Mastishk aur Gyantantu ki Bimariya

Author(s): Sudhir V Shah
Publisher: Chetna Sudhir Shah
Catalog link: https://jainqq.org/explore/001801/1

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/ mastiSka aura jJAnataMtu kI bImAriyA~ - Do. sudhIra vI. zAha svAsthya prazikSaNa mArgadarzikA) Dendrite. Axon Synaptic terminal Neurons in younger brain sensorimotor area frontal eye field lobe frontal lobe prefront visual Broca's area (in left hemisphere) temporal bon Visual association auditory association (including Wernicke's area, o left hemisphere) OMGa wajurminwww For PrivateaPersonalise only

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mastiSka aura jJAnataMtu kI bImAriyA~ __ (svAsthya prazikSaNa mArgadarzikA) DISEASES OF THE BRAIN & NERVOUS SYSTEM (A Health Education Guide) DaoN. sudhIra vI. zAha ema.DI., DI.ema. (nyUrolojI) kansalTanTa nyUrophijiziyana * oNnararI praoNphesara eNDa heDa opha DipArTamenTa opha nyUrolojI * ke. ama. skUla oNpha posTagrejyuoTa meDisina enDa risarca, ahamadAbAda * ana. aca. ela. myu. meDikala kaoNleja, ahamadAbAda * DAyarekTara oNpha nyUrosAyansIja * sTaliMga haoNspiTala, ahamadAbAda * oNnararI nyUrophijiziyana : * hijha ekselansI, dha gavarnara oNpha gujarAta * vI. esa. janarala haoNspiTala, ahamadAbAda * DaoN. jIvarAja mahetA heltha phAunDezana, ahamadAbAda klinika : nyUrolojI senTara 206/7/8, saMginI kaoNmpleksa, parimala relave kraoNsiMga ke pAsa, elisabrija, ahamadAbAda - 380 006 phona : (079) 26467052, 26467467 Website : www.sudhirneuro.org

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* MASTISHK AUR GYANTANTU KI BIMARIYAAN DISEASES OF BRAIN - NERVOUS SYSTEM (A Health Education Guide) by Dr. Sudhir v. Shah * prathama saMskaraNa : I.sa. sitaMbara 2008 * prata : 4000 * kopIrAITa All rights reserved. No part of this book, including design, cover design, and icons may be reproduced or transmitted in any form, by any means (Electronic, photocopying, recording or otherwise) without the prior written permission of the publisher / author. * mUlya : 200*/rupaye (*isa Aya kI samagra rAzi garIba evaM jarUratamaMda dardIoM kI sahAya ke liye kharca kI jAtI hai / ) prakAzaka : sau. cetanA sudhIra zAha nyUrolojI senTara, 206/7/8, saMginI kaoNmpleksa, parimala relave kraoNsiMga ke pAsa, elisabrija, ahamadAvAda - 380006 phona : 079-26467052, 079-26467467. * vikretA gurjara prakAzana 202, tilakarAja, paMcavaTI pahalI lena, AMbAvADI, ahamadAbAda - 380 006 e-mail : goorjar@yahoo.com mudaNa saMskAra : mudreza purohita, sUryA oNphaseTa, AMbalI gAma, seTelAITa- bopala roDa, ahamadAbAda - 380058 phona : 02717-230112 e-mail : suryapress@gmail.com

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arpaNa jinheM sacamuca madada kI jarUrata hai aura jo dUsaroM kI madada ke lie sadaiva ___ tatpara hai una sabako... AbhAra mere variSTha, gurujana, kuTuMbIjana _aura zubhecchakoM tathA mitroM....kA DaoN. sudhIra vI. zAha

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+ : khAsa sUcanA : - yaha pustaka mastiSka ke vividha rogoM ke bAre meM jAnane ke lie hai / yaha tabIbI pAThya pustaka (Medical textbook) nahIM hai| pAThakoM ko vinaMtI ke ise paDhakara koI bhI davAI svaupacAra kI galatI na kreN| apane tabIba kI salAha ke anusAra hI davAI le, upacAra kreN|

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GODDESS OF CURE C kRti : DaoN. vI. je. zAha pa. pU. pitAzrI sva. DaoN. vI. je. zAha

