nwere mmetụta De anima brutorum (1672), ebe a kpọtụrụ lethargy (ụra na-arịa ọrịa), 'coma' (ụra siri ike), carus (enweghị mmetụta) na apoplexy (nke carus nwere ike ịgbanwere na nke ọ chọtara na ihe ọcha). Okwu ahụ bụ carus sitere na Grik, ebe enwere ike ịchọta ya na mgbọrọgwụ nke ọtụtụ okwu nke pụtara na-ehi ụra ma ọ bụ na-ewute ụra. A ka nwere ike ịchọta ya na mgbọrọgwụ nke okwu 'carotid'. Thomas Sydenham (1624-89) kwuru okwu 'coma' n'ọtụtụ ọrịa ọkụ (Sydenham, 1685).[10]

Ọtụtụ ụdị nsogbu nwere ike ịkpata coma. Pasent iri anọ nke ọnọdụ coma na-esite na nsị ọgwụ.[11] Ojiji ọgwụ ụfọdụ n'okpuru ọnọdụ ụfọdụ nwere ike imebi ma ọ bụ mebie ọrụ synaptic na usoro na-arịgo elu (ARAS) ma mee ka usoro ahụ ghara ịrụ ọrụ nke ọma iji kpalie ụbụrụ.[12] Mmetụta ndị ọzọ nke ọgwụ, nke gụnyere obi na ọbara mgbali elu, yana iku ume na ọsụsọ na-adịghị mma, nwekwara ike imerụ ọrụ nke ARAS n'ụzọ na-apụtaghị ìhè ma mee ka ọ daa. N'iburu n'uche na nsị ọgwụ bụ ihe kpatara ọtụtụ ndị ọrịa nọ na coma, ụlọ ọgwụ na-ebu ụzọ nwalee ndị ọrịa niile nọ na coma site n'ịhụ ogo pupil na mmegharị anya, site na vestibular-ocular reflex. (Lee Diagnosis n'okpuru ebe a.)[12]

Ihe nke abụọ na-akpata coma, nke mejupụtara ihe dị ka 25% nke ikpe, bụ enweghị ikuku oxygen, nke na-esikarị na nkwụsị obi.[11] Central Nervous System (CNS) chọrọ ikuku oxygen dị ukwuu maka neurons ya. Enweghị ikuku oxygen na ụbụrụ, nke a makwaara dị ka hypoxia, na-eme ka sodium na calcium si n'èzí nke neurons belata na intracellular calcium mụbaa, nke na-emebi nkwurịta okwu neuron.[13] Enweghị ikuku oxygen n'ime ụbụrụ na-akpatakwa ike ọgwụgwụ ATP na mmebi mkpụrụ ndụ site na mmebi cytoskeleton na mmepụta nitric oxide.

Pasent iri abụọ nke ọnọdụ coma na-esite na mmetụta ndị ọzọ nke ọrịa strok.[11] N'oge ọrịa strok, a na-egbochi ma ọ bụ gbochie ọbara na-aga n'akụkụ ụbụrụ. Ọrịa strok, ọbara ọgbụgba ụbụrụ, ma ọ bụ akpụ nwere ike ime ka ọbara ghara ịga. Enweghị ọbara na mkpụrụ ndụ dị n'ime ụbụrụ na-egbochi ikuku oxygen ịbanye na neurons, ma si otú a na-eme ka mkpụrụ ndụ mebie ma nwụọ. Ka mkpụrụ ndụ ụbụrụ na-anwụ, anụ ahụ ụbụrụ nọgidere na-emebi, nke nwere ike imetụta ọrụ nke ARAS.

15% fọdụrụnụ nke ndị na-arịa ọrịa na-esite na mmerụ ahụ, ọbara na-efubiga ihe ókè, nsogbu na-edozi ahụ, hypothermia, hyperammonemia, ọkwa glucose na-adịghị mma, na ọtụtụ nsogbu ndị ọzọ.[14] Ọzọkwa, nnyocha na-egosi na 1 n'ime ndị ọrịa 8 nwere mmerụ ahụ ụbụrụ na-enwe ọnọdụ coma.[15]

Mmerụ ahụ na ma ọ bụ abụọ nke ụbụrụ ụbụrụ ma ọ bụ reticular activating system (RAS) zuru ezu iji mee ka mmadụ banye n'ọnọdụ coma.[16]

Cerebral cortex bụ mpụga nke akwara akwara nke ụbụrụ.[17] Cerebral cortex nwere ihe na-acha ntụ ntụ nke nwere nucleus nke neurons, ebe akụkụ dị n'ime nke ụbụrụ nwere ihe ọcha ma nwee axons nke neuron. Ihe na-acha ọcha na-ahụ maka nghọta, nnyefe nke ntinye mmetụta site na ụzọ thalamic, na ọtụtụ ọrụ ndị ọzọ nke akwara, gụnyere echiche dị mgbagwoju anya.

