tag:blogger.com,1999:blog-46826383100101686752024-03-12T16:31:35.055-07:00Neurologiecurs universitar de neurologie pe intelesul tuturor!Charlieeehttp://www.blogger.com/profile/09400801131611961874noreply@blogger.comBlogger14125tag:blogger.com,1999:blog-4682638310010168675.post-33524714763875013302012-11-23T06:00:00.001-08:002012-11-23T06:00:51.631-08:00Nursing in epilepsie
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<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT"><u>Criza
de epilepsie</u></span></span><span style="font-size: medium;"><span lang="it-IT"> este
definita ca manifestare paroxistica
motorie,senzitiva,sezoriala,comportamentala,datorata unor descarcari
anormale electro-chimice la nivel cerebral.</span></span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT"><u>Elilepsia
este oafectiune cronica manifestata prin crize epileptice</u></span></span><span style="font-size: medium;"><span lang="it-IT">
neprovocate </span></span><span style="font-size: medium;"><span lang="it-IT"><u>repetate.</u></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT"><i><b>Fiziopatologie
si etiologie</b></i></span></span><span style="font-size: medium;"><span lang="it-IT">.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">1.Neuronii
poseda gradiente de permeabilitate si gradiente ale canalelor voltaj
dependente care pot fi afectate de modificari chimice si umorale .</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">2.Neuronii
pot deveni hiperexcitabili,hipersincronizati,producand descarcari
anormale .</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"> </span>
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><i>Cauze
ale crizelor.</i></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Traumatismele
cerebrale </span></span>
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Tumori</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Interventii
chirurgicale pe creier</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Tulburari
metabolice(hier- hipoglicemia,hiponatrenia,hipocalcemia,anoxia)</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Toxicitate
unor medicamente(teofilina,lidocaina,penicilina)</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Infectiile
SNC</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">AVC</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Sevrajul
alcoolic,barbituric</span></span></div>
<ol>
<li><div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Boli
congenitale</span></span></div>
</li>
</ol>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Necunocute.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><i><b>Clasificarea
crizelor</b></i></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT"><i>Crize
partiale simple</i></span></span><span style="font-size: medium;"><span lang="it-IT">:motorii,somatosenzitive,psihice,autonome
fara pierderea constientei.</span></span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT"><i>Crize
complexe partiale</i></span></span><span style="font-size: medium;"><span lang="it-IT">
cu alterarea dar fara pierderea totala a costientei</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">cu
automatisme simple sau complexe</span></span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT"><i>Crize
generalizate</i></span></span><span style="font-size: medium;"><span lang="it-IT"> cu
pierderea constientei ,atone sau cu convulsii </span></span>
</div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT"><i>Crize
partiale simple</i></span></span><span style="font-size: medium;"><span lang="it-IT">
care pot evolua spre crize partiale complexe sau secundar
generalizate.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;"><i><b>Manifestare
clinica.</b></i></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">Aceasta este
corelata cu aria cerebrala implicata in criza.</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">Se poate
limita la o anomalie sezitiva sau senzoriala,motorie simpla sau se
poate desfasura ca o pierdere a constientei cu sau fara convulsii.</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><i>Crizele
generalizate .</i></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-Se
manifesta cu pierderea cu pierderea constientei</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-Pacientul
are amnezia crizei</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">-Poate avea
sau nu manifestari motorii bilaterale .</span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT"><u>1.absenta
</u></span></span>
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">a)absenta
tipica.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">- debut brusc
cu pierderea constientei</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-durata
10-20sec.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-tonus
muscular conservat(fara cadere)</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">-automatism
simplu(masticatie,geturi diferite)</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-manifestari
vegetative</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-EEG-varf
unda, 3 Hz/sec,generalizat,sincron,simetric pe toate derivatiile.</span></span></div>
<div lang="fr-FR" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-acest
tip de crize nu apar de novo la adult</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">b)absenta
atipica</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-debut
mai lent,pierdere incompleta a constientei</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-se
asociaza mioclonii,automatisme sau atonie</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-tulburari
vegetative</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-poate
debuta si peste 20 ani.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><u>2.criza
mioclonica</u></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-debut
brusc</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">-pierdere de
constienta ,</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-mioclonii
bilaterale</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-durata
de cateva sec. sau minute</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><u>3.criza
generalizata de tip tonic</u></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-debut
brusc</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-pierdere
de cunostinta</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-contractura
musculaturii axiale cu extensia membrelor</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-manifestari
vegetative</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-durata
20sec-1min.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;"><u>4 criza
generalizata clonica.</u></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-debut
brusc</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-atonie
sau contractie tonica urmata de contractii clonice ale fetei si
membrelor.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-manifestari
vegetative</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-durata
1-2min.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Criza
generalizata tonico-clonica.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT"><u>Manifestari
prodromale</u></span></span><span style="font-size: medium;"><span lang="it-IT"> pot sa
apara cu una sau mai multe zile inaitea crizei si se manifesta prin
modificari ale dispozitiei,tulburari de somn mioclonii, cefalee </span></span>
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">In 50% din
cazuri poate fi precedata imediat in</span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT">aintea
crizei </span></span><span style="font-size: medium;"><span lang="it-IT"><u>de aura</u></span></span><span style="font-size: medium;"><span lang="it-IT">
manifestata prin simptome vegetative ,senzitivo-senzoriale sau
motorii ce au valoare localizatorie.</span></span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT"><u>Debut</u></span></span><span style="font-size: medium;"><span lang="it-IT">
brusc cu pierderea constientei.</span></span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT"><u>Faza
tonica</u></span></span><span style="font-size: medium;"><span lang="it-IT"> cu durata de
10-20sec.manifestata prin contractia in flexie a
trunchiului,membrelor superioare urmata de extensia puternica
atrunchiului si membrelor inferioare,deschiderea si inchiderea gurii.</span></span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT"><u>Faza
clonica</u></span></span><span style="font-size: medium;"><span lang="it-IT">,durata
1min. –convulsii clonice generalizate.</span></span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT"><u>Coma
</u></span></span><span style="font-size: medium;"><span lang="it-IT"> ,dureaza intre
20sec si 5min.se insoteste de midriaza,tahicardie,polipnee,relaxare
sfincteriana.</span></span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT"><u>Faza
postcritica </u></span></span><span style="font-size: medium;"><span lang="it-IT">dureaza
15min. Simptome : hipotonie generalizata,reflex plantar in extensie,
recapatarea treptata a constientei,somn postcritic.</span></span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT"><u>Starea
de rau epileptic</u></span></span><span style="font-size: medium;"><span lang="it-IT"> se
manifesta prin crize de epilepsie cu sau fara pierderea constientei
repetate ore sau zile fara revenirea intre crize.statusul epileptic
este o urgenta neurologica cu mortalitate mare (tulburarile
vegetative care o insotesc pot duce la deces) si risc de lezare
permanenta a creierului.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Starea
de rau poate fi provocata de intreruperea medicatiei,privarea de
somn,febra,tulburari metabolice(hipoglicemie,hiponatremie),alcool.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><i><b>Diagnostic
.</b></i></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">1.EEG
–localizeaza focarul epileptic,ajuta la clarificarea tipului de
criza.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">2.RMN,CT
identifica eventualele leziuni cerebrale.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT"><i><u><b>Management.</b></u></i></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">1.farmacoterapie</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">2.tratament
chirurgical cand se impune (PEIC)</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><i><b>Complicatii</b></i></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="fr-FR" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Stare
de rau epileptic</span></span></div>
<div lang="fr-FR" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Traumatisme
produse de caderi.</span></span></div>
<div lang="fr-FR" style="margin-bottom: 0in;">
<br />
</div>
<div lang="fr-FR" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><i><b>Culegerea
datelor</b></i></span></span></div>
<div lang="fr-FR" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">1.obtinerea
istoricului(semne prodromale,aura,desfasurarea crizei,starea
postcritica,numarul crizelor)</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">2.despre
criza:</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-simptome
dinaintea atacului:senzitive,motorii,vizuale,
olfactive,emotionale,hiperventilatie)</span></span></div>
<div lang="fr-FR" style="margin-bottom: 0in;">
<span style="font-size: medium;">-descrierea
fenomenelor motorii,in ce segment au debutat,cum au progresat </span>
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-pozitia
globilor oculari si a capului.</span></span></div>
<div lang="fr-FR" style="margin-bottom: 0in;">
<span style="font-size: medium;">-prezenta
automatismelor:inghitit repetat,frecatul mainilor etc.</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Incontinenta
sfincteriana</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-durata
fiecarei faze a atacului</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-prezenta
pierderii de constienta si durata.ei.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-comportamentuldupa
criza,inclusiv tulburarile de limbaj,deficite motorii.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-cosecintele
psihosociale ale crizelor.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-istoricul
de abuz de alcool sau droguri</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-medicatia
administrata si complianta.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">Noncomplianta
la regimul de tratament ca si toxicitatea medicatiei poate creste
frecventa crizelor. Ideal : dozarea drogurilor antiepileptice in
sange.</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><i><b>Diagnosticul
de nursing.</b></i></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">Alterarea
functiilor cerebrale datorita crizelor</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Risc
de afectare cerebrala</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Consecintele
sociale si economice.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><i><b>Interventia
de nursing</b></i></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">1.Mentinerea
cailor aeriene permeabile</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">2.Administrarea
oxigenului in timpul crizelor daca se instaleaza cianoza.</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">3.Administrarea
regulata a medicatiei</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">4.Dozarea in
sange a medicamentelor antiepileptice in scopul stabilirii dozelor
terapeutice eficiente</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Monitorizarea
functiilor ficatului si hemoleucogramei.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Prevenirea
traumatismelor.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">-.inlaturarea
pericolelor din mediul inconjurator.</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">-.plasarea
patului la inaltime mica</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">-.pacientul
nu va fi contentionat in timpul crizei</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">-.nu se pune
nimic in gura pacientului in criza</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">-. se
plaseaza pacientul in decubit lateral pentru a preveni aspiratia</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">-.protejarea
capului in criza</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">-.suprvegherea
pacientului in stare comfuzionala postcritica</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="fr-FR" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><u>Managementul
starii de rau epileptic.</u></span></span></div>
<div lang="fr-FR" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-mentinerea
cailor aeriene si presiunii arteriale</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">-analize de
urgenta:uree,glicemie,ionograma,dozarea anticonvulsivantelor in
sange(in conditii ideale)</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-administrarea
de oxigen</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-stabilirea
unei linii venoase</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">-administrarea
IV a medicatiei anticonvulsive:lorazepam,fenitoin</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">-administrarea
medicamentelor antiepileptice recomandate in tratamentul preventiv</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">-monitorizarea
regulata a nivelului medicamentului antiepileptic in sange.</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-supravegherea
eventualei depresii respiratorii si hTA provocate de medicatie.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-respiratie
protezata daca este nevoie</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-daca
medicatia administrata nu este eficace se recomanda anestezia
generala</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-monitorizare
neurologica continua</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-monitorizare
Eeg.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;"><u>Asistarea
la domiciliu si in comunitate</u></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">Consilierea
pacientilor pentru a nu se expune in mediu cu pericole la locul de
munca.</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Informarea
in ce priveste legile statului,(conducerea vehicolelor)</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Asigurarea
unui mediu fara pericole la domiciliu</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><u>Educatia
pacientului pentru mentinerea starii de sanatate</u></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">Icurajarea
pacientului sa-si determine elementele trigger ale crizei</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">Amintiti
pacientului importanta respectarii tratamentului</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Interzicerea
acoolului</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">Recomandarea
de a purta o bratara cu datele personale si legate de boala</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Recomandarea
unui stil de viata ponderat.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><i><u><b>Evaluare
finala</b></u></i></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Pacientul
respecta medicatia si celelalte recomandari.</span></span></div>
Charlieeehttp://www.blogger.com/profile/09400801131611961874noreply@blogger.comtag:blogger.com,1999:blog-4682638310010168675.post-30237509765719527062012-11-23T05:58:00.002-08:002012-11-23T05:58:50.646-08:00BOLI INFECTIOASE SI INFLAMATORII ALE CREIERULUI SI MENINGELUI
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<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">Infectii
cu bacterii ,virusuri, paraziti, alte microorganisme</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">1-MENINGITE</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">2-ENCEFALITE</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">3-MENINGOENCEFALITE</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">4-INFECTII
FOCALE ALE CREIERULUI</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">MENINGITE</span></span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">Sindrom
meningean:</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-Cefalee
intensa</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-Febra
(imunodeficienti, varstnici- poate lipsi)</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-Greturi,
varsaturi-sindrom HIC</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="font-size: small;">-Meningism
(cazuri extreme: postura in extensie a cefei pana la opistotonus,
,,cocos de pusca”)</span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-Semne
meningeale positive:</span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">-redoarea
cefei</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">-semnele
Lasegue, Brudzinski, Kernig</span></span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;">
</span>
</div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">A.Meningita
bacteriana acuta/ subacuta</span></span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="font-size: small;">Etiologia:
functie de varsta:</span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="font-size: small;">-nou nascuti(
sub 1 luna):E. coli, streptococci beta hemolitici grup B, Listeria
monocytogenes, enterobacterii gram negative</span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-copii
(frecvent 1-6 ani): Haemophylus influenzae, pneumococi, meningococ
(Neisseria meningitides)</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="font-size: small;">-adult:
pneumococ, meningococ, mai rar – stafilococ, enterococ gram
negative</span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">Fiziopatologie</span></span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">Cai
de infectie </span></span>
</div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">-hematogen
–ex. pneumonie pneumococica</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">-proces
de vecinatate –sinuzite, otite, mastoidite</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">-direct,
prin fistule lcr (frecvent post TCC)</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">Tablou
clinic</span></span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-sindrom
meningean</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-semne
generale :mialgii, fotofobie</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="font-size: small;">-rar, crize
epi, deficite nervi cranieni (ex. hipoacuzie post infectie cu
pneumococ)</span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-modificari
variabile ale constientei</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="font-size: small;">-M. cu N.
meningitides –hemoragie cutanata petesiala si infarct hemoragic al
glandei suprarenale cu soc endotoxic- sindrom
.Waterhouse-Friderichsen)</span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">*atipic:
fara meningism, febra, cu simptome psihotice sau crize epi</span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">Diagnostic
paraclinic</span></span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">1-LCR-
punctie lombara</span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">tipic:
pleiocitoza mai mare de 500 elemente/mmc, mai ales granulocyte,
albumina mai mare de 2g/l, glicorahie sub 0,5 g/l</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: small;"><span lang="en-US">culturi
de agent patogen din lcr + hemoculturi; 2/3 agent in microscopie
directa </span></span>
</div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">2-
laborator- HLG, creste PCR, VSH</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">3-imagistica-
CT, Rdg. Pulmonara</span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">Tratament</span></span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">Antibioterapie:
imediat dupa punctia lombara, functie de agentul presupus, apoi cf.
antibiograma</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="font-size: small;">Ex. adult:
cefalosporina de a 3-a generatie +ampicilina; alergie la
cefalosporina, vancomicina 2g ori 2; 7-21 zile~germene</span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">Complicatii</span></span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-neurologice:
hidrocefalie, empiem subdural, arterite, tromboze sinusuri venoase,
edem cerebral cu angajare, surditate</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-generale:
stare septica, coagulopatie de consum, ARDS, SIADH</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-mortalitate:
3%-20%</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">Obligativitatea
declararii!</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">B.Meningita
acuta virala</span></span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="font-size: small;">Sinonime:
meningita limfocitara, M. aseptic</span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">Etiologie</span></span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-enterovirusuri
(polio-, Coxsackie), arbovirusuri, HIV; rar, v. coriomeningitei
limfocitare, cytomegalovirus, v. herpetic tip 2, v. Epstein-Barr, v.
influenza</span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">Clinica</span></span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="font-size: small;">-simptome
prodromale – tip pseudogripal, gastrointestinal</span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="font-size: small;">-cefalee,
meningism, febra,simptome generale (mialgie, fatigabilitate)</span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">Diagnostic
paraclinic</span></span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-lcr-
pleiocitoza limfocitara 50-500/mmc, albumina <2g/l, raport glucoza
lcr/ ser >0,5</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-diagnostic
etiologic- serologie- Ac tip Ig M (crestere titru >4 ori dupa 4
saptamani); sinteza Ac intratecali specifici; insamantari pe animale,
biopsie</span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">Tratament</span></span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-simptomatic</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="font-size: small;">-etiologic-
antivirale pentru HSV, VZV, v. citomegalic</span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">C.Meningite
cronice</span></span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="font-size: small;">Sindromul
meningean apare gradual si fluctuant; febra, semnele clinice, de
laborator si generale pot lipsi; tipc –meningita tbc.</span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">1-Meningita
tbc</span></span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">Etiologie:
Mycobacterium tuberculosis; cale hematogena; generalizare precoce si/
sau tardiva</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">Clinica</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-sindromul
meningean apare progresiv</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="font-size: small;">-+/-febra,
simptome generale</span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-frecvent
paralizii de nervi cranieni: n. facial si oculomotori (localizare
bazala a meningitei)</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-deficite
focale (prin arterita cerebral)</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-hidrocefalie
prin tulburari de resorbtie a lcr</span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">Diagnostic
paraclinic</span></span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-BK
in lcr +alte fluide (sputa, secretie traheala, urina)</span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">*cultura
lcr</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">*PCR in
lcr (reactia de polimerizare in lant)</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: small;"><span lang="en-US">*ex.