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FOREWORD DR. B. S. SINGHAL M.D. (BOM.), F.R.C.P. (LONDON), F.R.C.P. (EDIN), F.A.M.S. PROFESSOR & HEAD DEPARTMENT OF NEUROLOGY Bombay Hospital Institute of Medical Science Neurologist - Bombay Hospital ENGLISH EDITION, 2002 Bombay Hospital MEDICAL RESEARCH CENTRE 12, Marine Lines, MUMBAI 400 020 Clinic (9122) 206 4747, 206 7676 Res. (9122) 363 0639, 363 7788 Diseases of the Brain and Nervous System (A Health Education Guide) Neurological illnesses account for nearly 20% of the burden of illnesses in the community. Sadly, there is not much awareness about the neurological illnesses and the patient and the family members are suddenly overcome with anxiety and apprehension, and do not know how to cope with neurological problems. Dr. Sudhir Shah's book serves to give the necessary information required. The original book was in Gujarati language, but he has taken pains to bring out this English edition. It is a fairly comprehensive book, dealing with all practical problems faced in neurology. It gives the description of the illness along with the management. I am confident that the reader will find it extremely useful and it will help the patients and relatives to cope with various neurological problems. He has also emphasized on preventive aspects of the illness and side effects of the commonly used drugs and in particular care to be taken for drugs used for prolonged periods. This book should be useful not only for the patient and the caretakers but also for the medical students and the physicians and those involved in the management of neurological illnesses. I enjoyed reading the book and I am confident that it will have a wide reception. I should compliment Dr. Sudhir Shah for having spared his time from his busy practice and academic work to write this book. 33 bloke B. S. Singhal Professor & Head Department of Neurology Bombay Hospital Institute of Medical Sciences Mumbai. April 10, 2002. E

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- Amukha bAhara se akharoTa ke AkAra jaisA dikhanevAlA mastiSka asaMkhya cetAtaMtuoM se banA huA hotA hai| eka sekanDa ke 16 ve bhAga meM tvarita nirNaya lene vAlA mastiSka samagra zarIra kA saMcAlana kendra hai / supara kampyUTara se bhI ucca koTi ke hamAre mastiSka aura cetAtaMtra ke bAre meM bahuta sAre saMzodhana hae hai| pUre zarIra meM mastiSka-cetAtaMtra eka ati saMvedanazIla taMtra hai aura usameM kahIM para bhI kSati ho to pUre zarIra ko usakI asara ho sakatI hai| aThAraha sAlase ahamadAbAda meM mere klinika "nyUrolojI senTara" meM, prakhyAta vI. esa. janarala haoNspiTala aura sTarliMga haoNspiTala, jIvarAja mahetA haoNspiTala meM gujarAta aura anya prAMta ke vividha mukAma se Ane vAle mere marIjoM ke ilAja ke daurAna jJAta huA ki marIjoM aura unake svajanoM ko mastiSka kI bImArI ke bAre meM jAnane kI utsukatA hotI hai| hindI yA anya bhASA meM isa bAreM meM eka hI sthala para jAnakArI mila sake aisA koI pustaka nahIM thA, isalie mana meM aisI sphuraNA huI ki mastiSka aura cetAtaMtra se saMbaMdhita bImAriyoM ke bAre meM kucha likhuM / samaya ke abhAva kI vajaha se yaha bAta Age nahIM bar3ha pAI, para bAda meM AkAzavANI para se sitambara 1999 meM subaha kA 'paheluM sukha' kAryakrama tathA dUradarzana para 'svAsthya sudhA' kAryakrama meM mastiSka kI kucha bImAriyoM ke bAre meM mere pravacana hue| unameM se mujhe mastiSka kI mukhya bImAriyoM ke bAre meM likhane kI preraNA huI / aura isa pustaka kA sarjana huA / prathama ye pustaka sana 2000 meM merI mAtRbhASA gujarAtI meM maiMne likhA, bAda meM aMgrejI saMskaraNa sana 2002 meM kiyA aura phira pustaka kI khUba prasiddhi kI vajaha se do aura saMskaraNa kie aura aba ye hindI saMskaraNa kara rahA huuN| __ yaha hindI pustaka sirpha anuvAda nahIM hai, balki isameM pichale pA~ca sAla meM AI huI kAphI naI jAnakArI, nayA saMzodhana samAviSTa kiyA hai;

