Ðe wò ŋutilã ƒe akpa ɖeka le ʋuʋum eye akpa kemɛa le lãmetutudɔa? Ðe wòate ŋu anye Brown-Séquard Dɔlélea?

Èse nɔnɔme wɔnuku aɖe si me màte ŋu aʋuʋu wò ŋutilã ƒe akpa ɖeka o eye màse naneke le akpa kemɛ o ŋu kpɔa? Ate ŋu adzɔ le afɔku aɖe megbe. Edzi ŋɔ vie, gake egbea míele nu ƒom tso nɔnɔme aɖe si ate ŋu adzɔ le ɣeyiɣi nyuitɔ dzi, gake mebɔ boo o, si woyɔna be Brown-Séquard Syndrome . Mègatsi dzi o, mina míaƒo nu tso eŋu bɔbɔe.

Nukae nye Brown-Séquard Syndrome, si nye dɔléle sia si wotsɔ ŋkɔ wɔnuku aɖe na?

Kpuie ko la, Brown-Séquard ƒe dɔléle (BSS) nye ahɔhɔ̃mekawo ƒe dɔléle si mebɔ kura o. Edzɔna ne nu gblẽ le wò aklã ŋu , gake nu gblẽ le wò aklã ƒe akpa ɖeka ko ŋu. Bu eŋu abe wò aklã, si le abe ka si tsɔa gbedasiwo tso wò ahɔhɔ̃ me yia wò ŋutilã katã me eye emegbe wòtsɔa nyatakakawo tso wò ŋutilã me trɔna yia wò ahɔhɔ̃ me ene. Eyata ne ka sia ƒe akpa ɖeka pɛ koe gblẽ ko hafi kuxi sia doa mo ɖa.

Nusi dzɔnae nye be le aklã si gblẽ la ƒe akpa ma ke la, lãmeka siwo le anyi wu alesi wògblẽe la gbɔdzɔna alo vuvu . Esia fia be màte ŋu aʋuʋu akpa ma o. Gake nukutɔe la, vevesese kple dzoxɔxɔ ƒe seselelãme bu le akpa kemɛ , gake le nusi gblẽ la ƒe seƒe te. Eɖi nya sesẽ vie, alo? Mina míaɖe eme geɖe wu.

Wò aklã nye nusi le abe ʋuƒo ene si tso ahɔhɔ̃a ƒe ke dzi va ɖo wò akɔta ƒe gɔme ke. Enye nusi me kɔ ŋutɔ. Lãmetsiŋusẽ ƒe ka geɖee wotsɔ wɔe. Enye míaƒe lãmekawo ƒe akpa vevi aɖe.

Wobua Brown-Séquard ƒe dɔlélea be enye abi si mede blibo o (SCI) . Esia fia be seselelãme, lãmekawo ƒe dɔwɔwɔ, alo evea siaa bu vie le afisi abixɔa le te. Le SCI blibo me la, seselelãme alo ʋuʋu aɖeke menɔa abixɔƒea te o.

Dzɔdzɔmeŋutinunyala Charles-Edouard Brown-Sequard, amesi ƒo nu tso nɔnɔmea ŋu zi gbãtɔ le ƒe 1849 me la ƒe ŋkɔe wotsɔ nɛ.

Aleke esia to vovo tso Central Cord Syndrome gbɔe?

Ðewohĩ èse Central Cord Syndrome (CCS) hã ŋu nya kpɔ. Togbɔ be wo ame evea siaa nye abi siwo mede blibo o le aklã me hã la, wonye nɔnɔme vovovo eve.

CCS nye abi si mede blibo o le aklã ƒe titina, zi geɖe le kɔ me. Esia nana abɔwo gbɔdzɔna wu afɔwo.

Gake le BSS , me la, nusiwo gblẽ le aklã ƒe akpa ɖesiaɖe ŋu le akpa ɖeka nana be akpa si ŋu dɔlélea le la tsia lãmetutudɔ, evɔ akpa kemɛ ya megasea veve o. Èse vovototo si le wo dome gɔmea?