bacteriscopic direct –reactia Ziehl-Nielsen</span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">Tratament:droguri
tuberculostatice in cvadrupla asociere (HIN,rifampicina,
pirazinamida, myambutol), apoi 3, 2 droguri, minim 12 luni</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">2-Alte
cauze de meningite cornice</span></span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-Fungi:
la pacinti imunodeprimati –Cryptococcus neoformans, Candida
albicans, aspergylus</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="font-size: small;">-Protozoare:
Toxoplasma gondii</span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-Paraziti:
cisticerci, echinococi</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-Noninfectioase:
sarcoidoza, meningita carcinomatoasa</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<br />
</div>
<div lang="en-US" style="margin-bottom: 0in;">
<br />
</div>
<div lang="en-US" style="margin-bottom: 0in;">
<br />
</div>
<div lang="en-US" style="margin-bottom: 0in;">
<br />
</div>
<div lang="en-US" style="margin-bottom: 0in;">
<br />
</div>
<div lang="en-US" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">ENCEFALITE</span></span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">Tipic:-
deficite neurologice focale</span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">-deficite
neuropsihologice</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: small;"><span lang="en-US">Etiologie:virusuri,
bacterii, fungi,protozoare, paraziti</span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">Bolile
prionice</span></span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">+alte
structuri afectate concomitant: nervi, plexuri nervoase, maduva
spinarii, meninge</span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">Sindrom
encefalitic</span></span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-Febra</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-Cefalee</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-Tulburari
de constienta</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-Tulburari
de personalitate si neuropsihologice</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-Crize
epileptic</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-Deficite
neurologice focale</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;">
</span>
</div>
<div style="margin-bottom: 0in;">
<span style="font-size: small;"><span lang="en-US">A.Encefalite
virale</span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">1-Encefalita
cu Herpes simplex</span></span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-HSV
tip 1</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">Patogenie-inflamatie
hemoragic- necrotica la baza lobi temporali si frontali +edem
cerebral ambe emisfere, mai mult de o parte</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">Clinica</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-prodrom
nonspecific- febra, cefalee, simptome generale</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-afectare
progresiva a constientei</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-crize
epi; frecvent crize partiale complexe cu/ fara generalizare</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="font-size: small;">-deficite
neurologice- afazie, hemipareza</span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-deficite
neuropsihologice (memorie, orientare)</span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">Diagnostic
paraclinic</span></span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-LCR:
<500 elemente/mmc, >limfocite; xantocromic</span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">-reactia
PCR pentru ADN viral primele zile, apoi la 2 saptamani, IgG specific</span></span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-EEG-
modificari focale temporal</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-CT-scan
poate fi normal sau hipodensitati frontal sau temporal; MRI</span></span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: small;"><span lang="en-US">Tratament-
Aciclovir intravenous, corticosteroizi, antiepileptice</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">2-Meningoencefalita
de primavara-vara</span></span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-Arbovirusuri;
intepatura de capusa; arii endemic (Austria,de ex.)</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-incubatie
4 saptamani- manifestari prodromale nespecifice</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-cefalee,
meningism, deficite neurologice cerebrale, dar si medulare, nervi
periferici</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-diagnostic:
Ac specifici IgM</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<br />
</div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;">
</span>
</div>
<div lang="en-US" style="margin-bottom: 0in;">
<br />
</div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="font-size: small;">3-Encefalita
HIV si infectii cu oportunisti la pacienti HIV pozitivi</span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-50%
din persoanele HIV + - infectii cerebrale alte parti ale SN </span></span>
</div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-infectii
HIV propriu-zise, cu oportunisti sau ambele!</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-encefalite,
mielopatie, mono- sau polineuropatie, miopatie</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">Encefalita:
tulburari neuropsihologice (delir, tulburari de personalitate,
dementa)</span></span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: small;"><span lang="en-US">4-Encefalita
cu Herpes Zoster</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-tipic:
radiculita!</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-complicatie
a afectarii unui nerv periferic (n.cranian)</span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">5-Alte
cauze de meningoencefalite virale</span></span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="font-size: small;">Echovirus, v.
Coxsackie A,B (mecanism fecal-oral),adenovirus (inhalare), v. hepatic
(fecal-oral, sexual, transfuzii sanguine), v. Epsten-Barr
(mononucleoza, adenopatii), cytomegalovirus (SIDA, alte
imunodepresii)</span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">B.Encefalite
fungice, cu paraziti, protozoare</span></span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">Cele
mentionate si la meningite, la persoane imunodeprimate (boli,
medicamente- chimioterapie, corticoterapie)</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">C.Meningoencefalite
spirochetale</span></span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">1-Neurosifilis</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">2-Neuroborelioza</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">3-Leptospiroza</span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">1-Neurosifilis</span></span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="font-size: small;">Etiologie:
Treponema pallidum; transmisie sexual</span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">Clinica</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="font-size: small;">*Stadiu
secundar: meningita sifilitica cu pareze de nervi cranieni</span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">*Stadiu
secundar: 1-2 ani dupa infectia primara netratata= sifilis
cerebrospinal, prin afectare vase, meninge</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-strock
ischemic multiplu</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-meningita
bazala: paralizii de nervi cranieni, cefalee</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-rar-
poliradiculonevrita, polineuropatie; mase granulomatoase mari –HIC</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">*Stadiu
cuaternar</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-tabes
dorsalis prin afectarea maduvei spinarii- cordoane dorsale, radacini
posterioare; 12 ani; ataxie, dureri lancinante, scadere reflexe
pupilare</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="font-size: small;">-paralizie
progresiva= meningoencefalita cronica; 10 -15 ani; granuloame
cazeoase; dementa progresiva, +/- agitatie maniacala,
depresie,sindrom schizofreniform</span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">Diagnostic
paraclinic</span></span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-teste
serologice: TPHA, 19-S-IgM-FTA-ABS</span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">Tratament:
penicilina G, tetraciclina, eritromicina</span></span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">2-Neuroborelioza</span></span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">=boala
Lyme</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">Etiologie:
Borrelia burgdorferi; intepatura de capusa Ixodis ricinus</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">Clinica:
SNC+ articulatii+ sistem cardiovascular+ ficat+ piele</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="font-size: small;">-eritem
cronic migratory, la locul intepaturii</span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-sistemic:
cefalee, febra, artralgii, limfadenopatii generalizate</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-15%:
meningita limfocitara +/- radiculonevrita (slabiciune, arsuri,
disestezii la membrele inferioare); diplegie facial; rar- plexita,
encefalita, mielita, vasculita cerebral</span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">+/-
miopericardita, acrodermatita cronica atrofianta, afectara hepatica</span></span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="font-size: small;">Diagnostic
paraclinic –IgM si G in lcr, ser+ lcr inflamator</span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">*teste
pozitive la 10% din persoane asimptomatice </span></span>
</div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">Tratament:
doxiciclina, cefalosporina a 3-a generatie</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">3-Leptospiroza</span></span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">Meningita
limfocitara –stadiu initial</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">Encefalita:
crize epi, psihoza</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">Mielita</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">+afectare
hepatica, renala, diateza hemoragica</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">D.Encefalita
in boli prionice</span></span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="font-size: small;">Prion=particule
infectioase alcatuite din proteine care se replica in celulele
corpului, chiar daca nu au material genetic (acid nucleic) propriu,
prin mutatii ale materialului genetic al gazdei.</span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-neuronii
infectati prin prioni pot sa moara dupa o latent de ani –zeci de
ani</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-trasaturi
patologice tipice: vacuolizari si formarea de placi amiloide</span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">Boli
cu prioni:</span></span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">1-Boala
Creutzfeld-Jakob ;1 caz/ 1000000/an</span></span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: small;"><span lang="en-US">Initial,
tulburari mentale, insomnia, fatigabilitate, apoi semne piramidale,
cerebeloase,tulburari de tonus muscular, fasciculatii , mioclonii.</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-2/3:
EEG unde trifazice si tetrafazice delta si teta periodice</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-evolutie
catre sindrom de decorticare, moarte in cateva luni</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">*varianta
: encefalopatia spongiforma bovina</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">2-Boala
Kuru</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="font-size: small;">3-Boala
Gerstmann-Straussler-Scheineker</span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">4-Glioza
familiala progresiva subcorticala</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">5-Insomnia
familiala fatala</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">E.Boli
cu virusuri lente</span></span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">Virus
lent= v. cu perioada de incubatie extrem de lunga; determina boala
progresiva, care nu raspunde la tratament. </span></span>
</div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">*Pancefalita
sclerozanta subacuta (PESS, SSPE)</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-copii,
tineri <18 ani cu infectie rujeolica inainte de 2 ani de viata</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-virus
rujeolic incomplete in oligodendrocite; imunitate celulara si umorala
modificata?</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">Clinic:
deficite intelectuale, epilepsie, mioclonii, distonie, coreoatetoza,
ataxie, corioretinita, rigiditate de decerebrare</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">EEG-
activitate delta periodica paroxistica (complexe Rademecker)</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="font-size: small;">LCR- index AC
antirujeolosi marit, benzi oligoclonale specifice rujeolei</span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-moarte
1-3 ani (6 saptamani- 10 ani)</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">Encefalita
postvaccinala</span></span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">-stadiu
de ipoteza! Complicatie postvaccin antivaricela, antirubeolic,
antivariola</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<br />
</div>
<div lang="en-US" style="margin-bottom: 0in;">
<br />
</div>
<div lang="en-US" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: small;"><span lang="en-US">INFECTII
FOCALE ALE CREIERULUI</span></span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">1-ABCES
CEREBRAL</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">2-EMPIEM
SUBDURAL CRONIC</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">1,2-
vezi curs neurochirurgie</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">3-ENCEFALITA
FOCALA</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">=microabcese
multiloculare, disseminate</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="font-size: small;">-Metastaze
septice in septicemia (>stafilococ, streptococ)</span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="font-size: small;">-Microtrombi
infectiosi – in endocardita bacteriana subacuta cu Streptococ
viridans </span>
</div>
Charlieeehttp://www.blogger.com/profile/09400801131611961874noreply@blogger.comtag:blogger.com,1999:blog-4682638310010168675.post-51032423979396372022012-11-23T05:57:00.000-08:002012-11-23T05:57:03.738-08:00Boli demielinizante
<style type="text/css">
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<br />
<div align="CENTER" style="margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b><span lang="en-US">Scleroza
multipla </span><span lang="en-US"> </span><span lang="en-US">
</span></b></span></span>
</div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>Sinonime:scleroza
in placi,leuconevraxita</b></span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>Definitie,date
epidemiologice</b></span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>Afectiune
cronica a SNC, caracterizata prin:</b></span></span></div>
<div style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b><span lang="en-US">_episoade
de inflamatie si demielinizare focala cu localizari multiple si
diseminari in timp, manifestate clinic ca pusee (recaderi) cu\ fara
remisiune,probabil prin mecanism autoimun mediat de limfocite T
impotriva proteinelor mielinei</span></b></span></span></div>
<div style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b><span lang="en-US">_degenerescenta
axonala _predominent in forme progresive; la baza leziunilor
ireversibile </span></b></span></span>
</div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>_degenerescenta,
functia anormala a oligodendrogliei</b></span></span></div>
<div style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b><span lang="en-US">Boala
neurologica cea mai frecventa a adultului tanar, 20-40 ani, de doua
ori mai frecventa la femei, cu o prevalent de 10-80/100 000 de
locuitori.</span></b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>_Rude
de gradul 1: risc de 20 ori mai mare</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>_CMH:
HLA-DR2, DW2, B7, A3</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b><br /></b></span></span>
</div>
<div style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b><span lang="en-US">FIZIOPATOLOGIE</span></b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>Factor
exogen declansator al procesului autoimun necunoscut, la o persoana
predispusa, determina o modificare complexa focala a BHE, cu pasajul
in parenchimul cerebral a limfocitelor T sensibilizate.</b></span></span></div>
<div style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b><span lang="en-US">ANATOMOPATOLOGIE</span></b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>Placi
de demielinizare multiple, diseminate pe suprafete mari, mai ales
perivenos:</b></span></span></div>
<div style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b><span lang="en-US">_active
(moi),edematoase, trandafirii, cu MAF cu mielina, apoi limfocite</span></b></span></span></div>
<div style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b><span lang="en-US">_vechi
(tari), fara celule inflamatorii, cu fibre demielinizate si glioza
astrocitara</span></b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>Localizare
: substanta alba periventriculara, nervul optic, TC, cerebel,
substanta alba lobi frontali, cordoane posterioare medulare cervical.</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b><br /></b></span></span>
</div>
<div style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b><span lang="en-US">TABLOU
CLINIC</span></b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>Clasic
:sindrom piramidal, sindrom cerebelos, sindrom vestibular de tip
central.</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>Debut:20-40
ani, rar sub 20 si peste 50; tulburari de sensibilitate, neuropatie
optica retrobulbara.</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>_Sindroame
piramidale (mono-, hemi-, parapareze,reflexe patologice etc.</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>_Tulburari
de sensibilitate: semn Lhermitte, parestezii, tulburari de
sensibilitate termica etc.</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>_Tulburari
cerebeloase</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>_Simptome
oculare (atrofie optica post atrofie optica retrobulbara) si de
trunchi cerebral _ oculomotricitate (pareze de nervi 3, 4, 6,
oftalmoplegii internucleare), sindrom vestibular de tip
central,pareza de nerv 7, disfagie etc.</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>_Tulburari
sfincteriene: retentie, incontinenta urinara etc.</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>_Rar:
crize epi, nevralgie esentiala de trigemen, tulburare cognitive,
polineuropatie etc.</b></span></span></div>
<div style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b><span lang="en-US">DIAGNOSTIC
PARACLINIC</span></b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>1.Rezonanta
magnetica nucleara (RMN, IRM)</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>_Leziuni
rotunde sau ovatare, de cativa mm-1cm, in hipersemnal T2 si PD</b></span></span></div>
<div style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b><span lang="en-US">*rar,
neregulate prin confluent a leziuni, f. rar aspect pseudotumoral</span></b></span></span></div>
<div style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b><span lang="en-US">*leziune
active=leziune captanta de gadolinium(Gd)</span></b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>_Criteriile
de diagnostic IRM Barkhof modificate cf. recomandarilor CI: 3 din 4:</b></span></span></div>
<ol>
<li><div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>1
leziune captanta de Gd sau 9 leziuni necaptante in hipersemnal T2</b></span></span></div>
</li>
<li><div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>>1
leziune infratentoriala</b></span></span></div>
</li>
<li><div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>>1
leziune juxtacorticala</b></span></span></div>
</li>
<li><div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>>3
leziuni periventriculare
</b></span></span>
</div>
</li>
</ol>
<div style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b><span lang="en-US">1
leziune medulara=1 leziune cerebrala</span></b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b><br /></b></span></span>
</div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>B.LCR</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>_nepatognomonic</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>*uneori
pleiocitoza discreta,dar <50\mmc</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>*uneori
hiperproteinorahie, dar <0,8g/l, la electroforeza lcr – benzi
oligoclonale de IgG cu index >0,7 fata de IgG din ser</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>C.Potentiale
evocate</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>_>vizuale
( mai ales pentru neuropatia optica retrobulbara sau pentru tablou de
mielita clinic)</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b><br /></b></span></span>
</div>
<div style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b><span lang="en-US">DIAGNOSTIC
POZITIV</span></b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>Asocierea
de semne clinice si paraclinice (pentru ca nu exista un singur semn
clinic sau investigatie paraclinica patognomonice!), care sa
demonstreze diseminarea in timp si spatiu a leziunilor cu caracter
inflamator.</b></span></span></div>
<div style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b><span lang="en-US">Criteriile
de diagnostic McDonald:</span></b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>1.>2
pusee si >2 leziuni (obiectivate clinic) Date aditionale
necesare</b></span></span></div>
<div style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b><span lang="en-US">Nici
una</span></b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>2.>2
pusee si 1 leziune diseminare in
spatiu
RMNsau</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b><br /></b></span></span>
</div>
<div style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b><span lang="en-US">2
leziuni RMN +ex.lcr sau asteapta alte pusee </span></b></span></span>
</div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>3.1
puseu si >2 leziuni diseminare intimp
RMN sau
asteapta al 2-lea puseu </b></span></span>
</div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>4.1
puseu si 1 leziune diseminare in timp si
spatiu</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>5.progresie
neurologica insidioasa lcr si diseminare RMN in timp si
spatiu</b></span></span></div>
<div style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b><span lang="en-US">DIAGNOSTIC
DIFERENTIAL</span></b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>A.Boli
considerate variante de SM= ALTE BOLI DEMIELINIZANTE</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>1-Nevrita
optica retrobulbara ( mai ales unilaterala)</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>2-
Neuromielita optica ( sindrom Devic)</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>3-Scleroza
difuza ( boala Schilder, scleroza mielinoclastica difuza)</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>4-Encefalomielita
acuta diseminata parainfectioasa\ postvaccinala</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>5-Mieloopticoneuropatia
subacuta</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>6-Scleroza
concentrica Balo</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>7-SM
pseudotumorala</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>8-Leucoencefalopatia
lacunara concentric</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b><br /></b></span></span>
</div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>B.Alte
boli inflamatorii ( infectioase si noninfectioase)</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>-Leucoencefalita
acuta hemoragica</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>-Mielita
acuta transversa</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>-Neuroborelioza
cronica</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>-Neurolues</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>-Infectii
cu retrovirusuri (HIV-1_SIDA, HTLV-1)</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>-MTS
septice, bruceloza</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>-Neurosarcoidoza</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>-LES,
b.Behcet, sdr. anticorpilor antifosfolipidici, alte boli de collagen</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>-Vasculite
cerebrale ( idiopatice, sistemice –Wegener etc.)</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>-Sindroame
paraneoplazice</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b><br /></b></span></span>
</div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b><br /></b></span></span>
</div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>C.Tulburari
metabolice si endocrine</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>-Deficitul
de vitamina B12, E, folati</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>-Mielinoliza
centropontina</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>-Disfunctii
tiroidiene</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>D.Boli
genetice si neurodegenerative</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>-Adrenoleucodistrofiile</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>-Ataxiile
primare</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>-B.neuronului
motor (SLA)</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>-B.