In the treatment of traumatic brain injury (TBI), there are 4 examination methods that have proved useful: skull x-ray, angiography, computed tomography (CT), and magnetic resonance imaging (MRI).[18] The skull x-ray can detect linear fractures, impression fractures (expression fractures) and burst fractures.[19] Angiography is used on rare occasions for TBIs i.e. when there is suspicion of an aneurysm, carotid sinus fistula, traumatic vascular occlusion, and vascular dissection.[20] A CT can detect changes in density between the brain tissue and hemorrhages like subdural and intracerebral hemorrhages. MRIs are not the first choice in emergencies because of the long scanning times and because fractures cannot be detected as well as CT. MRIs are used for the imaging of soft tissues and lesions in the posterior fossa which cannot be found with the use of CT.[21]

Ụdị mmeghachi omume Nkọwa
Oculocephalic reflex A na-eme Oculocephalic reflex, nke a makwaara dị ka anya nwa bebi, iji nyochaa iguzosi ike n'ezi ihe nke ụbụrụ.
  • A na-ebuli anya onye ọrịa n'ụzọ dị nro ma hụ cornea.
  • A na-ebugharị isi onye ọrịa gaa n'aka ekpe onye ọrịa, iji hụ ma anya na-anọ ma ọ bụ na-agbadata n'aka nri onye ọrịa; a na-anwa otu ihe ahụ n'akụkụ nke ọzọ.
  • Ọ bụrụ na anya onye ọrịa na-aga n'akụkụ megidere ntụziaka nke ntụgharị isi, mgbe ahụ a na-ekwu na onye ọrịa nwere ụbụrụ na-enweghị nsogbu.
  • Otú ọ dị, enweghị ike nke anya abụọ ịkwaga n'otu akụkụ nwere ike igosi mmebi ma ọ bụ mbibi nke akụkụ ahụ metụtara. N'ọnọdụ pụrụ iche, ebe naanị otu anya na-agbagọ ma nke ọzọ anaghị, nke a na-egosipụtakarị mmerụ ahụ (ma ọ bụ mmebi) nke medial longitudinal fasciculus (MLF), nke bụ ụbụrụ ụbụrụ.
Mmeghachi omume nke ìhè nke ụmụ akwụkwọ Mmeghachi omume nwa akwụkwọ na ìhè dị mkpa n'ihi na ọ na-egosi retina na-enweghị nsogbu, na nọmba akwara isi 2 (CN II)
  • Ọ bụrụ na pupils na-emeghachi omume na ìhè, mgbe ahụ nke ahụ na-egosikwa na nọmba akwara isi 3 (CN III) (ma ọ bụ ma ọ dịkarịa ala eriri parasympathetic ya) adịghị mma.
Oculovestibular reflex (Nnyocha Kalọm oyi)<br id="mwATE"><br><br><br> Nnyocha nke calorie na-enyocha ma ọrụ cortical na ụbụrụ
  • A na-agbanye mmiri oyi n'otu ntị ma na-ele onye ọrịa anya maka mmegharị anya
  • Ọ bụrụ na anya onye ọrịa jiri nwayọọ nwayọọ tụgharịa gaa na ntị ebe a gbara mmiri, mgbe ahụ ụbụrụ ahụ ka dị mma, agbanyeghị na enweghị ike ịkwaga na ntị a gbara na-egosi mmebi nke ụbụrụ n'akụkụ ahụ.
  • Cortex na-akpata nystagmus ngwa ngwa site na ọnọdụ a gbagọrọ agbagọ ma na-ahụkarị ya na ndị ọrịa maara ihe ma ọ bụ naanị na-ehi ụra.
Mmetụta nke oghere Mmetụta corneal na-enyocha ọrụ kwesịrị ekwesị nke akwara trigeminal (CN 5) na akwara ihu (CN 7), ma dị na nwata.
  • Ịmetụ cornea aka na anụ ahụ ma ọ bụ akwa ogho na-eme ka anya abụọ na-egbuke egbuke ngwa ngwa.
  • Ịmetụ sclera ma ọ bụ anya anya, igosi ọkụ ọkụ, ma ọ bụ ịkpali akwara supraorbital ga-akpali mmeghachi omume na-adịghị ngwa ngwa ma ka bụrụ nke a pụrụ ịdabere na ya.
  • Ndị nọ n'ọnọdụ coma ga-agbanwe mmeghachi omume corneal dabere na oke nke amaghị ihe ha na ebe mmerụ ahụ ha dị.[22]
Mmetụta nke mmegharị Ihe mgbagwoju anya, ma ọ bụ pharyngeal, na-emetụta n'etiti medulla ma na-agụnye nzaghachi mmeghachi omume nke pharyngeel elu na mkpakọ na ntụgharị ire na nzaghachi maka mkpali mmetụta nke mgbidi pharynge, ire azụ, tonsils, ma ọ dị na ogidi faucial.
  • A na-enyocha mmeghachi omume a site na imetụ pharynx azụ aka na ọnụ dị nro nke onye na-etinye ihe owuwu na ile anya maka ịdị elu nke pharynx.