Amekawoe ate ŋu axɔ nɔnɔme sia? Aleke gbegbe wòbɔe?

Brown-Séquard ƒe dɔlélea ate ŋu adze ame sia ame dzi. Ke hã, enye nɔnɔme si mebɔ kura o.Esia ate ŋu adzɔ metsɔ le ŋutsu alo nyɔnu nyenye me o.

Le United States ɖeɖe dzaa la, wogblɔna be ame yeye siwo ade 12,000 ye xɔa abi le aklã me ƒe sia ƒe. Le esiawo dome la, BSS nye 2% va ɖo 4% ko. Esia fia be le Sri Lanka la, agbɔsɔsɔa ate ŋu aɖiɖi wu gɔ̃ hã.

Nukae nye Brown-Séquard ƒe dɔléle (BSS) ƒe dzesiwo?

Zi geɖe la, BSS ƒe dzesiwo dzea egɔme ne eƒe aklã ƒe akpa ɖeka gblẽ vɔ.

Dzesi gbãtɔ siwo dzenae nye:

• Ŋutete be woaʋuʋu abɔ kple afɔ si le abi la te (lãmekawo ƒe ʋuʋu ƒe bu) le aklã ƒe abi la ƒe akpa ma ke. Esia ate ŋu adze egɔme abe gbɔdzɔgbɔdzɔ ene eye wòayi ŋgɔ ava zu lãmetutudɔ.
• Le go bubu me la, vevesese kple dzoxɔxɔ ƒe seselelãme si mede abi si woxɔ la nu o.

Bu eŋu ale. Ne BSS le ame aɖe ŋu, si nye abi si woxɔ le aklã me le eƒe akɔta ƒe ɖusime la, mate ŋu aʋuʋu eƒe ɖusime o, si fia be tso eƒe akɔta titina ayi anyime – eƒe ɖusime akɔta, afɔ, kple afɔ. Ke hã, le miame, tso woƒe akɔta titina yi anyime la, vevesese maganɔ wo ŋu o eye dzoxɔxɔ/fafa anɔ wo ŋu, gake woate ŋu aʋuʋu woƒe miame. Ta, kɔ, abɔta, kple abɔwo awɔ dɔ nyuie, eye abi sia makpɔ ŋusẽ ɖe edzi o.

Tsɔ kpe ɖe eŋu la, BSS ate ŋu ahe dzesiwo abe:

• Aɖuɖɔtoe kple aɖuɖɔ dzi ɖuɖu ƒe ŋutetemanɔamesi (aɖuɖɔ kple aɖuɖɔ ƒe dɔmawɔmawɔ nyuie).
• Lãmetsiwo ƒe gbɔdzɔgbɔdzɔ kple gbegblẽ (lãmekawo ƒe tsɔtsɔ) le teƒe si dɔlélea le.

BSS ƒe dzesiwo ate ŋu anɔ bɔbɔe ŋutɔ na ame aɖewo, eye woate ŋu asẽ ŋutɔ na ame bubuwo. Gake ne wodae nyuie la, dzesi siawo nyona ɖe edzi vivivi .

Ðe esia vea amea?

Ne nusi gbɔ BSS tso nye nudzɔdzɔ dziŋɔ aɖe abe tudada alo ʋufɔku ene la, ekema afɔkua ahe vevesese vɛ godoo. Gake le dɔlélea ŋutɔ, si fia be nusiwo gblẽ le aklã ŋu ta la, ɖewohĩ vevesese aɖeke manɔ eme o.

Gake ame aɖewo siwo ŋu BSS le ate ŋu ase seselelãme siwo mesɔ o (dysesthesia) le aklã ƒe gbegblẽ ta, si ate ŋu anye dzobibi, ʋuʋudedi, alo ʋuʋudedi.

Nukawo koŋue hea Brown-Séquard ƒe dɔléle (BSS) vɛ?

Nusiwo gbɔ BSS tsona wue nye abi siwo woxɔna le aklã ŋu:

• Tudada.
• Akplɔdada.
• Ʋufɔkuwo.
• Nuveviwɔame si me kɔ o.
• Aklã ƒe gbagbã le afɔku abe anyidzedze ene me.