Wilson</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>-Mitocondropatiile</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>E.Neoplazii:
limfom intracerebral, MTS cerebrale, T cerebrale primare</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>F.Malformatii
congenitale cranio-cerebrale, coloana vertebrale: malformatia
Arnold-Chiari, siringomielie/siringobulbie, discopatii vertebrale cu
mielopatie</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>G.Boli
toxice: leucoencefalopatia postchimioterapie/ postiradiere</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b><br /></b></span></span>
</div>
<div style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b><span lang="en-US">FORME
CLINICE</span></b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>Functie
de evolutie:</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>1-Forma
recurent-remisiva aproximativ 60-70%</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>-pusee
clinice acute, cu recuperare completa sau incomplete</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>-puseu=aparitia
de simptome noi sau reaparitia unora vechi, cu durata de minimum
24h,de obicei cu instalare in zile si durata de saptamani/ luni</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>-deficite
sechelare</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>2-Forma
secundar progresiva</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>-recuperare
partiala dupa puseu, cu progresie continua,uneori cu pusee;alteori
perioade de platou</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>-reprezinta
transformarea SMRR dupa 10 ani in medie</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>3-Forma
primar progresiva</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>-progresie
continua de la debut</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>-egal
F/B,debut la 40 ani;>maduva</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>4-Forma
progresiva cu recurente</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>-progresie
continua de la debut, dar cu episoade acute de agravare</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b><br /></b></span></span>
</div>
<div style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b><span lang="en-US">TRATAMENT</span></b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>Nu
exista tratament etiologic!</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>A-Tratament
care modifica evolutia bolii:</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>a-Imunomodulator</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>*Interferon
beta1a (Rebif,Avonex)</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>*Interferon
beta1b (Betaferon)</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>*Glatiramer
acetat (Copaxone)</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>b-Imunosupresor</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>*Mitoxantrona
(Novantrone)</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>*Alte
tratamente: Azatioprina, Metotrexat,Ciclofosfamida,Cladribinum</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>c-Alte
tratamente: plasmafereza, Natalizumab,mycophenolat, iradiere
limfocitara totala</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b> </b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>B-Tratamentul
puseului</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>Glucocorticoizii-
doze mari intravenos:</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>Metilprednisolon
in doze mari- 1g i.v. in1-2h, 3-5 zile,cu intreruperea progresiva sau
abrupt.</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>Alte
terapii- prednison oral 60-80mg/zi</b></span></span></div>
<div style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b><span lang="en-US">-dexametazona
8mg ori 4/zi</span></b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b><br /></b></span></span>
</div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>C-Tratamentul
simptomatic si recuperator</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>Ameliorarea
calitatii vietii</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>*Fizioterapie,terapie
ocupationala</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>*Tulburari
sfincteriene: vezica spastica- oxibutinin,tolteridona; flasca-
autosondare,sonda fixa</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>*Oboseala
cronica: amantadina,fluoxetina, modafinil</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>*Spasticitatea:
baclofen, benzodiazepine, gabapentin,toxina botulinica, proceduri
chirurgicale</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>*Disfunctii
sexuale: sildenafil</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>*Durerea;
functie de tipul de durere : pentru durerea neuropata-
gabapentin,carbamazepin,amitriptilina, nortriptilina</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>*Tremor-
dificil; dispositive medicale, propranolol, clonazepam,lamotriginum</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>*Tulburari
cognitive- vezi pct. A</b></span></span></div>
<div lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b>*Depresia:
psihoterapia, amitriptilina, inhibitori de recaptare a serotoninei
(fluoxetina, paroxetina, sertralina,citalopram), inhibitori ai
recaptarii noradrenalinei si serotoninei (venlafaxina)</b></span></span></div>
Charlieeehttp://www.blogger.com/profile/09400801131611961874noreply@blogger.comtag:blogger.com,1999:blog-4682638310010168675.post-13761701520033050792012-11-23T05:54:00.001-08:002012-11-23T05:54:48.826-08:00COMA
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<br />
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT"><i><b>Constienta
sau cunostinta</b></i></span></span><span style="font-size: medium;"><span lang="it-IT">
se poate defini ca starea in care individul este constient de el si
de mediul inconjurator.</span></span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT">Are
doi parametri:-</span></span><span style="font-size: medium;"><span lang="it-IT"><i>vigilitatea
</i></span></span><span style="font-size: medium;"><span lang="it-IT">sau starea de</span></span><span style="font-size: medium;"><span lang="it-IT"><i>
trezie-</i></span></span><span style="font-size: medium;"><span lang="it-IT"> apare intre
somn si veghe avind ca semn specific deschiderea ochilor.Se produce
datorita activarii sistemului reticulat activator ascendent(SRAA).</span></span><span style="font-size: medium;"><span lang="it-IT"><i>
</i></span></span>
</div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT"><i>-perceptivitatea</i></span></span><span style="font-size: medium;"><span lang="it-IT">
posibilitatea de integrare a senzatiilor prezente in experienta
senzoriala anterioara si elaborarea raspunsului la stimulii externi.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;"><i><b>Coma-este
un sindrom clinic caracterizat printr-o perturbare cantitativa a
constientientei cu pastrarea pana la un anumit prag a functiilor
vegetative.</b></i></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">Pacientul nu
se trezeste la stimuli de nici o natura.</span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT"><i><b>Aceasta
spre deosebire de somn care</b></i></span></span><span style="font-size: medium;"><span lang="it-IT">
determina o modificare a starii de constienta din care se revine la
stimuli.</span></span><span style="font-size: medium;"><span lang="it-IT"><i><b> </b></i></span></span>
</div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT">Alterarea
starii de constienta are </span></span><span style="font-size: medium;"><span lang="it-IT"><i><b>mai
multe trepte.</b></i></span></span><span style="font-size: medium;"><span lang="it-IT"> </span></span>
</div>
<div style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><span lang="it-IT"><i><b>Confuzia
</b></i></span></span></span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">se
datoreaza unor tulburari ale functiilor corticale si se</span></span></span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT"><i><b>
</b></i></span></span></span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">caracterizeaza</span></span></span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT"><i><b>
</b></i></span></span></span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">
prin: dezorientare</span></span></span><span style="color: black;"><span style="font-size: small;"><span lang="it-IT"><b>
,</b></span></span></span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">tulburari
de perceptie,incoerenta in gindire si actiune,tulburari de ritm
somn-veghe.</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><span lang="it-IT"><i><b>Delirul
</b></i></span></span></span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">se
manifesta prin: comfuzie,neliniste motorie, halucinatii,tulburari
vegetative.</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><span lang="it-IT"><i><b>Obnubilarea
</b></i></span></span></span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">se
caracterizeaza prin reactii intirziate si inprecise ,somnolenta.</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><span lang="it-IT"><i><b>Stupoarea</b></i></span></span></span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">
este starea in care un pacient desi nu este constient, nu
reactioneaza spontan.poate fi trezit de stimuli puternici,trezirea
este scurta si incompleta,raspunsurile verbale si gestuale sunt
defectuase. </span></span></span>
</div>
<div style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><span lang="it-IT"><i><b>Coma</b></i></span></span></span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">
este un status in care pacientul nu poate fi trezit de stimuli
externi sau nevoi interne,fiind alterate atat vigilitatea cat si
perceptivitatea.</span></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Diagnostiul
diferential al comei se face cu:</span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><span lang="it-IT"><i><b>Starea
vegetativa</b></i></span></span></span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">
se caracterizeaza prin lipsa perceptivitatii,mentinerea respiratiei
spontane si echilibrului hemodinamic.Ochii se inchid si se deschid
ciclic sugerind alternanta somn – veghe.</span></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Aceasta
poate fi un stadiu de revenire din coma sau poate persista pana la
deces.</span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><span lang="it-IT"><i><b>Mutismul
akinetic</b></i></span></span></span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">
–pacientul este vigil ,fara tulburari de perceptie dar areactiv.Se
mentin miscarile globilor oculari,deglutitia,reflexele cutanate.,</span></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Aceasta
stare se datoreaza perturbarii functiilor lobilor frontali si sau
sistemului limbic si nucleilor cenusii de la baza.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Sindromul
loked in se manifesta clinic prin tetraplegie cu deficit de functie
al nervilor cranieni cu mentinerea miscarilor de verticalitate a
globilor oculari si micarii pleoapelor.Sunt mentinute vigilitatea si
constienta.Poate comunica printr-un cod al globilor oculari.Leziunea
consta in intreruperea cailor cortico-bulbare,cortico-spinale,partial
lezarii formatiei reticulate.nucleilor nervilor cranieni cu
conservarea partii dorsale a puntii si mezencefalului.</span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><span lang="it-IT"><i><b>Bazele
neuroanatomice ale constientei.</b></i></span></span></span><span style="color: black;"><span style="font-size: small;"><span lang="it-IT"><i><b>
</b></i></span></span></span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT"><i>Sistemul
reticulat activator ascendent </i></span></span></span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">porneste
de la nivelul puntii superioare si a mezencefalului, din nucleii
reticulati,se conecteaza la nucleii nespecifici ai talamusului, de
unde impulsurile ajung prin proiectii difuze la scoarta cerebrala.</span></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Acestora
se adauga proiectii activatoare extratalamice
colinergice,noradrenergice si serotoninergice de la nivelul nucleilor
reticulati situati in tot trunchiucerebral.</span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">Afectarea
cortexului cerebral bilateral,a sistemului reticulat activator
ascendent , cailor</span></span></span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT"><i>
</i></span></span></span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">
intra si extratalamice determina starea de coma.</span></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><i><b>Cauzele
comei</b></i></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><span lang="it-IT"><i>Procese
expansive supra si subtentoriale</i></span></span></span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">
ce determina cresterea presiunii intracraniene si fenomenul de
angajare cu compresiunea trunchiului cerebral.</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><span lang="it-IT"><i>Leziuni
supra si subtentoriale</i></span></span></span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">
care afecteaza direct sistemul reticulat activator
ascendent(SRAA).Pot fi ,encefalite,demielinizari masive in trunchiul
cerebral, infarcte,supradoze de sedative ,tulburari metabolice cu
encefalopatie. </span></span></span>
</div>
<div style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><span lang="it-IT"><i>Suferinta
difuza a scoartei cerebrale</i></span></span></span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">
datorita hipoxiei,ischemiei,tulburarilor metabolice,encefalitei.</span></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">Etiologia
comelor</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;"><span lang="it-IT"><b>Come
metabolice</b></span></span></span><span style="color: black;"><span style="font-size: small;"><span lang="it-IT">
</span></span></span><span style="color: black;"><span style="font-size: small;"><span lang="it-IT"><b>Prin
leziuni</b></span></span></span><span style="color: black;"><span style="font-size: small;"><span lang="it-IT">
</span></span></span><span style="color: black;"><span style="font-size: small;"><span lang="it-IT"><b>structurale
Prin leziuni structurale </b></span></span></span>
</div>
<div style="margin-bottom: 0in; margin-left: 2.65in;">
<span style="color: black;"><span style="font-size: small;"><span lang="it-IT"><b>difuz</b></span></span></span><span style="color: black;"><span style="font-size: small;"><span lang="it-IT">e
</span></span></span><span style="color: black;"><span style="font-size: small;"><span lang="it-IT"><b>
focale</b></span></span></span><span style="color: black;"><span style="font-size: x-small;"><span lang="it-IT">
meningita
infarct cerebral </span></span></span>
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: x-small;">hipoxia
encefalita hemoragia
cerebrala</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: x-small;">diabetul
alte
infectii tumori</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: x-small;">hipoglicemia
leziuni axonale
abces cerebral</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: x-small;">encefalopatia
hepatica HSA
hematom subdural</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: x-small;">tulb
electrolitice
epilepsia infarct de
trunchi</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: x-small;">encef.
de dializa boli
sistemice hemoragii de trunchi</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: x-small;">deficitul
de tiamina boala cardiaca
</span></span>
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: x-small;">porfiria
</span></span>
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: x-small;">mixedemul
</span></span>
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: x-small;">droguri/toxice
</span></span>
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: x-small;">hipotermie
</span></span>
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: x-small;">hipertermia
</span></span>
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><i><b>Fiziopatologia
si simptomatologia comelor.</b></i></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><span lang="it-IT"><i>Coma
metabolica- </i></span></span></span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">se
produce datorita afectarii metabolismului cerebral.</span></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Creierul
uman consuma 5mg/100g de tesut/min de glucoza si 3,3mlO2/100g pe
ora.Creierul are o rezerva de glucoza foarte mica si nu are de loc
rezerva de O2.Din aceasta cauza este dependent de fluxul sanguin
cerebral .In medie acesta este de 55ml/100gtesut/min.Scaderea sub
10ml/min determina leziuni hipoxice si ischemice ireversibile.In
encefalopatiile metabolice datorita anomaliilor de aport energetic
apar modificari ale neurotransmitatorilor ale potentialelor
membranare de repaus,modificari structurale si biochimice neuronale
si gliale.</span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><span lang="it-IT"><i>Medicamentele
depresoare</i></span></span></span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">,produc
coma prin inhibitia concomitenta a SRAA si a cortexului cerebral.</span></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Comele
metabolice au o evolutie progresiva .</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">In
timpul comei, cel mai frecvent, RFM si oculomotricitatea sunt
pastrate.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Un
semn inportant este prezenta miscarilor involuntare de tip tremor,
mioclonii multifocale,flapping,rigiditate de decerebrare.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><i>Come
determinate de procese expansive intracraniene(PEIC)</i></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT"><i>supratentoriale.</i></span></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">PEIC
determina hipertensiune intracraniana(HIC),deplasari anormale ale
structurilor cerebrale,formarea unor conuri de presiune care patrund
(se angajeaza)in orificiile naturale sau depresiunile peretilor
craniului.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">1.Angajarea
transtentoriala a uncusului temporal(conul de presiune temporal)este
frecvent,grav,dar si accesibil tratamentului operator.De aici decurge
importanta diagnosticului rapid.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Simptomele
se datoresc suferintei trunchiului cerebral prin compresiune
directa,deplasare si torsionare cit si tulburarilor de circulatie
sanguina si LCR.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Clinic:-
tulburari de constienta</span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">-
hipertonia ceafei prin distensia cortului cerebelului</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">-
crize de rigiditate de decerebrare</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">-tulburari
ale functiilor vegetative(polipnee,tahicardie,HTA,</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">hipertermie,sughit)</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">-
midriaza fixa ipsilaterala </span></span></span>
</div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">-
hemipareza controlaterala.</span></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">2.Sindromul
central de deteriorare rostro-caudala se datoreaza deplasarii
nucleilor de la baza si diencefalului in incizura cortului
cerebelului comprimind trunchiul cerebral si arterele acestuia. </span></span>
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Se
manifesta prin:-respiratie Cheyne-Stockes,</span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">-paratonie
</span></span></span>
</div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">.