  • Ndị nọ n'ọnọdụ coma ga-egosipụtakarị mmeghachi omume na-adịghị mma ma ọ bụrụ na e mebiri glossopharyngeal (CN 9) ma ọ bụ vagus nerve (CN 10).
  1. ↑ Weyhenmyeye, James A. (2007). Rapid Review Neuroscience 1st Ed. Mosby Elsevier, 177–9. ISBN 978-0-323-02261-3. 
  2. ↑ 2.0 2.1 Bordini (2010). "Coma scales: a historical review". Arquivos de Neuro-Psiquiatria 68 (6): 930–937. DOI:10.1590/S0004-282X2010000600019. PMID 21243255. 
  3. ↑ Cooksley (2017-02-01). "The management of coma" (in English). Medicine 45 (2): 115–119. DOI:10.1016/j.mpmed.2016.12.001. ISSN 1357-3039. 
  4. ↑ Marc Lallanilla (2013-09-06). What Is a Medically Induced Coma? (en). livescience.com. Retrieved on 2022-04-23.
  5. ↑ The Glasgow structured approach to assessment of the Glasgow Coma Scale. www.glasgowcomascale.org. Retrieved on 2019-03-06.
  6. ↑ Coma - an overview | ScienceDirect Topics. www.sciencedirect.com. Retrieved on 2022-04-28.
  7. ↑ Glasgow Coma Scale - an overview | ScienceDirect Topics. www.sciencedirect.com. Retrieved on 2022-04-23.
  8. ↑ Laureys (2009). "Coma". Encyclopedia of Neuroscience 2: 1133–1142. DOI:10.1016/B978-008045046-9.01770-8. 
  9. ↑ Hannaman, Robert A. (2005). MedStudy Internal Medicine Review Core Curriculum: Neurology 11th Ed. MedStudy, (11–1) to (11–2). ISBN 1-932703-01-2. 
  10. ↑ Wijdicks (2008-03-01). "Historical study of coma: looking back through medical and neurological texts". Brain 131 (3): 877–889. DOI:10.1093/brain/awm332. ISSN 0006-8950. PMID 18208847. 
  11. ↑ 11.0 11.1 11.2 Liversedge (2010). "Coma". Anaesthesia & Intensive Care Medicine 11 (9): 337–339. DOI:10.1016/j.mpaic.2010.05.008. 
  12. ↑ 12.0 12.1 Young (2009). "Coma". Ann. N. Y. Acad. Sci. 1157 (1): 32–47. DOI:10.1111/j.1749-6632.2009.04471.x. PMID 19351354. 
  13. ↑ Busl (2010). "Hypoxic-ischemic brain injury: Pathophysiology, neuropathology and mechanisms". NeuroRehabilitation 26 (1): 5–13. DOI:10.3233/NRE-2010-0531. PMID 20130351. 
  14. ↑ Ali (2022). "Hyperammonemia". StatPearls. PMID 32491436. 
  15. ↑ Lombardi (2002-04-22). "Sensory stimulation for brain injured individuals in coma or vegetative state". Cochrane Database of Systematic Reviews 2002 (2): CD001427. DOI:10.1002/14651858.cd001427. ISSN 1465-1858. PMID 12076410. 
  16. ↑ Coma - an overview | ScienceDirect Topics. www.sciencedirect.com. Retrieved on 2022-04-23.
  17. ↑ S. (2011). Human anatomy, 3rd, New York: McGraw-Hill. ISBN 9780073525600. OCLC 318191613. 
  18. ↑ Lee (April 2005). "Neuroimaging in Traumatic Brain Imaging". NeuroRx 2 (2): 372–383. DOI:10.1602/neurorx.2.2.372. ISSN 1545-5343. PMID 15897957. 
  19. ↑ Nakahara (January 2011). "Linear fractures occult on skull radiographs: a pitfall at radiological screening for mild head injury". The Journal of Trauma 70 (1): 180–182. DOI:10.1097/TA.0b013e3181d76737. ISSN 1529-8809. PMID 20495486. 
  20. ↑ Korkmazer (2013-04-28). "Endovascular treatment of carotid cavernous sinus fistula: A systematic review". World Journal of Radiology 5 (4): 143–155. DOI:10.4329/wjr.v5.i4.143. ISSN 1949-8470. PMID 23671750. 
  21. ↑ Haupt (2015). "Coma and cerebral imaging" (in en). SpringerPlus 4 (1): 180. DOI:10.1186/s40064-015-0869-y. ISSN 2193-1801. PMID 25984436. 
  22. ↑ (2007) Textbook of clinical neurology, Goetz, Christopher G., 3rd, Philadelphia: WB Saunders. ISBN 9781416036180. OCLC 785829292. 
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