Ne afɔku sia tɔgbe dzɔ ɖe dziwò la, ele vevie ŋutɔ be nàyi kɔdzi si te ɖe ŋuwò kaba eye nàdi atikewɔla enumake.

Tsɔ kpe ɖe esia ŋu la, BSS ate ŋu adzɔ hã le nusiwo menye le vo me o ta, gake womebɔ vie o:

• Vidzidɔ ƒe ƒunukpeƒetetedɔ.
• Decompression sickness nye nɔnɔme si dzɔna ne wodo go nyaƒoɖeamenu si gbɔ eme le tsi te vɔ megbe.
• Disk si ƒu kplakplakpla le akɔta (herniated disc).
• Dɔlékuiwo abe taɖuame ene.
• Dɔléle si nye Multiple Sclerosis (MS) ƒe dɔléle.
• Kekeli ƒe keklẽ.
• Ʋuka aɖe si naa ʋuka si me ʋu sina tona le aklã me ƒe xexe (spinal ischemia).
• Aklã me dɔdzẽwo.
• Lãmetsiŋusẽ si woyɔna be transverse myelitis.
• Yɔmekpe ƒe dɔléle.

Aleke ɖɔktawo dea dzesi esiae? (Dɔléle ƒe dzesi) .

Ne wò ɖɔkta susu be BSS le ŋuwò la, awɔ nu siwo gbɔna:

• Ewɔa ŋutilãmedɔdada blibo .
• Wowɔa ahɔhɔ̃mekawo ƒe dodokpɔ si me wodzroa ʋuʋu kple seselelãme me tsitotsito.
• Woabia nya tso wò atikewɔwɔ ŋutinya, ahɔhɔ̃mekawo ƒe kuxiwo, kple afɔku ɖesiaɖe si nèdo ŋu.

Emegbe, woaɖe gbe be woawɔ dodokpɔ geɖe, abe MRI scan , ene, atsɔ aɖo kpe dɔlélea dzi eye woakpɔe ɖa be nu bubu siwo gbɔ wòtso hã.

Dodokpɔ kawoe wole wɔwɔm na esia?

Ne wosusu be BSS le ame ŋu la, wò ɖɔkta ate ŋu abia be woawɔ dodokpɔwo abe:

• MRI scan (Magnetic Resonance Imaging): Esia nye dodokpɔ si me vevesese aɖeke mele o. Ezãa magnet gã aɖe, radio ƒe ƒutsotsoewo, kple kɔmpiuta tsɔ wɔa ŋutinuwo kple nuwo ƒe wɔwɔme siwo le ŋutilãa me ƒe nɔnɔmetata siwo me kɔ ŋutɔ. MRI ɖea vi ŋutɔ na BSS elabena ate ŋu akpe ɖe ame ŋu woade dzesi nusiwo gblẽ le akɔta ƒe wɔwɔme ŋu eye wòakpe ɖe ame ŋu woake ɖe nusi gbɔ BSS si dzɔna afɔku manɔmee tso ŋu.
• Myelogram kple CT scan (Computed Tomography): Ne màte ŋu awɔ MRI o la, wò ɖɔkta ate ŋu abia be woawɔ myelogram eye emegbe woawɔ CT scan na wò akɔta. Dodokpɔ siawo ate ŋu adi be nusiwo gblẽ le lãmeka siwo le wò aklã ƒe akpa ɖeka ŋu. Myelogram nye nɔnɔmetatawo dodokpɔ si me woléa ŋku ɖe kadodo siwo le wò akɔta, diskwo, aklã, lãmekawo, kple lãmekawo ƒe kewo dome ŋu. CT scan zãa X-ray kple kɔmpiuta tsɔ ɖea wò ŋutilã ƒe akpa si le eme ƒe nɔnɔmetata tsitotsito.
• Ʋudodokpɔ: Ne nusi gbɔ BSS tsona me mekɔ o la, wò ɖɔkta ate ŋu aɖe gbe be woawɔ ʋudodokpɔ geɖe atsɔ akpɔe ɖa be dɔlékui siwo ate ŋu ahe dɔlélea vɛ hã.
• Lumbar puncture / Spinal tap: Ne wosusu be multiple sclerosis (MS) , transverse myelitis, alo tuberculosis gbɔe BSS tso la, wò ɖɔkta ate ŋu awɔ akɔtadɔ aɖe atsɔ axɔ ahɔhɔ̃mekawo ƒe tsi (CSF) . CSF nye tsi si me kɔ si ƒo xlã wò aklã kple ahɔhɔ̃.