- abolirea RFM si miscarilor oculare reflexe pe
verticala </span></span></span>
</div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">-
rigiditate de decorticare si decerebrare</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">-
midriaza fixa si tulburari respiratorii ce anunta stopul
cardio-respirator</span></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">3.Deplasarea
laterala a structurilor supratentoriale profunde pe sub coasa
creierului determina un tablou clinic ce evlueaza de la somnolenta la
coma.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"> </span>
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><i>Come
determinate de PEIC subtentoriale. </i></span></span></div>
<div align="JUSTIFY" lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Procesele
expansive din fosa posterioara au la dispozitie un spatiu mai redus
de dezvoltare.De aceea evolueaza mai rapid spre angajare,comprimind
trunchiul cerebral.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">1.Angajarea
amigdalelor cerebeloase in foramen magnum se manifesta prin:</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-redoarea
simpla acefei sau insotita de atitudini speciale ale capului(imobili-</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">tate,retrocolis,laterocolis)</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-crize
de rigiditate de decerebrare,la un bolnav constient</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-hipertonie,</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-accese
de hipersomnie,</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-hipertermie,</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-tulburari
respiratorii si de ritm cardiac.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><i><b>Examinarea
pacientului comatos.</b></i></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><span lang="it-IT"><i><b>S</b></i></span></span></span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">copul
examinarii este determinarea nivelului de constienta,topografiei
leziunii,etiologiei.</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><span lang="it-IT"><i>Istoricul
–</i></span></span></span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">se
va concentra pe modul de debut si evolutie,antecedente</span></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">(boli,tratamente,addictii,traumatisme).</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><span lang="it-IT"><b>Examenul</b></span></span></span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">
general si pe aparate.</span></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT"><u>Stabilirea
scorului Glasgow.</u></span></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;"><u>Deschiderea
ochilor Raspuns motor Raspuns verbal
Evaluare</u></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">4
spontan 6 la ordin 5
orientat 8 coma usoara</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">3
la ordin 5 localizeaza 4
confuz 7-6 coma medie</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">2
la durere 4 fara tinta 3
neadecvat 5 coma profunda</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: small;">1absent
3 in flexie 2
neinteligibil </span></span>
</div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: small;"><span lang="it-IT">2
in extensie 1 absent </span></span></span>
</div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"> <span style="font-size: small;"><span lang="it-IT">1
absent </span></span></span>
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<ul>
<li><div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Prezenta
sindromului meningean sugereaza meningita,hemoragie subarahnoidiana.</span></span></div>
</li>
<li><div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Hipotermia
insoteste coma prin expunere la frig,mixedem,leziuni
hipotalamo-ipofizare,intoxicatia cu barbiturice,fenotiazine,alcool.</span></span></div>
</li>
<li><div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Hipertermia
40-44gradeC poate insoti un proces infectios,AVCsupraacut,starea de
rau epileptic,sindromul neuroleptic malign,hipertermia
maligna,intoxicatia cu anticolinergice.</span></span></div>
</li>
<li><div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Examenul
tegumentelor-echimoze, coloratie</span></span></div>
</li>
<li><div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Marca
traumatica.</span></span></div>
</li>
<li><div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Mase
ganglionare.</span></span></div>
</li>
<li><div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Respiratia
se noteaza-frecventa si tipul.</span></span></div>
</li>
<li><div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">TA-hta
sugereazaIM,hemoragii interne,intoxicatii cu alcool,barbiturice.HTA
,posibil AVC hemoragci,encefalopatie hipertensivc.</span></span></div>
</li>
<li><div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Ritmul
cardiac – n.b. bradicardie in HIC.</span></span></div>
</li>
</ul>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Examenul
neurologic.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Postura:</span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">-deviatia
capului si globilor oculari de partea opusa hemiplegiei=leziune
supratentoriala.</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">-“”
“” “” “” de aceeasi
parte cu hemiplegia=leziune pontina.</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">-postura
de decorticare=leziune deasupra nucleului rosu.</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">-postura
de decerebrare.</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">-miscari
involuntare:mioclonii( in comele metabolie),flapping(com hepatica
,uremica,intox. cu fenitoin)</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">-crampe,tetanie(tulburari
electrolitice).</span></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Raspunsul
motor.</span></span></div>
<ul>
<li><div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">miscarea
de aparare in abductie este semn de integritate a caii piramidale. </span></span>
</div>
</li>
</ul>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">-
apararea in adductie/flexie a membrului stimulat,rigiditatea de
decerebrare sunt patologice.</span></span></span></div>
<ul>
<li><div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">asimetria
miscarilor este semn de lateralizare(deficit de partea care este
retrasa cu intarziere)</span></span></div>
</li>
</ul>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Reflexele
de trunchi cerebral.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">1.Respiratia</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-respiratia
ciclica de tip Cheyne-Stockes consta in apnee urmata de hiperpnee.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-hiperventilatia
centrala neurogena este o respiratie rapida de 40-70/min. Apare in
acidoza,leziuni ale mezencefalului si puntii.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-respiratia
apneustica consta in pauze prelungite dupa fiecare inspir.Apare in
leziuni ale puntii inferioare.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-respiratia
tip ‘’cluster’’consta in scurte perioade de respiratie urmate
de apnee ce se succed periodic(bulb).</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-respiratia
ataxica este neregulata ca amplitudine si frecventa. Se manifesta in
leziuni bulbare inferioare.necesita intubare de urgenta.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-gaspingul
este o inspiratie abrupta urmata de expir apoi pauza lunga inaintea
inspirului urmator.Apare cu putin inaintea mortii.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">2.Modificarile
pupilare si reflexele pupilare.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-pupilele
diencefalice –miotice,reactive la lumina-in leziuni talamice
,hipotalamice,emisferice.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-pupile
in pozitie medie –au diametrul de 4-7mm,areactive,-leziuni
mezencefalice(tectum).</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-pupile
pontine -miotice’’ac de gamalie’’,RFM diminuat.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-sindrom
Horner-leziune bulbara.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-midriaza
unilaterala-compresiune ipsilaterala a nervului III.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-RFM
este in general conservat in comele metabolice.Este abolit in
intoxicatia cu barbiturice.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-mioza-intoxicatie
cu opiacee.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-midriaza
–intoxicatie cu anticolinergice, antidepresive.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">3.Motilitatea
oculara.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">In
coma se examineaza reflexele oculo cefalice,oculo vestibulare,r.
corneean.</span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">Reflexele
oculo cefalice-rotatia rapida,apoi lenta acapului-flexia/extensia
capului determina miscari conjugate ale globilor oculari in </span></span></span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT"><u>directia</u></span></span></span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">
opusa miscarii capului.Absenta miscarilor globilor oculari la
manevrele oculocefalice in coma,traduce o leziune difuza a
trunchiului cerebral.Daca reflexele oculo-cefalice sunt normale nu
mai este necesara examinarea reflexelor oculovestibulare.</span></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Reflexele
oculo-vestibulare-se iriga lent cu 10ml de apa rece conductul auditiv
extern in pozitia capului la 30grade.Functionarea normala
atrunchiului cerebral determina dupa 30 sec. o deviatie tonica a
globilor oculari ipsilateral irigarii.Daca scoarta cerebrala
functioneaza normal un nistagmus cotrolateral care corecteaza
deviatia.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Reflexul
corneean-evalueaza integritatea trunchiului si
nervilorV(punte)-VII.Medicamentele depresoare ale SNC abolesc
r.corneean inaintea RFM.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Examene
paraclinic</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-ex.toxicologice</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-ex.biochimice.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-ex.hematologice.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-ex.oftalmoscopic</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-ex.radiologice.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-exCT-demonstreaza
existenta unor leziuni structurale.Nu pot fi evidentiate infarctul
cerebral recent,leziunile trunchiului cerebral,hematoame izodense,
encefalita,disparitia fluxului cerebral.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-exRMN
este mai putin performant in hemoragii,dar poate evidentia leziuni in
trunchiul cerebral care nu sunt decelabile prin CT.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-exLCR
se pratrica atunci cind se suspicioneaza un proces infectios si CT
este normal.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-ECG
.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-EEG
este util in statusul epileptic neconvulsiv.Are modificari
patognomonice in encefalopatia hepatica.Este util in aprecierea
statusului cortical in evolutia comei.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><span lang="it-IT"><i><b>Tabloul
clinic al stadiilor comei</b></i></span></span></span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">.</span></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Stadiul
I.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-cortical</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-pacientul
poate fi trezit pentru perioade scurte de timp</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-raspunde
incoerent la intrebari</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-inlatura
stimulii nociceptivi</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-sindrom
bipiramidal</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-RFM,r.cornean,
deglutitie prezente,</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-nu
are tulburari sfincteriene</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-nu
are tulburari vegetative</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-la
revenire pastreaza o vaga amintire a episodului.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">StadiulII</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-diencefalic</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-nu
se trezeste la stimuli</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-la
stimuli verbali geme</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-raspuns
motor prin flexia bratelor si extensia mbr. inferioare</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-posibil
miscari involuntare de tip coree,tremor,dischinezii oro-faciale</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-semne
piramidale</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-tulb.
vegetative,respiratie Cheyne-Stokes</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-la
revenire, amnezia totala a episodului</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Stadiul
III</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-mezencefalic</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-nu
poate fi trezit</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-la
durere reactie motorie prin rigiditate de decerebrare</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-RFM
absent</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-globii
oculari nu sunt in axe,pot prezenta miscari spontane”hoinare”</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-respiratie
de tip hiperpnee</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-semne
piramidale.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Stadiul
IV</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-pontin</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-nu
poate fi trezit</span></span></div>
<div lang="fr-FR" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-nu
reactioneaza la nociceptie</span></span></div>
<div lang="fr-FR" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-reflex
cornean absent</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-mioza
bilaterala</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-hipotonie
bilaterala, ROT abolite</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-tulburari
respiratorii care necesita asistare,tulb. de ritm,hipotensiune</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Stadiul
V</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-bulbar</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-areactiv
la stimuli</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-hipotonie
care mascheaza semnele piramidale</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-midriaza
bilaterala</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-aboliera
r.de tuse</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-respiratie
ataxica,tendinta la stop</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-bradi/tahicardie,hipotensiune</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Stadiul
VI.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-moarte
cerebrala.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Criteriile
mortii cerebrale</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">.1Midriaza
fixa la lumina si durere</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">2.Reflex
cornean absent</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">3.Reflex
oculocefalic,oculovestibular absent</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">4.Reflex
faringian absent</span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">5.Absenta
reactiilor voluntare motorii</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">6.Centrul
respirator nu reactioneaza la cresterea CO2.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Corelatii
clinico –anatomice in come.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><u>Afectare
emisferica bilaterala.</u></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">-semne
simetrice</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">-mioclonii</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">-reflexe
de trunchi normale.</span></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><u>PEIC
supratentoriale cu compresiunea trunchiului cerebral.</u></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">-paralizie
de n.III ipsilaterala</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">-hemiplegie
controlaterala.</span></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><u>Leziuni
de trunchi cerebral.</u></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">-tulburari
precoce de oculomotricitate</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">-reflex
oculo cefalogir anormal</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: medium;"><span lang="en-US">-raspuns
motor asimetric.</span></span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><u>Toxic/metabolic.</u></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: medium;"><span lang="en-US">-pupile
reactive</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: medium;"><span lang="en-US">-tulb.
oculomotorii tardive </span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">-rigiditate
de decerebrare</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">-miclonii
multifocale.</span></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Diagnosticul
diferential al comelor.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><u>Come
fara semne de lateralizare ,fara sd. meningean.</u></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">-anoxic-ischemica</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">-metabolica</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">-toxica</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">-hiper/hipotermie</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">-epilepsie.</span></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><u>Come
fara semne defocar dar cu sindrom meningean</u></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"><u> </u></span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT"><u>-</u></span></span></span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">HSA</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">-meningita</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT"><u>Come
cu semne de lateralizare sau semne de trunchi cerebral.</u></span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">-tumori
cerebrale</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">-hemoragie
cerebrala</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">-infarct
cerebral</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">-abces
cerebral</span></span></span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT"><u>
</u></span></span></span>
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Principii
de tratament.</span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">-asigurarea
cailor aeriene ,suport ventilater daca se inpune.</span></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-montare
de cateter.Recoltare de analze.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-se
va redresa TA,tulburarile metabolice.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-pentru
scaderea HIC se va practica hiperventilatie,administra sol.
hiperosmolare,manitol20%1-2g/kgcorp i.v.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-in
tumori se poate administra corticoterapie(edem vasogenic) Nu este
indicat in edemul citotoxic si osmotic(AVC,coma cetozica)</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><span lang="it-IT"><u>Terapia
empirica –</u></span></span></span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">
se va aplica pacientilor in coma de etiologie necunoscuta. Data fiind
frecventa comei hipoglicemice se vor administra 50 ml dextroza
oricarui pacient in coma de origine necunoscuta. Concomitent 100mg
tiamina iv. pentru prevenirea encefalopatiei Wernike la alcoolici
Tratamentul specific se instituie imediat dupa stabilirea etiologiei.</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><span lang="it-IT"><u>Ingrijirea
pacientului comatos-</u></span></span></span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">
se va mentine tensiunea arteriala corespunzatoare perfuziei
renale,miocardice,cerebrale .</span></span></span></div>
<ul>
<li><div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">ventilatie
cu oxigenare adecvata pentru prevenirea aparitiei infectiilor ,
hipercapniei .Se vor inlatura protezele dentare , se va aplica sonda
oro-faringiana pentru a preveni obstruarea cailor aeriene , se vor
aspira secretiile.</span></span></div>
</li>
<li><div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Se
va monta sonda nazo-gastrica in scop nutritiv .Pielea va fi
protejata prin igiena locala , intoarcerea bonlavului la 3 ore .</span></span></div>
</li>
<li><div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Evitarea
turburarilor urologice prin montarea de cateter cu 3 cai dintre care
una cu irigatie continua cu acid acetic 0,25 % , aceasta se va
clampa pentru 3-4 ore pentru asigurarea bunei tonicitati vezicale.</span></span></div>
</li>
<li><div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Leziunile
oculare se vor preveni prin instilarea de metil celuloza 1-2
picaturi in ochi .</span></span></div>
</li>
<li><div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Pentru
starea de agitatie se recomanda Lorazepam 1-2 mg la 12 ore sau
Haloperidol 1-5mg la 12 ore im.</span></span></div>
</li>
<li><div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Se
va institui rapid tratamentul crizelor epileptice </span></span>
</div>
</li>
</ul>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><b>Prognosticul</b></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Depinde
de etiologie ,antecedentele personale si de starea neurologica a
pacientului.Statusul vegetativ prelungit peste 30 de zile de la
evenimentul acut are sanse minime sau absente de recuperare .</span></span></div>
Charlieeehttp://www.blogger.com/profile/09400801131611961874noreply@blogger.comtag:blogger.com,1999:blog-4682638310010168675.post-2013946668086104092012-11-23T05:53:00.000-08:002012-11-23T05:53:06.555-08:00EPILEPSIA
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<br />
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT"><b>Epilepsia
</b></span></span><span style="font-size: medium;"><span lang="it-IT">este afectiunea
neurologica cronica manifestata prin </span></span><span style="font-size: medium;"><span lang="it-IT"><b>crize
epileptice</b></span></span><span style="font-size: medium;"><span lang="it-IT">
recurente , neprovocate</span></span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">.</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT"><b>Criza
epileptica</b></span></span><span style="font-size: medium;"><span lang="it-IT"> este un
episod paroxistic avand ca manifestare clinica modificari in
activitatea motorie ,a senzatiilor,emotiilor memoriei sau/si a
constientei,datorat unei descarcari electro-chimice anormale la nivel
cerebral.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT">Crizele
epileptice se definesc cu termenul de </span></span><span style="font-size: medium;"><span lang="it-IT"><b>repetate</b></span></span><span style="font-size: medium;"><span lang="it-IT">
cand sunt separate de intervele scurte de timp(ore,minute)de revenire
completa.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT">Crizele
repetate, neseparate de interval de revenire, defineste starea de </span></span><span style="font-size: medium;"><span lang="it-IT"><b>rau</b></span></span><span style="font-size: medium;"><span lang="it-IT">
</span></span><span style="font-size: medium;"><span lang="it-IT"><b>epileptic</b></span></span><span style="font-size: medium;"><span lang="it-IT">
.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT"><b>Crizele
epileptice</b></span></span><span style="font-size: medium;"><span lang="it-IT"> care se
datoreaza unei tulburari acute reversibile ca de </span></span>
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">exemplu
hipoglicemia ,sevrajul la alcool,nu fac parte din boala epileptica.
.Ele dispar odata cu cauza care le-a declansat.</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT"><b>Diagnosticul
de epilepsie</b></span></span><span style="font-size: medium;"><span lang="it-IT"> se
stabileste cind pacientul a prezentat minim doua crize neprovocate la
distanta de 24 ore.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="fr-FR"><b>Sindromul
epileptic</b></span></span><span style="font-size: medium;"><span lang="fr-FR"> se
defineste prin tipul de crize, EEG ,status neurologic,etiologie,
prognostic,raspuns terapeutic.</span></span></div>
<div lang="fr-FR" style="margin-bottom: 0in;">
<br />
</div>
<div lang="fr-FR" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">Epilepsia
cuprinde diferite tipuri de crize si sindroame epileptice.</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT"><b>Tipuri
de crize.</b></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">1.A-crize
partiale sau focale in care descarcarea neuronala incepe sau ramane
cantonata la o zona a creierului.</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">II B.-crize
generalizate -descarcari neuronale ,care se extind la ambele
emisfere de la inceput.</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="fr-FR"><i><b>I.A
Crize partiale sau focale</b></i></span></span><span style="font-size: medium;"><span lang="fr-FR"><b>.</b></span></span></div>
<div lang="fr-FR" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">Crizele se
caracterizeaza prin simptome clinice sugestive pentru localizarea </span>
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">focarului de
descarcare neuronala, si prin pastrarea starii de constienta. Toate
crizele partiale debuteaza prin activarea unui focar epileptic.
Uneori acesta se poate generaliza la nivelul ambelor emisfere.</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">EEG
prezinta anomalii focale.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT">a)
</span></span><span style="font-size: medium;"><span lang="it-IT"><i>crize motorii</i></span></span><span style="font-size: medium;"><span lang="it-IT">-
focar in lobul frontal controlateral manifestarii clinice</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT">*</span></span><span style="font-size: medium;"><span lang="it-IT"><i>crize
motorii strict localizate</i></span></span><span style="font-size: medium;"><span lang="it-IT">-contractii
tonice sau clonice limitate la un membru ,fara tendinta de iradiere.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">EEG
–focar iritativ la nivelul ariei 4.</span></span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT">*</span></span><span style="font-size: medium;"><span lang="it-IT"><i>crize
motorii jacsoniene</i></span></span><span style="font-size: medium;"><span lang="it-IT">
–contractii tonice urmate de convulsii la un segment ce se extind
la tot hemicorpul din aproape in aproape conform somatotopiei
reprezentate de homuncusul de la nivelul ariei motorii.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">EEG focar
iritativ prerolandic.</span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT">*</span></span><span style="font-size: medium;"><span lang="it-IT"><i>crize
versive</i></span></span><span style="font-size: medium;"><span lang="it-IT">-devierea
conjugata a capului si globilor oculari spre partea opusa
focarului(adversive) sau spre focar(ipsiversive).</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">EEG
focar iritativ frontal (arie 8).</span></span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT">*</span></span><span style="font-size: medium;"><span lang="it-IT"><i>crize
posturale -</i></span></span><span style="font-size: medium;"><span lang="it-IT">
torsionarea trunchiului spre partea opusa focarului ,ridicarea
membrului superior controlateral focarului, extensia celuilalt membru
superior si a membrelor inferioare.
