{"id":4845,"date":"2023-02-17T19:37:37","date_gmt":"2023-02-17T19:37:37","guid":{"rendered":"https:\/\/www.karotidnahirurgija.com\/?page_id=4845"},"modified":"2023-02-24T10:18:15","modified_gmt":"2023-02-24T10:18:15","slug":"22-1-angio-neuroloski-nalaz","status":"publish","type":"page","link":"https:\/\/www.karotidnahirurgija.com\/?page_id=4845","title":{"rendered":"22.1. ANGIO-NEUROLO\u0160KI NALAZ"},"content":{"rendered":"

\"\"<\/a><\/p>\n

<\/p>\n

ENDOVASKULARNA HIRURGIJA<\/h1>\n

<\/a><\/h1>\n

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22.1.\u00a0 ANGIO – NEUROLO\u0160KI NALAZ<\/h2>\n<\/h1>\n
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Ateroskleroza<\/strong> velikih supraaortalnih stabala dugo ostaje asimptomatska<\/strong>. Dobra kolateralna cirkulacija izme\u0111u brahiocefalinih stabala, u vi\u0161e nivoa (rameni pojas, vrat, intrakranijalno), \u010dini da se hemodinamski problem dobro kompenzuje.<\/p>\n

Prelazak u simptomatski stadijum<\/strong> de\u0161ava se zbog nestabilnosti ateroskleroti\u010dnog plaka i distalne embolizacije. Hemodinamski uslovi za pojavu simptoma brahiocefali\u010dke ishemije se sti\u010du u slu\u010daju multiplih ekstenzivih lezija supraaortalnih arterija.<\/p>\n

Simptomi lo\u0161e perfuzije karotidnog sliva su nesvestica, omaglica, malaksalost, hemipareza, hemiplegija, amaurosis fugax, aphasio, disphasio itd).<\/p>\n

Simptomi posteriorne (veretebrobazilarne) insuficijencije su vrtoglavica, omaglice, nesvestice, diplopije, ataksija, bilateralni motorni ili senzorni deficit, dizartrija i drop ataci (iznenadni pad bez gubitka svesti).<\/p>\n<\/p>\n<\/div>\n

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A.cerebri anterior <\/strong>\u201canterior cerebral artery\u201d (ACA), nakon odvajanja od unutra\u0161nje karotidne arterije, ide koso medijalno, spaja se sa suprotnom ACA pomo\u0107u prednje komunikantne arterije, a zatim prati medijalnu stranu hemisfere, za koju daje svoje grane.<\/em><\/p>\n

A.cerebri posterior<\/strong> \u201cposterior cerebral artery\u201d (PCA) je zavr\u0161na grana bazilarne arterije i pru\u017ea se od zavr\u0161ne ra\u010dve bazilarne arterije do spoja sa a. communicans posterior <\/em>Irigaciono podru\u010dje prednje i zadnje cerebralne arterije na mo\u017edanim hemisfera.<\/em><\/p>\n<\/div>\n

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Irigaciona podru\u010dja:
(A) a.cerebri anterior,
<\/em>(B) a.cerebri media i
(C) a.cerebri posterior. Ishemi\u010dki infarkt se lokalizuje u slivu ledirane arterije, \u0161to odre\u0111uje tip i vrstu neurolo\u0161kog deficita.<\/em><\/p>\n

(A) cerebri media <\/strong>\u201cmiddle cerebral artery\u201d (MCA) je najja\u010da grana unutra\u0161nje karotidne arterije. Le\u017ei najpre bazalno, a zatim ulazi kroz proksimalni deo Sylvius-ove jame u insulo-operkularni predeo, gde daje ve\u0107inu svojih leptomeningealnih grana, koje se distribuiraju po lateralnoj strani hemisfere.<\/em><\/p>\n<\/div>\n

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Ishemija<\/b> <\/b>gornjih<\/b> <\/b>ekstremiteta<\/b> <\/b>se javlja u slu\u010daju okluzije ili te\u0161ke stenoze brahiocefali\u010dnog trunkusa i\/ili subklavijalne arterije, pogotovo kod multiplih lezija supraaortalnih grana. Simptomi ishemije se javljaju u rasponu od povremenog i blagog ose\u0107aja hladno\u0107e, parestezija i bledila do jakog bola u miru, embolizacije digitalnih arterija i gangrene prstiju.<\/p>\n