Nukawoe nye Brown-Séquard ƒe dɔléle (BSS) ƒe atikewo?

BSS dada nɔ te ɖe nusi gbɔ aklãa ƒe gbegblẽ tso dzi.

Le goawo katã me la, BSS dɔdamɔnu ƒe taɖodzinuwoe nye:

• Mɔ̃ kple seselelãme ƒe dɔwɔwɔ ta kpɔkpɔ alo eƒe nyonyome .
• Mɔxexe ɖe nusiwo gblẽ le nu evelia ŋu nu.
• Kuxiwo dzi ɖeɖe kpɔtɔ.

Ahiã be woawɔ atike na amesi ŋu BSS le tso abi si wòxɔ le aʋawɔnu ɖaɖɛ aɖe me, abe abi si wotsɔ hɛ ƒoe ene, ŋu ne ʋu le dodom le eŋu eye eƒe lãmekawo gblẽ. Tsɔ kpe ɖe eŋu la, amesiwo xɔ abi bubuwo le afɔku si he BSS vɛ me la ahiã atikewɔwɔ bubuwo na abi mawo hã.

BSS dada ƒe akpa vevi eve li: atikewɔwɔ gbãtɔ kple gbugbɔgaɖɔɖo .

Atikewɔwɔ Gbãtɔ

BSS ƒe atikewɔwɔ gbãtɔ ate ŋu anye:

• Amekoko: Le nɔnɔme siwo me BSS dzɔna afɔku aɖeke manɔmee me la, zi geɖe la, mɔ̃wo ƒe nutete alo aklã ƒe ʋuʋu gbɔe wòtsona. Ele be woawɔ dɔ na ame be woaɖe nutete sia dzi akpɔtɔ.
• Atike siwo xea mɔ na ʋu ƒe sisi: Amesiwo xɔ abi le aklã me la le afɔku me be ʋu nate ŋu axɔ ʋukawo me (Venous Thromboembolism - VTE) . Esia lɔ nusiwo le abe deep vein thrombosis (DVT) kple aklã me ʋu ƒe sisi ene ɖe eme . Wò ɖɔkta ate ŋu ana atike siwo woyɔna be ʋumenugbagbeviɣitikewo , abe heparin alo warfarin ene, be wòaxe mɔ na ʋu ƒe sisi na wò.
• Ŋutilã takpɔkpɔ (be woaxe mɔ ɖe abadzivɔwo nu): Be nàxe mɔ ɖe nyaƒoɖeamenu ƒe abi/abadzivɔwo nu la, wò atikewɔlawo akpe ɖe ŋuwò nàtrɔ ahatrɔ wò nɔnɔme gaƒoƒo eve ɖesiaɖe ya teti. Woakpe ɖe ŋuwò be wò ŋutigbalẽ nanɔ dzadzɛ eye wòaƒu, eye woatsɔ tsilénu asisi ɖe ŋutigbalẽ si ƒu ŋu.
• Gastrostomy tube (G-tube): Be dɔgbo ƒe ʋuʋu le paralytic ileus ta dzi naɖe akpɔtɔ la, wò ɖɔkta ate ŋu ade G-tube wò dɔgbo me. G-tube nye mɔ̃ si tsɔa nunyiame tso dɔgboa me yia dɔgboa me tẽ. Paralytic ileus nye lãmekawo ƒe tete hena ɣeyiɣi aɖe si kplɔa nuɖuɖu toa dɔgboa me. Esia bɔ ɖe abi siwo woxɔna le aklã me.
• Yagbɔgbɔ ƒe kpekpeɖeŋu: Ne gbɔgbɔ sesẽ na wò le wò aklã ƒe abi si nèxɔ ta la, ahiã be woatsɔ wò aƒo ka na yagbɔgbɔmɔ̃ . Esia nye mɔ̃ si kpena ɖe ŋuwò nègbɔa ya, alo gbɔa ya na wò.
• Ahɔhɔ̃mekawo ƒe tsinyegoe dzi kpɔkpɔ: Amesiwo xɔ abi le aklã me, siwo dome BSS hã le, ate ŋu abu tsinyegoe dzi ɖuɖu. Ne edzɔ alea la, ate ŋu ahiã be woatsɔ aɖuɖɔtoe kple atike bubu siwo do ƒome kple aɖuɖɔtoedɔdamɔnu.
• Autonomic dysreflexia dada: Ame siwo xɔ abi le aklã me ate ŋu akpɔ tɔtrɔ gãwo le ʋu ƒe sisi kple dzesi bubuwo me. Ele be woatsɔ atike siwo kpɔa ʋu ƒe sisi kple dzi ƒe tsotso dzi akpɔ esia gbɔ nyuie.
• Avɔ siwo ɖɔa dzoxɔxɔ ɖo: Zi geɖe la, esesẽna na amesiwo ŋu BSS le be woaɖɔ woƒe ŋutilã ƒe dzoxɔxɔ ɖo. Atikewɔlawo ƒe ƒuƒoƒoa ate ŋu ana avɔ siwo léa dzoxɔxɔ ɖe te be woakpe ɖe esia ŋu.