EEG- focar iritativ central.</span></span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT">*</span></span><span style="font-size: medium;"><span lang="it-IT"><i>crize
de arie motorie suplimentara</i></span></span><span style="font-size: medium;"><span lang="it-IT">
–ridicarea bratului in abductie si flexie, rotarea capului si
ochilor de aceeasi parte, oprirea vorbirii urmata de repetarea unui
cuvant.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">EEG- focar
iritativ central.</span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT">*</span></span><span style="font-size: medium;"><span lang="it-IT"><i>crize
afazice de tip receptiv sau expresiv</i></span></span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT"><i>.</i></span></span><span style="font-size: medium;"><span lang="it-IT">EEG-
focar iritativ fronto-temporal.</span></span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT">*</span></span><span style="font-size: medium;"><span lang="it-IT"><i>crize
operculare-</i></span></span><span style="font-size: medium;"><span lang="it-IT">
hipersalivatie, masticatie.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">.EEG-focar
iritativ fronto temporal.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT">b)</span></span><span style="font-size: medium;"><span lang="it-IT"><i>crize
senzitive</i></span></span><span style="font-size: medium;"><span lang="it-IT">-generate
de un focar parietal.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT">*</span></span><span style="font-size: medium;"><span lang="it-IT"><i>crize
senzitive jacksoniene</i></span></span><span style="font-size: medium;"><span lang="it-IT">-parestezii
la nivelul hemicorpului opus focarului cu extindere de tip din
aproape in aproape.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">EEG focar
iritativ centro-parietal.</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT">c)</span></span><span style="font-size: medium;"><span lang="it-IT"><i><b>crize
senzoriale</b></i></span></span><span style="font-size: medium;"><span lang="it-IT">(iluzii,halucinatii
simple).</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><i>*vizuale</i></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">Iluzionale
-perceperea deformata a obiectelor si spatiului</span></div>
<div lang="fr-FR" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Halucinatorii
simple(focar occipital)sau complexe cu focar temporal</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">Agnozice cu
imposibilitatea de a recunoaste imagini,persoane. </span>
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT">*</span></span><span style="font-size: medium;"><span lang="it-IT"><i>auditive</i></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">Iluzionale-
perceperea deformata a sunetelor(focar temporal)</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">Halucinatorii-cu
perceptii elementere(focar- arie auditiva
primara),voci,conversatii,(focar extins in afara ariei primare spre
arii temporale integrative).</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">Agnozice
–incapacitatea de a recunoaste sunete complexe.</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT">*</span></span><span style="font-size: medium;"><span lang="it-IT"><i>olfactive,gustative.</i></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Iluzionale
–perceptia paroxistica deformata aunor mirosuri sau gusturi
existente.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Halucinatorii-
perceperea unor mirosuri,gusturi ireale(crize uncinate)</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT">*</span></span><span style="font-size: medium;"><span lang="it-IT"><i>vestibulare</i></span></span><span style="font-size: medium;"><span lang="it-IT">.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Iluzionale-plutire(temporal)</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Halucinatorii-senzatii
de rotire,miscare aobiectelor(temporal,parieto-occipital)</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="fr-FR">d)</span></span><span style="font-size: medium;"><span lang="fr-FR"><i><b>crize
vegetative
</b></i></span></span>
</div>
<div lang="fr-FR" style="margin-bottom: 0in;">
<br />
</div>
<div lang="fr-FR" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">crize
de hiperhidroza-tumori de lob frontal</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">crize de
hipertermie- tumori pineale,nuclei bazali.</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">crize
vegetative diencefalice- HTA,tahicardie ,hipersalivatie,midriaza</span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">-hipertermie,miscari
de masticatie,halucinatii.</span></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"> </span>
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT">e)</span></span><span style="font-size: medium;"><span lang="it-IT"><i><b>crize
cu simptome psihice</b></i></span></span><span style="font-size: medium;"><span lang="it-IT">(cu
simptome psihosenzoriale,cognitive, afective).</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="fr-FR">Cu
simptome </span></span><span style="font-size: medium;"><span lang="fr-FR"><i>psihosenzoriale</i></span></span><span style="font-size: medium;"><span lang="fr-FR">
- halucinatii complexe</span></span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="fr-FR">Cu
simptome </span></span><span style="font-size: medium;"><span lang="fr-FR"><i>cognitive</i></span></span><span style="font-size: medium;"><span lang="fr-FR">-senzatie
deja vu sau jamais vu,gandire fortata.</span></span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="fr-FR">Cu
simptome </span></span><span style="font-size: medium;"><span lang="fr-FR"><i>afective</i></span></span><span style="font-size: medium;"><span lang="fr-FR">-anxietate,furie,euforie.</span></span></div>
<div lang="fr-FR" style="margin-bottom: 0in;">
<br />
</div>
<div lang="fr-FR" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Criza
partiala simpla poate evolua spre criza partiala complexa,criza ge-</span></span></div>
<div lang="fr-FR" style="margin-bottom: 0in;">
<span style="font-size: medium;">neralizata
sau stare de rau epileptic focal.</span></div>
<div lang="fr-FR" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;"><i><b>I.B
Crize partiale complexe-temporale sau de regiune
temporo-parieto-occipitala</b></i></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">Simptomele
constau in modificarea starii de constienta cu automatisme
motorii,gestuale,ambulatorii, verbale,rotatorii,gelastice(ras).</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Criza
poate debuta cu tulburarea de constienta sau cu manifestarea focala.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Dureaza
2-3 minute.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">EEG
– focar iritativ temporo-frontal sau centro-parietal.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Clinic:</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">-modificarea
starii de constienta - confuzie,obnubilare,incapacitate de a raspunde
la stimulii externi prin modificarea perceptiei.</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">-automatisme
motorii - comportament motor stereotip,continuarea activitatii
aparent normal,miscari masticatorii etc.</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">-automatisme
gestuale - imbracare,aranjarea obiectelor.</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">-automatisme
verbale - repetarea unui cuvant,fraze.</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">-automatisme
ambulatorii - bolnavul se deplaeaza pe distante uneori mari,avand un
comportament aparent normal desi nu este constient .</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">-automatisme
rotatorii</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-automatisme
de ras(gelastice).</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">Criza simpla
poate evolua spre criza generalizata, sau spre stare de rau partial
complex cu repetarea crizelor timp de ore,zile.</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT"><b>II
Crize generalizate</b></span></span><span style="font-size: medium;"><span lang="it-IT">.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">-se
caracterizeaza prin pierderea constientiei cu sau fara manifestari
motorii bilaterale,amnezia crizei,EEG cu anomalii generalizate.</span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT">1.</span></span><span style="font-size: medium;"><span lang="it-IT"><i>Criza
de absenta</i></span></span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT">-absenta
tipica:debut brusc ,pierderea completa acontientei cu durata de
10-20sec.,conservarea tonusului muscular,asocierea de automarisme
simple,manifestari vegetative.EEG in criza-complex
varf-unda,bilateral,sincron,cu frecventa de 3Hz si normal in afara
crizei.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">Criza minora
sau petit mal este specifica copilariei ulterior fiind inlocuita de
crize generalizate tonico-clonice. Acest tip de criza nu apare de
novo la adult manifestari asemanatoare la adult poarta numele de
pseudoabsenta.</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT">-absenta
atipica- debut mai lent,pierderea incompleta a constientei,mani-</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">festari
asociate ca miclonii,atonie,automatisme, ale membrelor,tulburari
vegetative(pierderea urinei,tuse,stranut). Acest tip de criza se
poate manifesta si dupa 20 ani.</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"> </span>
</div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT">2.</span></span><span style="font-size: medium;"><span lang="it-IT"><i>Crizele
mioclonice</i></span></span><span style="font-size: medium;"><span lang="it-IT">.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Debut
brusc</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Pierderea
constientei</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Mioclonii
bilaterale</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Durata
de secunde,minute.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT">3.</span></span><span style="font-size: medium;"><span lang="it-IT"><i>Crizele
generalizate de tip tonic</i></span></span><span style="font-size: medium;"><span lang="it-IT">.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Debut
brusc</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Pierderea
constientei</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Contractia
tonica bilaterala a musculaturii axiale cu extensie la membre</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Manifestari
vegetative.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Durata
de 20sec.-1min.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT">4.</span></span><span style="font-size: medium;"><span lang="it-IT"><i>Crizele
generalizate de tip clonic</i></span></span><span style="font-size: medium;"><span lang="it-IT">.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Debut
brusc</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Atonie
sau contractie tonica urmata de contractii clonice ale
fetei,membrelor</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Manifesteri
vegetative</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Durata
1-2min.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT">5.</span></span><span style="font-size: medium;"><span lang="it-IT"><i>Criza
generalizata de tip tonico-clonic( grand mal)</i></span></span><span style="font-size: medium;"><span lang="it-IT">.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">Clinic:debut
brusc prin pierderea constientei si cadere.
Urmeaza</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">-1 Faza
tonica cu durata de 10-20sec.cu contractia in flexie a trunchiului si
membrelor superioare,apoi extensia puternica a trunchiului si
membrelor inferioare,dechiderea/inchiderea gurii.
</span>
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">-2. Faza
clonica-cu durata de un minut,consta in convulsii clonice
generalizate.</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">-3.Faza de
coma-20sec.-5min.-midriaza tahicardie,polipnee,relaxare sfincteriana.</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">-4. Faza
postcritica-15min.,hipotonie generala</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">incetarea
tulburarilor generale,reflex plantar in extensie,recapatarea treptata</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">a
constientei.Faza somnului postcritic.In unele cazuri exista o faza
prodromala(20-30%)cu durata de ore sau zile in timpul careia
pacientul acuza modificari ale dispozitiei,tulburari
vegetative,mioclonii.</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Crizele
pot fi precedate cu cateva zile de faza prodromala manifestata prin
cefalee,anxietare,ameteli,mioclonii,parestezii.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">Aura (50% din
cazuri) cu durata de cateva secunde precede si anunta pierderea
constientei.Consta in simptome vegetative,senzitive,snzoriale sau
motorii avand valoare localizatoare.</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT"><i>Starea
de rau epileptic</i></span></span><span style="font-size: medium;"><span lang="it-IT">-crize
tonico-clonice repetate timp de ore sau zile fara revenirea completa
a constientei.Se insoteste de tulburari vegetative severe care pot
antrena decesul.Coma postcritica este prelungita(24h).</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;"><b>Principalele
cauze ale crizelor.</b></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">1.cauze
prenatale-displazii corticale,malformatii cerebrale,leziuni ischemice
intrauterine,infectii intrauterine ale SN, intoxicatii medicamentoase
materno-fetale.</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">2.cauze
neonatale-encefalopatii hipoxice dupa nasteri distocice,hemoragii
cerebrale.</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">3.cauze
postnatale.</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">a)
infectii cerebrale:-encefalite</span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">-abcese
cerebrale</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">-parazitoze</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT">-
SIDA.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">b)traumatisme.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">c)tumori</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">d)intoxicatii
cu alcool,sevraj,crize recurente legate de intoxicatia cronica </span></span>
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">alcoolica.Intoxicatii
cu medicamente,droguri,alte toxice.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">e)boli
vasculare cerebrale.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">f)boli
ale sistemului imunitar</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">g)boli
degenerative.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;"><i><b>Fiziopatologia
epilepsiei</b></i></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT"><i><b>.</b></i></span></span><span style="font-size: medium;"><span lang="it-IT">
Hiperexcitabilitatea neuronala si dezvoltarea neurocircuitelor
anormale concura la aparitia unei activitati anormale la nivelul unor
populatii de neuroni corticali sau hipocampici.Exista o predispozitie
genetica care determina un prag comvulsivant mai scazut la unii
indivizi dar si posibilitatea ca in urma unor stari patologice sa
apara populatii neuronale cu prag scazut de excitatie care
constituie focarul epileptic. Un rol important il joaca canalele
ionice de calciu si sodiu si neurotransmitatorii excitatori care sunt
tinta medicatiei antiepileptice.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Criza
focala implica doar o arie localizata a cortexului in timp ce criza
generalizata implica simultan arii extinse corticale din ambele
emisfere.Pierderea constientei apare prin extinderea anomaliei spre
talamus si SRAA(substanta reticulata activatoare ascendenta).</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">Crizele
epileptice induc o crestere anormala a metabolismului
cerebral,crestera fluxului sanguin,consumului de glucoza si oxigen.
In crizele severe, consumul de glucoza si oxigen peste rezervele
foarte limitate ale creierului duce la epuizare metabolica,
acumulare de lactat,inhibitie a sintezei de proteine.</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT"><b>Diagnostic</b></span></span><span style="font-size: medium;"><span lang="it-IT">.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">Primul pas
este stabilirea aspectului clinic - tipului crizei- care este facila
daca medicul asista la criza si mai dificila prin anamneza.</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">Pentru
indeplinirea criteriilor diagnosticului de epilepsie trebuie
stabilita recurenta crizelor si caracterul lor neprovocat( in absenta
hipiglicemiei,intoxicatiilor).</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Criza
unica nu se poate eticheta epilepsie.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;"><b>Investigatii
paraclinice.</b></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">-EEG normala
in stare de veghe este compusa din unde alfa(frecventa de 8-12Hz) si
beta(13-30Hz) activitatea electrica acelor doua emisfere fiind
simetrica.</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-EEG
patologic inregistrata in stare de veghe, poate prezenta asimetrie
emisferica,grafoelemente patologice persistente sub forma de focar
precum undele teta(4-7Hz)si delta (1-3Hz),descarcari de varfuri si
varf-unda.</span></span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT">-CT si
RMN,pot evidentia patologia organica sau malformativa.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT"><b>Diagnosticul
diferential</b></span></span><span style="font-size: medium;"><span lang="it-IT"> se face
cu: :</span></span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT">-sincopa</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">-AIT-ul</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">-miscarile
involuntare(spasm hemifacial,</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">-narcolepsia,</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">-cataplexia,</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">-migrena,</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">-crizele
psihogene .</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><b>Tratamentul.</b></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT">1.Tratamentul
</span></span><span style="font-size: medium;"><span lang="it-IT"><i>cronic</i></span></span><span style="font-size: medium;"><span lang="it-IT">
al epilepsiei:</span></span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT">-evitarea
factorilor declansatori-masuri generale de dieta cu evitarea
hipoglicemiei,consumului de alcool,cafea, privarii de somn.</span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">-evitarea
expunerii in mediu cu periculozitate.</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">-tratamentul
trebuie urmat 3 ani dupa ultima criza,dupa care se inrerupe </span></span></span>
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">progresiv
sau in functie de caz va fi urmat toata viata.</span></span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT">-se
recomanda monoterapie,cu un antiepileptic(AE) ales in functie de
tipul de crize,sindromul epileptic.In cazul in care crizele persista
la un prim AE corect ales se poate adauga un al doilea AE si
exceptional un al treilea.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">AE actioneaza
pe baza unor mecanisme inhibitorii induse de GABA,inhi-</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">bitia
efectului actiunii aminoacizilor excitatori pe receptorii NMDA,AMPA, </span>
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">modularea
canalelor de sodiu voltaj dependente,modularea canalelor de calciu.</span></span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT"><i>Acidul
valproic</i></span></span><span style="font-size: medium;"><span lang="it-IT"> si
sarurile sale exercita actiune inhibitorie asupra canalelor de sodiu
si prin GABA.Este indicat in toate tipurile de crize,atat
generalizate cat si focale.</span></span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT"><i>Carbamazepina
</i></span></span><span style="font-size: medium;"><span lang="it-IT">actioneaza prin
canalele de sodiu voltaj dependente,are indicatie in crizele focale
si generale, dar nu in absente.Are efecte secundare </span></span>
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">hematologice
si hepatice.</span></span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT"><i>Oxcarbazepinul</i></span></span><span style="font-size: medium;"><span lang="it-IT">
este analog de carbamazepin,din generatia noua, cu mai putine efecte
secundare.</span></span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT"><i>Fenitoinul
</i></span></span><span style="font-size: medium;"><span lang="it-IT">blocheaza canalele
de sodiu.are indicatie in crizele generalizate si focale.Efecte
secundare:tulburari cardiace,hipertrofie gingivala, atrofie
cerebeloasa.</span></span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT"><i>Fenobarbitalul
–</i></span></span><span style="font-size: medium;"><span lang="it-IT">efect inhibitor
GABA.Util in terapia de urgenta.Produce se-</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">dare
si tulburari cognitive.</span></span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT"><i>Etosuximida</i></span></span><span style="font-size: medium;"><span lang="it-IT">
–in crizele de absenta.</span></span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT"><i>Primidona</i></span></span><span style="font-size: medium;"><span lang="it-IT">-precursor
al fenobarbitalului,indicata in crize focale.</span></span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT"><i>Clonazepamul</i></span></span><span style="font-size: medium;"><span lang="it-IT">
–faciliteaza inhibitia GABA.Are indicatie in crizele mioclonice si
atone.</span></span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT"><i>Lamotrigina</i></span></span><span style="font-size: medium;"><span lang="it-IT">-inhiba
neurotransmitatorii excitatori glutamat,aspartat.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Indicat
in toate formele de crize,apartine generatiei noi de AE,cu mai putine
efecte secundare.</span></span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT"><i>Topiramatul</i></span></span><span style="font-size: medium;"><span lang="it-IT">-blocheaza
canalele de calciu,faciliteaza circuitele GABA.Are indicatie in toate
formele decrize.Efecte secundare:scderea in greutate, afectare
mnezica.</span></span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT"><i>Levetiracetamul</i></span></span><span style="font-size: medium;"><span lang="it-IT">-mecanism
de actiune neelucidat.Are indicatie in crizele focale,mioclonice si
absente.</span></span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT"><i>Gabapentinul</i></span></span><span style="font-size: medium;"><span lang="it-IT">-in
crizele focale cu sau fara generalizare.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">Tratamentul
chirurgical este rezervat crizelor refractare.Constau ,dupa caz in
rezectii a portiuni din lobul temporal anterior,excizie stereotaxica
a leziunilor circumscrise cauzatoare de
crize(cavernoame,hamartroame).</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><b>Tratamentul
crizei epileptice.</b></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">Se vor
instrui apartinatorii pentru comportamentul paramedical de prevenire
a traumatismului indus de cadere ,pozitionarea in decubit lateral,</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">asigurarea
cailor respiratorii,interzicerea interventiei intempestive asupra
comportamentului tonico-clonic.</span></span></div>
<div style="margin-bottom: 0in;">
<span style="font-size: medium;"><span lang="it-IT"><i>Profilaxia
</i></span></span><span style="font-size: medium;"><span lang="it-IT">repetarii crizei :</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-administrarea
unui anticonvulsiv cu actiune rapida</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">-diazepam
i.v.0,15-0,25mg/kg corp.(1f.=5mg.) la adult.