Subclavian<\/b><\/i> <\/b><\/i>steal<\/b><\/i> <\/b><\/i>syndrom<\/b><\/i><\/p>\n

Subclavian<\/b><\/i> <\/b><\/i>steal<\/b><\/i> <\/b><\/i>syndrom<\/b><\/i> <\/b><\/i>\u201cKra\u0111a krvi\u201d podrazumeva fenomen retrogradnog protoka krvi kroz vertebralnu arteriju zbog okluzije ili te\u0161ke stenoze po\u010detnog dela subklavijalne arterije.<\/p>\n

Iz cerebralne cirkulacije krv se usmerava u gornji ekstremitet, zato \u0161to je cerebralna cirkulacija o\u010duvana, a ruka zbog zna\u010dajne stenoze ili okluzije subklavijalne arterije ishemi\u010dna. Uz uslov da izme\u0111u ova dva sliva postoji kolateralna cirkulacija u nivou Willis<\/i>-ovog poligona. U tim uslovoma prestaje anterogradni krvotok kroz ipsilateralnu vertebralnu arteriju, jer za njega vi\u0161e nema hemodinamskih uslova, a razvija se retrogradni protok \u010dime se krv iz mozga kompenzatorno odliva u ishemi\u010dni gornji ekstremitet.<\/p>\n

Subclavian<\/b><\/i> <\/b><\/i>steal<\/b><\/i> <\/b><\/i>syndrom<\/b><\/i> <\/b><\/i>je pra\u0107en simptomima posteriorne cerebralne ishemije (vertebrobazilarna insuficijencija) i simptomima ishemije ipsilateralnog gornjeg ekstremiteta.<\/p>\n

Asimptomatski<\/b> <\/b>subclavian<\/b><\/i> <\/b><\/i>steal<\/b><\/i> <\/b><\/i>syndrom<\/b><\/i> <\/b><\/i>ozna\u010dava postojanje stenoze (okluzije) po\u010detnog dela subklavijalne arterije i retrogradnog protoka kroz ipsilateralnu vertebralnu arteriju ali bez subjektivnih tegoba. U tom slu\u010daju se simptomi (vrtoglavica, nesvestica, diplopije itd.) mogu izazvati funkcionalnim<\/b> <\/b>testovima<\/b> <\/b>(Ratschaw<\/i> <\/i>test) koji podrazumevaju elevaciju ekstremiteta i aktiviranje muskulature (brzo otvaranje i zatvaranje \u0161ake) \u0161to pove\u0107ava potrebu gornjih ektremiteta za krvlju. Ovim testom se potencira kvantitet \u201ckra\u0111e\u201d arterijske krvi iz intrakranjalne cirkulacije kroz bazilarnu i vertebralnu arteriju. Zato mo\u017ee provocirati tranzitorne neurolo\u0161ke simptome.<\/p>\n

Ratschaw<\/b><\/i> <\/b><\/i>test.<\/b> <\/b>Aktivacija muskulature (rad) ruku mo\u017ee da izazove ili pogor\u0161a simptome ishemije, kao funkcionalni test. Uvek treba uraditi i testove za sindrom gornje torakalne aperture (Adson, hiperabdukcija, Monroe itd.)s i Raynaud-ov fenomen (hladna voda), a ponekad i elektromiografiju gornjih ekstremiteta, zbog diferencijalne dijagnostike.<\/p>\n<\/div>\n


\n<\/p>\n","protected":false},"excerpt":{"rendered":"

ENDOVASKULARNA HIRURGIJA 22.1.\u00a0 ANGIO – NEUROLO\u0160KI NALAZ Ateroskleroza velikih supraaortalnih stabala dugo ostaje asimptomatska. Dobra kolateralna cirkulacija izme\u0111u brahiocefalinih stabala, u vi\u0161e nivoa (rameni pojas, vrat, intrakranijalno), \u010dini da se hemodinamski problem dobro kompenzuje. Prelazak u simptomatski stadijum de\u0161ava se zbog nestabilnosti ateroskleroti\u010dnog plaka i distalne embolizacije. Hemodinamski uslovi za pojavu simptoma brahiocefali\u010dke ishemije se […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-4845","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"\n22.1. 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