Gbugbɔgaɖɔɖo

Le atikewɔwɔ gbãtɔ na BSS megbe la, ele be woadze gbugbɔgaɖɔɖo, abe kamedede kple dɔwɔwɔ ƒe atikewɔwɔ ene gɔme kaba ale si wòanya wɔ be wòana wòanyo ɖe edzi eye/alo wòagate ŋu aʋuʋu.

Taɖodzinu siwo le kamedede ƒe atikewɔwɔ ŋu:

• Lãmetsiwo ƒe ŋusẽ me léle ɖe asi kple lãmekawo ƒe dɔwɔwɔ nyuie.
• Ʋuʋu ƒe didime si le ƒunukpeƒewo me léle ɖe asi .
• Xɔ mɔ na ŋutigbalẽ ƒe gbagbã to nɔnɔme nyuitɔ kple kpekpeme tɔtrɔ me.
• Ʋuʋu yi teƒe bubu ƒe nyonyo .

Lãmesẽfefewɔwɔ bia kamedede kple atikewɔwɔ siwo kpena ɖe ŋuwò nèɖea vevesese dzi kpɔtɔna eye wònana nègawɔa dɔ nyuie henɔa ʋuʋum nyuie. Wò ŋutilãmedɔdala awɔ dɔ kpli wò be wò ʋuʋu nanyo ɖe edzi. Woate ŋu ana mɔ̃ siwo akpe ɖe ŋuwò nàwɔ gbesiagbedɔwo, abe asigɛwo, asigɛwo, abɔ kple afɔdzidelawo, alo bunɔkeke ene, wò.

Dɔwɔwɔ ƒe atikewɔwɔ lɔ atikewɔwɔ kple kamedede siwo kpena ɖe ŋuwò be nàgakpɔ ɖokuiwò si le wò agbe ƒe akpa sia akpa le ŋutilã alo ahɔhɔ̃mekawo ƒe kuxi aɖe megbe ɖe eme. Ne èxɔ dɔdamɔnu na BSS la, àsrɔ̃ mɔ yeye siwo dzi nàto awɔ gbesiagbedɔwo, abe ɖokuiwò dzadzraɖo, nuɖuɖu, kple awudodo ene, kple kpekpeɖeŋunu alo wo manɔmee.

Ðe woate ŋu axe mɔ ɖe esia nu be wòagadzɔ oa?