La copil
0,2-0,3mg/kgcorp.Administrarea pe cale venoasa se poate repeta dupa
20min.</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-combaterea
factorilor precipitanti:febra,hipoglicemia</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;"><i>Tratamentul
starii de rau epileptic.</i></span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<br />
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">Tratamentul
presupune internare daca este posibil in Terapie intensiva.</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">I.Primele
10 minute:</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">*asigurarea
permeabilitatii cailor aeriene superioare,preferabil intubatie
oro-traheala,administrare de oxigen,monitorizarea functiilor vitale;</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">*montarea
unei linii venoase pentru recltarea de analize hematologice si
biochimice si pentru administrarea de tratament;<br />*anamneza,ex.
clinic general si neurologic,ECG.</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">*combaterea
factorilor precipitanti:</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-glucoza
50% 25-50ml la adult;copil 25ml/kgc;</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-combaterea
febrei;</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-tiamina
100mg i.v.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-corectarea
tulb. hidro-electrolitice.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">Tratament
medicametos antiepileptic.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">-diazepam,i.v.,diluat
in 10ml ser glucozat 10% 0,15-0,25mg/kgc la </span>
</div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">adult,
0,2-0,3mg/kgc la copil.</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">-pe cale
retala 0,2mg/kgc la adult si 0,3-0,5mg/kgc la copil.</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">-lorazepam
i.v.,2mg la adult si 0,05-0,10mg/kgc la copil;se poate repeta
administrarea maxim de patru ori la intervale de 2min.</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">-fenitoin-se
administreaza folosind alta cale venoasa,de preferinta cu prima doza
de diazepam sau lorazepam sau imediat dupa aceea ;bolus de
15-20mg/kgc,pana la 50mg/min la adult si 3mg/kgc la copil,timp de
20min.;</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">se
poate repeta dupa 20min in doza de 10mg/min.Necesita monitorizarea
functiei respiratorii si cardiace.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">II.Urmatoarele
20min.</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">*monitorizarea
functiilor vitale;<br />*continuarea
investigatiilor:CT,PL.<br />*continuarea tratamentului de corectare
adresat cauzelor statusului;<br />*continuarea tratamentului
anticonvulsivant:</span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-size: medium;"><span lang="it-IT">-fenitoin
p i.v.10mg/kgc sau midazolam 0,1-0,4mg/kgc/ora in pi.v.</span></span></span></div>
<div lang="da-DK" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">III.Urmatoarele
30min,daca crizele nu s-au oprit:</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">*transferare
obligatorie in ATI ;</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="font-size: medium;">*intubatie
orotraheala obligatorie<br />*anestezie cu tiopental
pi.v.50-150mg/ora la adult,2-4mg/kgc la copil</span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">sau
pentobarbital 1-4mg/kgc/ora la adult,1-3mg/kgc ora la
copil.<br />*sustinerea functiilor vitale;</span></span></div>
<div lang="it-IT" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-size: medium;">*monitorizare
EEG daca este posibil, pentru urmarirea disparitiei activitatii
electrice iritative.</span></span></div>
Charlieeehttp://www.blogger.com/profile/09400801131611961874noreply@blogger.comtag:blogger.com,1999:blog-4682638310010168675.post-53100431076774246162012-11-22T19:06:00.002-08:002012-11-22T19:06:30.849-08:00Scoarta Cerebrala - Sindroamele corticale (partea a IIa)<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><u>Lobul
temporal.</u></span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<br />
</div>
<ul>
<li><div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">aria
41-izocortex heterotipic granular-esta aria primara,distrugerea
bilaterala duce la surditate corticala. In leziuni iritative apare
tinitus.</span></span></span></div>
</li>
<li><div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">aria
42- izocortex heterotipic granular,lezata bilateral determina
agnozia pentru sunete,muzica.</span></span></span></div>
</li>
<li><div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">aria
22- aria intelegerii limbajului in emisferul dominant(izocortex
homotipic cu rol asociativ)</span></span></span></div>
</li>
<li><div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">lezarea
ariilor 22+42 dominant =surditate verbala sau afazie senzoriala
Wernike, constand in neintelegerea sensului
cuvintelor,propozitiilor.</span></span></span></div>
</li>
<li><div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">aria
olfactiva – paleocortex, pe suprafata interna a l.temporal .
leziunile iritative duc la halucinatii olfactive,stari afective de
fericire,stari onirice.</span></span></span></div>
</li>
</ul>
<div lang="ro-RO" style="margin-bottom: 0in;">
<br />
</div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<br />
</div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><u>Lobul
occipital.</u></span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<br />
</div>
<ul>
<li><div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">aria
17- izocortex heterotipic granular, situata pe suprafata interna a
scizurii calcarine;pe ea se proiecteaza retina punct cu punct.
Leziunile distructive produc hemianopsie controlaterala cu pastrarea
vederii maculare.leziuni iritative produc fotopsii,fosfene.</span></span></span></div>
</li>
<li><div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">aria
18 – rol asociativ. In leziuni iritative apar perceptii sub forma
unor imagini elementare(linii,cercuri)</span></span></span></div>
</li>
<li><div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">aria
19 – sediul integrarii complete vizuale , sediul lexiei,se extinde
spre zonele de granita cu lobii T,P. Excitatia ariei produce
perceptia unor imagini complexe.</span></span></span></div>
</li>
</ul>
<div lang="ro-RO" style="margin-bottom: 0in; margin-left: 0.5in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Lezarea
ariei1 18+19 duce la agnozie vizuala sau cecitate psihica.</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in; margin-left: 0.5in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Leziuni
in emisferul nedominant determina agnozia vizuospatiala cu perceptie
distorsionata a spatiului,lipsa de apreciere a plasarii pacientului
in raport cu obiectele. Prosopagnozia consta in nerecunoasterea
figurilor.</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in; margin-left: 0.5in;">
<br />
</div>
<div align="CENTER" lang="ro-RO" style="margin-bottom: 0in; margin-left: 0.5in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"><i><u><b>Afazia.</b></u></i></span></span></span></div>
<div align="CENTER" lang="ro-RO" style="margin-bottom: 0in;">
<br />
</div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Afazia
este o tulburare dobâdită de întelelegerere si exprimare
alimbajului.</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Ariile
legate de funcţia limbajului sunt:</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Lobul
frontal-aria 44 Broca -exprimare verbală.</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Lobul
temporal-aria 42,22- intelegerea verbală.</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Lobul
occipital-aria 19 - lexia.</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Aria
Broca are rolul de a genera cuvinte.</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Aria
Wernike recunoaste sunetele ca şi cuvinte . Este legata de aria
Broca prin fascicolul arcuat.Aceste două zone sunt legate de aria
conceptulă unde se recunoaşte sensul cuvintelor.</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<br />
</div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><u>Tipuri
de afazie :</u></span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">-afazia
Broca</span></span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">-afazia
Wernike</span></span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">-afazia
de conductie(fascicul arcuat)</span></span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">-afazia
transcorticala senzoriala </span></span></span></span>
</div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">-afazia
transcorticală motorie.</span></span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<br />
</div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><i><u><b>Afazia
Broca ,expresiva sau motirie.</b></u></i></span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-lezarea
ariei 44 frontale</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-intelege
cuvintele dar nu le poate (afemie= imposibilitatea articularii
cuvintelor)</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-vorbire
nonfluenta,telegrafica fara prepozitii,conjunctii.</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-nu
poate denumi obiectele,foloseste parafraze</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-nu
poate repeta o propozitie</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Lezarea
ariei 46 produce agrafie.</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<br />
</div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><i><u><b>Afazia
transcorticala motorie.</b></u></i></span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Se
manifesta ca afazia Broca dar poate repeta propozitiile.</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<br />
</div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Afazia
senzoriala Wernike sau afazia receptiva.</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-lezarea
ariei 42 duce la nerecunoasterea fonemelor limbii materne care apar
ca zgomote</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-leziunea
ariei 42 ,22 determina surditatea verbala </span></span></span>
</div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-nu
intelege limbajul,</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-poate
vorbi,fluent dar cuvintele nu au sens(salata de cuvinte)</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-jargonafazie
–inlocuirea silabelor ,cuvinteloralcatuind un nou linbaj
neinteligibil.</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-repetarea
la cerere a unei propozitii nu este posibila.</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<br />
</div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><i><u><b>Afazia
transcorticala senzoriala</b></u></i></span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-asemanator
afaziei Wernike,cu conservarea vorbirii repetate</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<br />
</div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><i><u><b>Afazia
de conductie.</b></u></i></span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-lezarea
fascicolului arcuat</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-intelegere
si exprimare conservate</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-repetarea
la cerere aunei propozitii nu este posibila.</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<br />
</div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<br />
</div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><i><u><b>Afazia
mixta sau globala.</b></u></i></span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-leziuni
extinse ale ariei Broca si Wernike</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-nu
intelege nu poate exprima nimic.</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<br />
</div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><i><u><b>Afazia
mixta transcorticala.</b></u></i></span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-asemanator
afaziei mixte cu conservarea repetarii.</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<br />
</div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Teste
pentru evaluarea afaziei.</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-vorbirea
spontana-denumire de obiecte</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-vorbire
automate(numara)</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-vorbire
repetata</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-executare
de ordine complexe</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-
,, ,, ,, ,, simple</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-
,, ,, ,, ,,, ,, cu dicriminare dreapta stanga</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-scris-.citit.</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<br />
</div>
<div align="CENTER" lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"><i><u><b>Apraxia.</b></u></i></span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<br />
</div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Praxia
se refera la functia gestuala sau executare cu un scop a unei
succesiuni de miscari.</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<br />
</div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><u>Ariile
implicate sunt :</u></span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">-aria
40,39 domonant.</span></span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">-aria
22 posterior dominant</span></span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">-raspantia
parieto-occipitala bilateral</span></span></span></span></div>
<ul>
<li><div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Fa
,piciorul F3.</span></span></span></div>
</li>
<li>
</li>
</ul>
<div lang="ro-RO" style="font-style: normal; margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><u>Gesturile
pot fi:</u></span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">-tranzitive(legarea
sireturilor)</span></span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">-intranzitive</span></span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">-elementare(deschide
gura)</span></span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">-descriptive(gestul
de a bate cu ciocanul)</span></span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">-conventionale(salut).</span></span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<br />
</div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><i><u><b>Apraxia
ideatorie</b></u></i></span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-leziuni
in aria40,39,T1dominant</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-se
considera o agnozie de utilizare a obiectelor</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-nu
executa gesturi tranzitive si intranzitive.</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<br />
</div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><i><u><b>Apraxia
ideomotorie.</b></u></i></span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-leziuni
aria 40,39 nedominant</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-poate
fi globala sau la un hemicorp</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-afecteaza
atat actele simple cat si cele complicate</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-pot
indeplini spontan unele acte dar nu si la ordin.</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-sunt
afectate gesturile intranzitive predominant.</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<br />
</div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<br />
</div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<br />
</div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><i><u><b>Apraxia
constructiva.</b></u></i></span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-leziuni
de emisfer dominant si nedominant</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-lipsa
de apreciere a relatiilor dintre elemente</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-nu
poate desena sau construi folosind cuburi.</span></span></span></div>
<div lang="en-US" style="margin-bottom: 0in;">
<br />
</div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><i><u><b>Apraxia
de imbracare.</b></u></i></span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-leziune
parieto-occipitala nedominanta</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-tulburari
de schema corporala ,agnozie vizuala </span></span></span>
</div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-nu
se poate imbraca.</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<br />
</div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><i><u><b>Apraxia
facio-buco-linguala.</b></u></i></span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-leziunea
in piciorul F3 dominan</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-nu
executa miscari la cerere in teritoriul descris dar le executa
automat.</span></span></span></div>
Charlieeehttp://www.blogger.com/profile/09400801131611961874noreply@blogger.comtag:blogger.com,1999:blog-4682638310010168675.post-45167348704881812812012-11-22T19:05:00.003-08:002012-11-22T19:05:30.657-08:00Scoarta Cerebrala - Sindroamele corticale (partea I)
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<div lang="en-US" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Creierul
este compus din:</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">emisferele
cerebrale</span></span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">trunchiul
cerebral</span></span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">cerebel</span></span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Emisferele
cerebrale sunt pereche,înparţite în lobi delimitaţi parţial de
principalele şanţuri :</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">lobul
frontal</span></span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">lobul
parietal</span></span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">lobul
temporal</span></span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">lobul
occipital</span></span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">lobul
insulei-în profunzimea şanţului silvian</span></span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">lobul
limbic-este un lob de sinteză cu funcţii viscerale şi in reglarea
comportamentelor. Este constituit din marginile laterale ale lobilor
frontal,parietal, occipital,temporal,înconjurând partial trunchiul
în partea rostrala.</span></span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><u>
<span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">Citoarhitectura
emisferelor cerebrale.</span></span></span></u></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<br />
</div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Brodman
a descris 52 de ariii funcţionale.</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><i>Cortexul
are 6 straturi:</i></span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">1.molecular
– are rol asociativ</span></span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">Este
compus dintr-o reţea de dendrite şi axoni paraleli cu suprafaţa
scoarţei şi un numar relativ mic de neuroni.</span></span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">2.granular
extern – rol asociativ</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">-
compus dintr-un numar mare de neuroni de talie mare si mijlocie,</span></span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">3.piramidal
extern – rol asociativ</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">-compus
din neuroni de talie mijlocie</span></span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">4.granular
intern – rol de recepţie senzitivo-senzorianl</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">-densitate
mare de neuroni de talie mica.</span></span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">5.piramidal
intern – rol motor </span></span></span>
</div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">-
compus din celule gigante Betz,celule mari si mijlocii cu densitate
mare.</span></span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">6.stratul
celulelor fuziforme – rol asociativ</span></span></span></div>
<ul>
<li><div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">neuroni
de forme si marimi diferite,densitate medie.</span></span></span></div>
</li>
</ul>
<div lang="en-US" style="margin-bottom: 0in;">
<br />
</div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">Structura
cu 6 straturi se gaseşte pe 80% din cortex iar filogenetic este
neocortex(izocortex). 12% reprezinta paleocortexul(allocortex) si
are numai 3 straturi(molecular extern,granular şi piramidal).</span></span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<br />
</div>
<div lang="ro-RO" style="margin-bottom: 0in;">
</div>
<div lang="ro-RO" style="margin-bottom: 0in;">
</div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><i>Izocortexul
(neocortex) poate fi:</i></span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">-homotipic:
cea mai intinsa reprezentare,are 6 straturi de grosimi diferite,are
rol asociativ ;este implicat in functiile psihice.</span></span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">-heterotipic:
unele straturi sunt slab reprezentate sau lipsesc; are functii
elementare.</span></span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">Este
de doua tipuri: </span></span></span></span>
</div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">a)agranular
– in acest caz stratul granular este f.slab reprezentat iar in aria
motorie primara nu exista strat granular ; stratul piramidal este f.
dezvoltat. In aria motorie primara stratul V contine celulele
gigntice Betz iar in rest cortexul agranular contine celule de
talie mijlocie piramiddale.</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">b)
granular – cu cu straturi granulare mai dezvoltate si putine celule
piramidale .Acest tip de cortex este specific ariilor senzitive
primare 3,1,2, ariei vizuale 17,auditive 41,42.</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<br />
</div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><u>Lobul
frontal.</u></span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">La
nivelul lobului frontal se localizeaza urmtoarele arii Brodmann:</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">-aria
4 compusa din izocortex hezerotipic agranular corespunzator Fa.la
acest nivel există o proiectie somtotopica a segmentelor corpului în
funcţie de complexitatea mişcărilor executate (astfel mâna şi
faţa au cea mai mare reprezentare).</span></span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Leziunile
distructive ale ariei 4 determina paralizie.</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Leziunile
iritative produc crize motorii focale(in cazul în care criza
evolueaza din aproape în aproape pe schema somatotopica poarta
numele de criza jacksoniană motorie).</span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">-aria
6 ,izocortex heterotipic agranular,nu conţine celule piramidale
gigante. Leziunile unilaterale distructive produc reflex de apucare
forţata controlateral si trecere dificila de la o mişcare la alta.
Leziunile iritative produc rotaţia capului(criza adversiva) ,rotaţia
corpului,mişcări masticatorii şi de supt.</span></span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">-aria
8 ,izocortex heterotipic agranular este aria oculogiră. Leziunile
distructive duc la deviatia laterala a globilor oculari spre partea
leziunii iar în cele iritative ochii deviaza controlateral.</span></span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">-aria
9,10,11,12,13 constituie cortexul prefrontal ,izocortex homotipic.Are
rol asociativ, în gâdirea sintetica,anticipativă.Sindromul
prefrontal are două forme clinice: a) apatie, lipsa de
iniţiativă,indiferenţă .b) euforie,dezihibiţie,calambururi,
glume puerile</span></span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">-aria
44 din emisferul dominant situata la baza Fa anterior,este aria
exprimării verbale. Lezarea ei duce la afazie motorie Broca.</span></span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">-pe
faţa orbitara a l.frontal se află centri vegetativi cu rol in
funcţiile cardio-respieratorii. </span></span></span></span>
</div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<br />
</div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><u>Lobul
parietal.</u></span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">-aria
3,1 în Pa(parietala ascendentă) structural izocortex heterotipic
granular , aria unde se proiectează fibrele senzitive plecate de la
talamus, este aria senzitiva primară.distrugerea ei duce la
hemihipoestezie controleterală pentru toate modurile de
sensibilitate. Excitaţia ei duce la crize jacksoniene senzitive.</span></span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">-aria
2 (izocortex heterotipic granular) are rol sintetic in topognozie
,stereognozie,hilognozie,morfognozie.</span></span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">-aria
39-leziunea in emisferul dominant se manifesta prin sindrom Gerstman
- agrafie,alexie,acalculie,dzorientare dreapta/stanga,agnozie
digitala,tulburari apraxice. </span></span></span></span>
</div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">-ariie
39 si 40 din emisferul nedominant cu rol in somatognozie,determina in
leziuni distructive</span></span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;"> </span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">*
hemiasomatognozie cu neglijare sau negarea hemicorpului opus</span></span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">*agnozia
deficitului</span></span></span></span></div>
<div style="margin-bottom: 0in;">
<span style="color: black;">
</span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">*anozodiaforie
– indiferenta fata de boala.</span></span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Sindromul
Anton –Babinschi = asomatognozie+anozognozie+anozodiaforie.</span></span></span></div>
<div lang="ro-RO" style="margin-bottom: 0in;">
<br />
</div>
Charlieeehttp://www.blogger.com/profile/09400801131611961874noreply@blogger.comtag:blogger.com,1999:blog-4682638310010168675.post-19285021741864905102012-11-22T19:00:00.002-08:002012-11-22T19:00:56.403-08:00Sindroame parkinsoniene
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<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Sunt
secundare unor cauze decelabile sau au etiologii necunoscute.</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">1.parkinsonismul
infectios-apare post encefalic in infectii virale,fungice la
intervale mari (15 ani)</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-se
asociaza uneori cu :crize neurologice,tulburari vegetative,semne
piramidale, ticuri, spasme, bleforos ,diskinezii</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">2.parkinsonismul
hipoxic-datorat sensibilitatii la hipoxie a ggl bazali</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">3.hidrocefalia</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">4.parkinsonismul
indus medicamentos-diltiazem,neuroleptice,antiemetice,reserpina</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-tratament-intreruperea
tratamentului.Anticolinergice+diazepam</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">5.tumori</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">6.traumatic-mici
hemoragii in ggl bazali la boxeri.</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">7.vascular-pacienti
cu factori de risc vascular</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-microinfarcte
in ggl bazali</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-semne
piramidale</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-parkinsonism
„lower body” cu tulburari de mers</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-nu
raspunde la L-dopa</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">8.toxic-CO,etanol,metanol</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">9.sindroame
parkinsonism plus</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-paralizia
progresiva supranucleara generalizata</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-atrofia
multisistem SHY-DRAGER</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<br />
</div>
<div align="CENTER" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><i><u><b>Sindromul
neostriat</b></u></i></span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-se
caracterizeaza prin hipotonie si miscari involuntare</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">1.Coreea
acuta Sydenham sau dansul sf Vitus</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<br />
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Etiologie:afectarea
neostriatului prin mecanism imunoalergic dupa infectia cu streptococ
beta hemolitic</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-se
produc anticorpi care reactioneaza incrucisat cu antigene
citoplasmatice din nc caudat si nc subtalamic</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-poate
coexista cu endocardita,miocardita,artrita</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-debut
cu modificari psihice de la iritabilitate la confuzie (interesare
corticala encefalitica)</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-coree,grimase,mers
dansant,scaparea obiectelor din mana ,hipotonie</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<br />
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Diagnostic</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-tablou
clinic</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-tablou
inflamator</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-ASLO,exudat
faringian</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<br />
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Tratament</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-sterilizarea
focarului streptococic (antibiotice)</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-salicilati,corticoterapie</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-neuroleptice-ptr
blocarea excesului de dopamina-Haloperidol</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-amigdalectomie</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">2.Coreea
cronica Huntington</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-boala
ereditara cu transmitere autosomal dominanta cu un tablou clinic
constand in miscari involuntare si dementa (leziunea nc caudat si
putamen)</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-gena
respinsabila a fost loclaizata pe bratul scurt al cromozomului 4</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<br />
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Morfopatologic
</span></span></span>
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-atrofie
corticala difuza</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-atrofie
caudo-putaminala</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-reducerea
nivelului GABA in striat si substanta neagra</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-reducerea
nr de receptori de acetil colina si dopamina in striat</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-reducerea
receptorilor de NMDA in cortex-striat</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<br />
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Tablou
clinic</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">a)sindromul
corei-debut la 30-40 de ani (fenomenul de anticipatie in generatii
succesive scade varsta de debut)</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-miscari
coreice</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-mers
dansant</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-initial
hipotonie apoi hipertonie plastica</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-atitudini
distonice</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-sdr
piramidal</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-in
evolutie miscarile scad facand loc bradikineziei si rigiditatii</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">b)sdr
mental-tulburari psihice:comportamentale,psihoza cu halucinatii</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-tulburari
intelectuale-tulburari de vorbire,de memorie,tulburari vizuale
spatiale,incapacitatea de planifica actiuni ,de a rezolva probleme</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-alte
manifestari –epilepsie</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-final-casexie</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<br />
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Forme
clinice</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-forma
juvenila sub 20 de ani cu bradikinezie,rigiditate,degradare mentala
severa</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-forma
tardiva-60-70 ani=predomina sdr coreic cu degradare mentala usoara</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-forme
asociate cu amiotrofie spinala</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<br />
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Paraclinic</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-LCR
normal</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-EEG
necaracteristic</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-IRM
atrofie corticala si a capului nc caudat</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">PET
hipometabolism in striat si putamen</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<br />
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Tratament
simptomatic</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-antidepresive,antipsihotice</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-depletori
presinaptici de dopa (Haloperidol)</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Sfatul
genetic</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<br />
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Diagnostic
diferential</span></span></span></div>
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-sdr
coreice vasculare
,hipoxice,tumorale,iatrogene,DHL,Parkinson,Alzheimer</span></span></span></div>
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</div>
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</div>
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</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Calibri, sans-serif;"><span style="font-size: x-small;"><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO"><b>S</b></span></span></span></span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO"><i><u><b>indroame
panstriate</b></u></i></span></span></span></span></span></span></span></div>
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-clinic
se asociaza cu simptome de neostriat si paleostriat (sdr
parkinsonian, hipotonie, ticuri, coree atetoza,distonii )</span></span></span></div>
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</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><b>Degenerescenta
hepato-lenticulara</b></span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-este
o tezaurismoza constand in stocarea cuprului in ficat si in ggl
bazali</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-gena
incriminata este situata pe bratul lung al cromozomului 13</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-cauza
–absenta sintezei ceruloplasminei,tracus portal cuprului</span></span></span></div>
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<br />
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Tablou
clinic</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-hepatic-excesul
de cupru intracelular produce citoliza si ciroza postnecrotica</span></span></span></div>
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-neurologic-tablou
psihic de la tulburari de comportament la dementa</span></span></span></div>
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-tremor
de repaus,postural</span></span></span></div>
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-ipertonie,bradikinezie,dizartrie,disfagie,paratonie,tulburari
de coordonare</span></span></span></div>
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-la
tanar predomina sdr paleostriat,la adult panstriat</span></span></span></div>
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</div>
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Paraclinic</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-ceruloplasmina
scazuta</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-depuneri
de cupru in cornee</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-IRM,CT-atrofie
corticala,cerebeloasa,hidrocefalie</span></span></span></div>
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Tratament</span></span></span></div>
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-dieta
cu alimente cu continut scazut in cupru-nu este necesara</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-chelatori
de cupru-penicil amina 1-2 g/zi+piridoxina-toata viata</span></span></span></div>
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-efecte
secundare-eruptii cutanate,tulburari
gastrointestinale,miopatie,neuropatie,nefropatie.</span></span></span></div>
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</div>
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</div>
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Distoniile</span></span></span></div>
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-sunt
tulburari de miscare care consta in contractii ale grupurilor
musculare sustinute ce imprima pozitii anormale</span></span></span></div>
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-patogenia
este neurodinamica (nu s-au gasit modificari morfologice cerebrale)</span></span></span></div>
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-torticolisul</span></span></span></div>
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-distonia
de torsiune</span></span></span></div>
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-tratament-toxina
botulinica;unele distonii multifocale raspund la L-dopa</span></span></span></div>
Charlieeehttp://www.blogger.com/profile/09400801131611961874noreply@blogger.comtag:blogger.com,1999:blog-4682638310010168675.post-57323325229673022942012-11-22T18:57:00.003-08:002012-11-22T18:58:42.537-08:00BOALA PARKINSON PRIMARA - Tratamentul
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><u>Tratamentul
medicamentos</u></span></span></span></div>
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">1.Primul
medicament testat in anii 50 a fost Atropina si moleculele inrudite
cu rol anticolinergic.Nu a putut fi folosit in practica deoarece nu
trecea bariera hemato-encefalica eficient,iar dozele mari produceau
efecte secundare.</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Trihexifenidilul
a fost primul compus sintetic cu proprietati anticolinergice.</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-amelioreaza
rigidiatea,hipokinezia,tremorul.</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-contraindicatie
pacientilor cu tulburare cognitiva</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-doza
1 tb de 2mg x 3 /zi</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-produse:Romparkin,Artan</span></span></span></div>
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</div>
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</div>
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">2.Amantadina-blocant
al receptorilor glutamatergici de tip NMDA</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-amelioreaza
rigiditatea,hipokinezia</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-in
prezent se asociaza in caz de diskinezii secundare tratamentului cu
L-Dopa</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-efecte
adverse-in doze mari:confuzii,insomnie,convulsii</span></span></span></div>
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-doza
:100mg x3/zi</span></span></span></div>
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</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">3.Tratamentul
dopaminergic-se face cu :L-Dopa,agonisti dopaminergici</span></span></span></div>
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">L-Dopa
este precursorul levogir al dopaminei,traverseaza bariera
hemato-encefalica,este convertita in dopamina de catre aminoacid
decarboxilaza la nivelul neuronilor dopaminergici.</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-amelioreaza
rigiditatea,bradikinezia,tremorul,tulburari de mers,miscarile fine</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-doza:300-1000
mg/zi</span></span></span></div>
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-Simptomele
date de leziunile din afara sistemului strio-nigric care produc
hipotensiune ortostatica,tulburari digestive,alterarea reflexelor
posturale,tulburari cognitive,blocajul motor nu raspund la L-Dopa.</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-efecte
adverse: datorate utilizarii in periferie de neuroni a L-Dopei
sunt:greata, varsaturi, tulburari de ritm, constipatie ,hipotensiune.</span></span></span></div>
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-pentru
combaterea acestor efecte se folosesc in asociere cu L-Dopa
inhibitori periferici de decarboxilaza :benserazida,carbidopa</span></span></span></div>
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Madopar-200
mg L-dopa +50 mg benserazida</span></span></span></div>
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Nakom,Zimox-200mg
L-Dopa +25 mg carbidopa</span></span></span></div>
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<li><div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><i><u>Complicatiile
tardive ale tratamentului cu L-Dopa</u></i></span></span></span></div>
</li>
</ul>
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-dupa
o perioada de o luna pana la cativa ani de raspuns bun si constant la
3 doze zilnice pot sa apara complicatii ale tratamentului.La 5
ani,jumatate din pacienti au aceste complicatii.</span></span></span></div>
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">1.Fluctuatii
motorii-alternanta perioadelor de bine (ON) cu perioade de reaparitia
simptomelor (OFF)</span></span></span></div>
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Tipuri
de fluctuatii:</span></span></span></div>
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">WEARING-OFF-epuizarea
efectului medicatiei inainte de urmatoarea doza.Se explica prin
scaderea duratei de actiune a L-Dopei probabil prin reducerea
numarului de neuroni dopaminergici.Exista wearing-off
nonmotor-dureri,crampe</span></span></span></div>
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Fenomenul
ON-OFF –instalare brusca a simptomelor la un pacient in ON</span></span></span></div>
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Fenomenul
DELAYED-ON raspunsul terapeutic la L-Dopa apare mai tarziu sau deloc.
(de ex.in cazul administrarii cu mancarea care impiedica absorbtia
L-Dopa)</span></span></span></div>
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">2.Dischineziile-miscari
involuntare complexe coreice sau distonii (contractii prelungite ale
unor segmente)</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-diskineziile
„de varf de doza” apar in perioada de „ON”-se datoreaza
excesului tranzitor de dopamina in striat (globul palid intern este
excesiv inhibat in talamusul excesiv activat).</span></span></span></div>
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-diskinezii
bifazice la inceputul si sfarsitul perioadei de ON</span></span></span></div>
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-distonia
matinala</span></span></span></div>
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Diskineziile
se explica prin modificarea pragurilor de raspuns ale globului palid
intern si modificarilor ireversibile al ggl bazali prin
neuroplasticitate aberanta .O data aparute nu mai dispar.Un rol il
joaca si timpul scurt de injumatatire a L-Dopei,ceea ce duce la o
stimulare dopaminergica pulsatila.</span></span></span></div>
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-Amatadina
se foleseste in tratamentul diskineziilor</span></span></span></div>
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<br />
</div>
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</div>
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</div>
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><i><u>Agonistii
dopaminergici</u></i></span></span></span></div>
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-stimuleaza
direct receptorii din striat,fara a fi nevoie de metabolizare in
neuroni</span></span></span></div>
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">a)agonisti
dopaminergici ergolinici</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-bromocriptina
</span></span></span>
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-pergolidul</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-cabergolina</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">b)agonisti
dopaminergici nonergolinici</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-pramipexol
0,7 mg</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-ropinirol
1,25 mg</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-piribedil
50mg</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<br />
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Calibri, sans-serif;"><span style="font-size: x-small;"><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO"><i><b>Pramipexolul
si ropinirolul </b></i></span></span></span></span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">sunt
eficiente in monoterapie la debutul bolii.</span></span></span></span></span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-scad
riscul complicatiilor motorii</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-sunt
eficace 2-3 ani apoi necesita asocierea cu L-Dopa</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-efecte
adverse-greata,hipotensiune,adormire,sincopa,halucinatii</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Apomorfina
este agonist dopaminergic nonergolinic –se administreaza injectabil
subcutan in starea severa de OFF care nu raspunde la ajustarea
medicatiei.</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Tratamentul
se incepe cu agonisti sub 65 de ani si cu L-dopa dupa 65 de
ani.Decizia de tratament cu L-Dopa trebuie adaptata individual.</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<br />
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><i><u>Inhibitori
de O-metiltrasnferaza</u></i></span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-reduc
metabolizarea L-dopei si dopaminei in periferie si central Tolcapone.</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-Tolcapone-100,200mg/cp</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-Entacapone-200mg/cp</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-se
administreaza la fiecare doza de L-dopa pana la 1600 mg ptr.
entacapone.</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-exista
asociere de L-Dopa +carbidopa+entacapone (Stalevo)</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<br />
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><i><u>Inhibitori
de MAO-B</u></i></span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-selegilina
5 mg/cp-are si efect neuroprotector,monoterapie ptr scurt timp apoi
in asociere cu L-dopa permite a nu se creste doza de L-dopa.</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-rasagilina-1mg
monoterapie la debut apoi in asociere cu L-dopa.Are efecte
antiapoptotice</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<br />
</div>
<div align="JUSTIFY" lang="ro-RO" style="font-weight: normal; margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><u>Tratamentul
tulburarilor psihice</u></span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-neurolepticele
clasice agraveaza simptomele bolii</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-se
folosesc neurolepticele atipice:Clozapina 25-100mg/cp,Quetiapina
(Seroquel) 25-100-250mg/cp</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-se
monitorizeaza hemoleucograma</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<br />
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><u>Tratamentul
tulburarilor cognitive</u></span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-Rivastigmina
1,5-6 mg/cp</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-hipotensiunea
–Fluorocortizon (Astonin 0,1 mg/zi)</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<br />
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><b>Metode
chirurgicale</b></span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-palidotomia
stereotoxica-au efecte trecatoare si efecte secundare deranjante</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-stimularea
cerebrala profunda-stimularea cu frecventa de 130 Hz a structurilor
cerebrale produce depolarizarea permanenta si inactivarea
structurilor stimulat.Tinta:nc subtalamic al lui Luys cu ameliorarea
rigiditatii ,bradikineziei si tremorului.</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-sub
70 de ani</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-pacient
L-dopa responsiv</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-fara
tulburari psihice</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-fara
semne nondopaminergice importante (hipotensiune ortostatica)</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<br />
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Transplantul
de celule stem poate fi o reusita pentru viitor.</span></span></span></div>
Charlieeehttp://www.blogger.com/profile/09400801131611961874noreply@blogger.comtag:blogger.com,1999:blog-4682638310010168675.post-30833446359380911502012-11-22T18:55:00.000-08:002012-11-22T18:55:26.749-08:00Criterii de confirmare a b.Parkinson.