Mɔ ɖeka kolia si dzi nàto axe mɔ ɖe Brown-Séquard ƒe dɔlélea nue nye be nàwɔ ɖe dedienɔnɔ ŋuti ɖoɖo siwo wowɔna ɖaa dzi be màgblẽ nu le wò aklã ŋu o. Le kpɔɖeŋu me, kpɔ nyuie ne èle ʋu kum hele zɔzɔm le mɔ dzi.

Mɔnukpɔkpɔ kawoe li be woahaya tso nɔnɔme sia me? (Nyagblɔɖi) .

Mɔkpɔkpɔ be woahaya tso BSS me nɔ te ɖe nu geɖe dzi, siwo dometɔ aɖewoe nye nusi gbɔ aklãa ƒe gbegblẽ tso kple alesi gbegbe wògblẽe.

Gake le nusianu me la, zi geɖe la, alesi wohayana tso BSS me nyona . Mɔnukpɔkpɔ nyui aɖe le amesiwo ŋu BSS le si be woagawɔ dɔ aɖewo ake, siwo dome azɔlizɔzɔ hã le. Gake hayahaya nye nusi yia edzi blewu . Eƒe hayahaya nɔa blewu vie, exɔa ɣleti etɔ̃ va ɖo ade tso esime dɔlélea dze egɔme, eye ate ŋu axɔ ƒe eve hafi lãmekaawo nahaya keŋkeŋ.

Kuxi kawoe ate ŋu ado mo ɖa ne womewɔ atike nɛ o?

Ne womeda Brown-Séquard ƒe dɔlélea ɖi o la, kuxiwo abe:

• Ƒodo ƒe ʋuʋu.
• Teteɖeanyi.
• Ʋu ƒe sisi le lãme na ame (Hypotension).
• Aklã me ʋu ƒe sisi.
• Dɔlékuiwo – akpa gãtɔ le lãkusi kple aɖuɖɔtoe me.
• Lãmetsiwo ƒe lãmetutudɔ tegbee.

Ɣeyiɣi kawoe nye nyuitɔ kekeake siwo nàte ŋu ayi ɖɔkta gbɔ?

Ne kasia lãmekawo ƒe gbɔdzɔgbɔdzɔ alo lãmetutudɔ kple/alo wò ŋutilã ƒe akpa ɖeka megate ŋu sena le ɖokuiwò me o la, yi xɔ si te ɖe ŋuwò le nudzɔdzɔ kpatawo gbɔ me kaba ale si nàte ŋui .

Ne wokpɔ Brown-Séquard ƒe dɔlélea le ŋuwò la, ele be nàkpɔ wò atikewɔlawo ƒe ƒuƒoƒoa edziedzi be nàkpɔ egbɔ be wò aklã ƒe abi la le hayahayam nyuie. Kpɔ egbɔ be yewɔ wò kamedede kple dɔdamɔnu ƒe ɣeyiɣiwo be nàkpɔ egbɔ be yehaya nyuie eye kaba ale si nàte ŋui.

Nu vevitɔ kekeake si dzi wòle be nàɖo ŋkui (Take-Home Message) .

Brown-Séquard ƒe dɔlélea ate ŋu ado vɔvɔ̃ na ame vie be woase. Gake nya nyuiae nye be ame geɖe siwo ŋu dɔléle sia le la gagakpɔa woƒe lãmekawo kple seselelãme ƒe ŋutetewo alo nyona ɖe edzi le ɣleti ʋɛ aɖewo ƒe hayahaya megbe. Ðo ŋku edzi be wò atikewɔlawo ƒe ƒuƒoƒoa anɔ anyi ɣesiaɣi akpe ɖe ŋuwò nàgadze mɔ nyuitɔ dzi. Eyata sẽ ŋu eye nàwɔ ɖe aɖaŋuɖoɖo siwo wona dzi.

` Brown-Séquard Syndrome, aklã, aklã, lãmekawo, lãmetutudɔ, seselelãme ƒe bu, aklã ƒe gbegblẽ