<style type="text/css">
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<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<br />
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Bradikinezie
si cel putin unul din urmatoarele:</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-rigiditate</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-tremor
4-6Hz</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-instabilitate
posturala(nedatorata difunctiei vestibulare,proprioceptive,vizuale
,cerebeloase)</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<br />
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><i><b>Criterii
de sustinere</b></i></span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<br />
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-debut
unilateral</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-tremor
de repaus</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-evolutie
progresiva</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-asimetrie
persistenta </span></span></span>
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-raspuns
la L-dopa</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-coree
indusa de L-dopa</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-resposivitate
la L-dopa de cel putin 5 ani</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-evolutie
clinica de 10 si peste 10 ani.</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<br />
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><i><b>Criterii
de excludere</b></i></span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<br />
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-AVCrepetate
cu sindrom parkinsonian progresiv</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-istoric
TCC repetate</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-istoric
encefalita</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-crize
oculogire</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-tratament
neuroleptic </span></span></span>
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-remisie
sustinuta</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-simptome
strict unilaterale 3 ani</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-paralizie
supranucleara a privirii</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-semne
cerebeloase</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-afectare
vegetativa precoce</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-dementa
severa precoce</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-rezistenta
la L-dopa</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-expunere
la MPTP.</span></span></span></div>
Charlieeehttp://www.blogger.com/profile/09400801131611961874noreply@blogger.comtag:blogger.com,1999:blog-4682638310010168675.post-48967194746944855262012-11-22T18:50:00.002-08:002012-11-22T18:51:21.094-08:00BOALA PARKINSON PRIMARA - II.Manifestari nonmotorii <style type="text/css">
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Pot
preceda tulburarile motorii cu ani.</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">A-tulburari
de somn-</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">1)se
manifesta in stadiul REM prin hipertonie ,miscari violente,strigate</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">2)
prin agravarea rigiditatii datorita epuizarii efectelor
medicatiei,crampe ce duc la trezire</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">3)dificultate
la adormire sau adormiri bruste si somnolenta diurna</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">4)sindromul
picioarelor nelinistite la culcarea in pat.</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">B)sdr
vegetativ-hipotensiune ortostatica,constipatie,tulburari de
mictiune,seboree,edeme gambiere,tulburari de dinamica sexuala</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">C)tulburari
cognitive si psihiatrice</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-40-70%
dezvolta tulburari cognitive cu sindrom disexecutiv (tulburari de
concentrare,atentie,tulburari de a elabora un plan ,de a rezolva
probleme )</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-dementa
apare la cel putin 2 ani de la debut (debutul precoce implica
diagnosticul diferential cu dementa cu corpi Lewy ).dementa se
explica prin deficit colinergic si contraindica tratamentul
colinergic</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-depresia
se explica prin deficitul de dopamina.</span></span></span></div>
Charlieeehttp://www.blogger.com/profile/09400801131611961874noreply@blogger.comtag:blogger.com,1999:blog-4682638310010168675.post-4848689130060539402012-11-22T18:49:00.000-08:002012-11-22T18:51:53.102-08:00BOALA PARKINSON PRIMARA - I.Sdr parkinsonian motor.<style type="text/css">
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">1)Hipertonia
parkinsoniana denumita rigiditate,este plastica,adica constanta.Pe
parcursul miscarii se poate constata fenomenul de roata dintata si
semnul Noica.Rigiditatea este egal distribuita cu o usoara
predominata pe flexori si pe musculatura axiala (consecinta: postura
cu atitudine in flexie si aplecarea trunchiului in fata.).</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">2)Hipokinezia
– dificultate in initierea miscrii cu scaderea spontaneitatii
miscarii,saracia comportamentului motor pana la akinezie,situatie in
care pentru un timp bolnavul nu poate initia nicio miscare pe o
perioada de timp.</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Expresii
ale hipokineziei:</span></span></span></div>
<ul>
<li><div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">facies
fijat</span></span></span></div>
</li>
<li><div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">reducerea
clipitului</span></span></span></div>
</li>
<li><div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">intredeschiderea
permanenta a gurii</span></span></span></div>
</li>
<li><div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">hipofonie</span></span></span></div>
</li>
<li><div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">disfagie</span></span></span></div>
</li>
<li><div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">tulburari
ale miscarilor fine (scris micrografic)</span></span></span></div>
</li>
<li><div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">imposibilitatea
de a efectua doua actiuni simultane (salut in timpul mersului)</span></span></span></div>
</li>
</ul>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">3)Bradikinezia
se refera la lentoarea miscarilor si insoteste hipokinezia</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">4)Tremorul
4-6Hz, este predominent in repaus si dispare in actiune si in
somn.Este asimetric-unilateral la debut , f rar la extremitatea
cefalica.Numai ½ din bolnavi au tremor la debut ,1/4 il dezvolta
in evolutie.Aspect de „numaratul banilor”.</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Tremorul
parkinsonian trebuie diferentiat de tremorul
esential,familial,benign,postural si intentional,frecvent la nivelul
capului,ameliorabil la doze mici de alcool si propranolol.</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">5)Instabilitatea
posturala se caracterizeaza prin caderi frecvente
,propulsii,retropulsii.Se datoreaza leziunilor trunchiului cerebral
datorita carora se altereaza reflexele statiunii bipede. Pacientul
initiaza greu primul pas dupa care alearga cu pasi tot mai repezi
(festinatia mersului). Postura caracteristica este cu usoara
anteflexie a trunchiului,dand impresia in timpul mersului de ,,fuga
dupa centrul de greutate,,.</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">6)Tulburarea
de mers –datorita rigiditatii hipokineziei,tulburarilor posturale
,disparitia balansului membrelor superioare,freezingul sau blocajul
motor la trecerea prin spatii stramte.</span></span></span></div>
Charlieeehttp://www.blogger.com/profile/09400801131611961874noreply@blogger.comtag:blogger.com,1999:blog-4682638310010168675.post-55548415935189890802012-11-22T18:48:00.000-08:002012-11-22T18:48:19.880-08:00BOALA PARKINSON PRIMARA. (sdr. paleostriat sau nigrostriat)
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Descrisa
in 1817 de James Parkinson ca paralizia agitata.</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<br />
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="color: black;"> <span style="font-family: Calibri, sans-serif;"><span style="font-size: x-small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">Etiologie
incomplet cunoscuta,pare multifactoriala.</span></span></span></span></span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-genetica-mai
ales in formele cu debut precoce si juvenile:</span></span></span></div>
<ul>
<li><div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">mutatii
ale genei „parkina”,proteina abudenta in substanta neagra-defect
transmis autozomal recesiv</span></span></span></div>
</li>
<li><div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">mutatii
ale genei ce codifica alfa sinucleina ,o proteina ce se presupune ca
are un rol in neuroplasticitatea sinaptica si in modulare
transmisiei dopaminergice.se gaseste in terminatiile presinaptice.</span></span></span></div>
</li>
</ul>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-toxica
exogena-folosirea pesticidului paraquat intr-o anumita zona a
determinat cazuri recvente de b. Parkinson.</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-toxici
endogeni-prin formarea radicalilor liberi in metabolismul
monoaminelor.</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; margin-left: 0.5in; orphans: 2; widows: 2;">
<br />
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="color: black;"> </span><span style="color: black;">
<span style="font-family: Calibri, sans-serif;"><span style="font-size: x-small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO"><b>Etiopatogenie.</b></span></span></span></span></span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<br />
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">In
cadrul imbatranirii numarul de neuroni dopaminergici din substanta
neagra scade.</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">In
b.Parkinson rata pierderii este mai mare decat pierderea fiziologica.</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Boala
,datorata denervarii striate dopaminergice,devine manifesta cand in
substanta neagra sunt functionali 20% din neuroni,iar cantitatea de
dopamina din striat a scazut la jumatate, consecinta unui proces
degenerativ neuronal difuz. </span></span></span>
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Leziunile
neuropatologice caracteristice sunt incluziile eozinofile
intracitoplasmatice numite corpi Lewy.</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Corpii
Lewy sunt agregate de proteine nefunctionale care nu pot fi epurate
de neuron.Dintre proteinele componente,alfa sinucleina si ubiquitina
se gasesc in cantitatea cea mai mare. </span></span></span>
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Un
alt mecanism ce duce la pierderea neuronilor dopaminergici este cel
de apoptoza declansat de un posibil factor toxic care intervine in
verigile metabolice celulare . </span></span></span>
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<br />
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><b>Clasificare
neuropatologica in functie de extinderea leziunilor la nivel
cerebral(Braak):</b></span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<br />
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Stadiul
1-afecteaza nucleul dorsal al vagului,bulbii olfactivi</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Stadiul
2- afecteaza nucleul rafeului,locus cerulens</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Stadiul
3- afecteaza substanta neagra,complex amigdalian</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Stadiul
4-gg bazali</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Stadiul
5-6 cortexul ccerebral</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<br />
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Leziunile
progreseaza de jos in sus, de la nivelul trunchiului cerebral la
cortex.</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<br />
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><b>Manifestari
clinice</b></span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<br />
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-debut
insidios prin tremor izolat unilateral,dificultate in initierea
miscarilor,tulburari de mers,voce monotona,tulburari de somn,depresie
,durere cervicala,senzatie de slabiciune.</span></span></span></div>
Charlieeehttp://www.blogger.com/profile/09400801131611961874noreply@blogger.comtag:blogger.com,1999:blog-4682638310010168675.post-23191007310524770552012-11-22T18:45:00.000-08:002012-11-22T18:45:19.534-08:00TULBURARI ALE MISCARII
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<span style="color: black;"><span style="font-family: Calibri, sans-serif;"><span style="font-size: x-small;"><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="it-IT">Activitatea
motorie este controlata de:</span></span></span></span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">circuitele
ganglionilor bazali si cerebel.</span></span></span></span></span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Circuitele
ggl. bazali avtiveaza sau inhiba programe motorii automate necesare
actelor motorii voluntare invatate si posturii.</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Cerebelul
controleaza echilibrul,coordonarea ,tonusul,invatarea actelor motorii
noi.</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<br />
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="color: black;"><u> </u></span><span style="font-family: Calibri, sans-serif;"><span style="font-size: x-small;"><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO"><i><u><b>Etajele
circuitelor de control ale ggl. bazali:</b></u></i></span></span></span></span></span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; margin-left: 0.3in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><b>I.Etajul
cortical </b></span></span></span>
</div>
<ul>
<li><div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Campul
4 S</span></span></span></div>
</li>
<li><div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Campul
6 b Brodman</span></span></span></div>
</li>
<li><div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Campul
8</span></span></span></div>
</li>
<li><div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Ariile
somatosenzitive 3,1,2 parietale</span></span></span></div>
</li>
<li><div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Aria
19 occipitala</span></span></span></div>
</li>
</ul>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; margin-left: 0.3in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><b>II.Etajul
diencefalic </b></span></span></span>
</div>
<ul>
<li><div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Ganglionii
bazali sau corpii striati –(sunt strabatuti de fibre nervoase)</span></span></span></div>
</li>
</ul>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; margin-left: 0.79in; orphans: 2; widows: 2;">
<br />
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">1)Nucleul
caudat –filogenetic neostriat- contine mediatori chimici:
acetilcolina, dopamina, noradrenalina,serotonina,acid
gamaaminobutiric (GABA)</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">2)
Nucleul lenticular- are aspect de piramida cu baza spre exterior si
varful indreptat infero-intern,spre genunchiul capsulei interne;prin
el trec fibrele piramidale si toate proiectiile talamocorticale,de la
nivelul trunchiului si maduvei spinarii.</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"> </span>
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="color: black;"> </span><span style="font-family: Calibri, sans-serif;"><span style="font-size: x-small;"><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO"><u>Nucleul
lenticular este compus din:</u></span></span></span></span></span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">a)putamen
spre exterior cu o structura asemanatoare caudatului (fibrogenetic
neostriat)</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">b)globul
palid –fibrogenetic paleostriat la fel ca substanta neagra
mezencefalica.Are o parte mediala si o parte externa.</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">3)Nucleul
subtalamic sau corpul lui Luys are legaturi in sens dublu cu globul
palid</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">4)Nucleii
extrapiramidali ai talamusului,ventral anterior si lateral</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<br />
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="color: black;"> </span><span style="font-family: Calibri, sans-serif;"><span style="font-size: x-small;"><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO"><b>III.Etajul
mezencefalic</b></span></span></span></span></span></span></span></div>
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<span style="color: black;"><span style="color: black;"> </span><span style="font-family: Calibri, sans-serif;"><span style="font-size: x-small;"><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">Substanta
neagra sau locus niger (fibrogenetic paleostriat) este localizata
intre calota si piciorul mezencefalului,din capatul rostral al puntii
pana in zona subtalamica.Are in continut melanina,iar partea compacta
care proiecteaza pe neostriat sintetizeaza dopamina.Partea reticulata
este in directa continuitate cu globul palid (paleostriat)..</span></span></span></span></span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="color: black;"> </span><span style="font-family: Calibri, sans-serif;"><span style="font-size: x-small;"><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">Aria
tegmentala ventrala mezencefalica medial fata de substanta neagra
contine celule dopaminergice ,proiecteaza pe nucleul acumbens (legat
de motivatie si placere),tuberculul olfactiv,nucleul
amigdalian,cortexul orbitofrontal,frontal medial-alcatuind sistemul
dopaminergic mezolimbic.</span></span></span></span></span></span></span></div>
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</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
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<br />
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="color: black;"> </span><span style="font-family: Calibri, sans-serif;"><span style="font-size: x-small;"><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO"><u>Conexiunile
ggl bazali</u></span></span></span></span></span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">1-circuitele
inchise –leaga scoarta cerebrala de nucleii striati prin circuitul
cortico-striocortical.Are rol in pornirea si oprirea miscarii.</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="color: black;">
</span><span style="font-family: Calibri, sans-serif;"><span style="font-size: x-small;"><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">-leaga
nucleii striati intre ei: strio-nigro-striat-functioneaza numai pe
parcursul miscarii folosind dopamina ptr calea nigro-striata si
acetilcolina ptr calea strio-nigerica.Dopamina accelereaza miscarile
si scade tonusul (accentuata in sistemul strionigric).Acetilcolina
scade viteza si creste tonusul (concentrata in nc. caudat si putamen)</span></span></span></span></span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">2-circuitele
deschise leaga globul palid de cornul anterior prin doua cai:</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="color: black;"> </span><span style="font-family: Calibri, sans-serif;"><span style="font-size: x-small;"><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">-calea
alfa sau palido talamo-cortico-spinala-trimite stimuli intariti in
talamus pe neuronii alfa tonici si alfa fazici prin intermediul
fasciculului piramidal</span></span></span></span></span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="color: black;"> </span><span style="font-family: Calibri, sans-serif;"><span style="font-size: x-small;"><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">-calea
gamma pleaca de la ggl palid ajunge la neuronii gamma tonici si gamma
fazici din maduva spinarii.Acestia sunt in legatura cu receptorii
fusului muscular.</span></span></span></span></span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">Mediatorii
chimici ai circuitelor ggl bazali -
dopamina,acetilcolina,GABA,serotonina.</span></span></span></div>
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<span style="color: black;"><span style="color: black;"> </span><span style="color: black;">
<span style="font-family: Calibri, sans-serif;"><span style="font-size: x-small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO"><i>Clinic
miscarea poate fi afectata prin </i></span></span></span></span></span></span></span>
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-tulburari
de tonus- hipertonie (globul palid+subst neagra-paleostriat)</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-miscari
involuntare-caudat.</span></span></span></div>
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<br />
</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="color: black;"> </span><span style="font-family: Calibri, sans-serif;"><span style="font-size: x-small;"><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO"><i>Clasificare
topografica a principalelor entitati :</i></span></span></span></span></span></span></span></div>
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">1-sdr.
paleostriat - boala Parkinsons si alte sdr. Parkinsoniene</span></span></span></div>
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">2-sdr.
neostriat - coreea acuta,coreea cronica,sdr coreice</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">3-sdr.
panstriat - distoniile,DHL</span></span></span></div>
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</div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Calibri, sans-serif;"><span style="font-size: x-small;"><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO"><b>Sindromul
parkinsonian</b></span></span></span></span><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><span lang="ro-RO">
caracterizat prin bradikinezie,hipertonie,tremor,tulburari posturale
este caracteristic unui grupde boli din care face parte :</span></span></span></span></span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-b.
Parkinson primara</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-sindroame
Parkinson plus:paralizia supranucleara progresiva,atrofia
multisistemica,sindromu Shy-Drager,degenerescenta
strio-nigrica,atrofia olivo-ponto-cerebeloasa,b.difuza cu corpi
Lewy,degenerescenta cortico-bazala.</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-parkinsonismul
din alte b.degenerative:Alzheimer,Huntington,B.de Guam.</span></span></span></div>
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-parkinsonismulsecundartoxicdupa:</span></span></span></div>
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<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-
mangan,MPTP,neuroleptic,reserpina,valproat,metoclopramid,blocanti ai
canalelor de calciu.</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-vascular:lacune,
b.Biswanger</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-hidrocefalie</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-TC</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-DHL</span></span></span></div>
<div align="JUSTIFY" lang="ro-RO" style="margin-bottom: 0in; orphans: 2; widows: 2;">
<span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: small;">-b.infectioase:encefalita,HIV,b.prionice.</span></span></span></div>
Charlieeehttp://www.blogger.com/profile/09400801131611961874noreply@blogger.com