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jisase ki yaha ekadama nayA pustaka hai| vaise to gujarAtI merI mAtRbhASA hai, phira bhI hindI hamArI rASTrabhASA hai; isalie yaha pustaka sarala hindI meM likhane kA vinamra prayAsa kiyA hai / isa pustaka ke hindI saMskaraNa ke lie mere mitra zrI maheza dave ne mujhe prerita kiyA / AzA hai ki, Isa pustaka meM merI koI bhASAkIya galatiyA~ ho to unako bar3e pyAra se Apa najara aMdAja kareMge / isa pustaka ke mAdhyama se sAmAnya janatA meM svAsthya jJAna kI vRddhi aura rogoM ke bAre meM jAnakArI dene kA merA vinamra prayAsa hai / svAbhAvika hai ki, isameM cikitsAzAstra ke draSTikoNa se gaharAIpUrvaka aura tajajJatAyukta jAnakArI nahIM hai, phira bhI mujhe AzA hai ki isameM sAmAnya vyakti ko jarUrI tamAma jAnakArI milegii| hAlAMki vartamAna nae saMzodhana aura davAI ke bAre meM ucita aura saMpUrNa jAnakArI isa pustaka meM samAviSTa karane kA prayAsa kiyA gayA hai / lekina naI davAI kA saMzodhana rojabaroja hotA rahatA hai isa bAreM meM hamAre vAcaka jAnate hai / vizeSa meM svayaM koI upacAra karane kA jokhima nahIM lenA cAhie / sirpha DaoNkTaroM ke mArgadarzana meM hI davA lenA ucita rhegaa| khAsa to - ekAda sAmAnya cihna para se paDhanevAle ko koI nyurolojikala bImArI ho gaI hai aisA bhrama nahIM karanA caahie| khAsa bAta to ye hai ki, yaha pustaka (gujarAtI) jaba pahale likhA thA to marIz2a aura unake parivArajanoM ko roga kI jAnakArI mile vahI Azaya thaa| kintu jaise jaise usakI sekar3oM kopiyA~ samAja meM pahu~cI to sabane mujhe saharSa batAyA ki phemilI DaoNkTarsa, meDikala sTuDanTasa, phijiyotherapIsTa, narsIsa aura janasAmAnya meM haraeka ke lie isa pustaka meM kucha na kucha mahatvapUrNa bAteM hai| yaha jAnakara mujhe bahuta khuzI huI / isa hiMdI pustaka ko taiyAra karane meM mere guruvarya DaoN. zrI guNavaMtarAya jI. ojhA aura DI.ena.bI. nyUrolojIkI merI chAtrA DaoN. raIsA vorA ne kAphI madada kI hai / sAtha meM mere klinika ke sahAyaka phijiziyana DaoN. amita bhaTTa aura merI suputrI helI zAha (meDikala sTuDanTa) ne vizeSa

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dhyAna diyA hai isalie maiM Ina sabhI kA kRtajJI hU~ / DaoN. atula paTela (ema.DI.)ne prakaraNa 13meM eIDsa ke bAre meM acche salAha-sUcana diye hai| usake uparAMta merI ardhAMginI zrImatI cetanA zAha ne bhI pUre pustaka meM mahatvapUrNa yogadAna diyA hai| sAthameM samaya ke abhAva ke bAvajUda unake suMdara samaya ke Ayojana kI vajaha se hI ina bImAriyoM ke bAre meM vyavasthita likhA gayA hai| isa pustaka ke mAdhyama se kAphI janajAgRti AI hai, kAphI logoM ko naI jiMdagI milI hai / kucha ora loga bImAriyoM ke rokathAma ke bAre meM jAgRta hote hai athavA samayasara bImArI ke upacAra se thor3e se ora bhI marIjoM kI jindagI bacatI hai to mere jIvana meM AnaMda kI anubhUti baDhegI aura mujhe saMtoSa milegaa| sAtha hI, dardI ke rogoM ke bAre meM paryApta jAnakArI milane se aura tabIbI kSetra kI maryAdA kI jAnakArI milane se DaoNkTara-pezanTa saMbaMdha meM yaha pustaka prema-vizvAsa baDhAyegA, aisI mujhe zraddhA hai| isa prakAzana meM preraNA aura mArgadarzana denevAle sabhI logoM kA dila se bhAvapUrvaka smaraNa karate hue mujhe kRtArthatA kA ehasAsa ho rahA hai / khAsakara mere guruvarya DaoN. harSadabhAI joSI, DaoN. pI.ema. dalAla, DaoN. aruNa zAha, DaoN. bhIma siMghala, DaoN. praviNA zAha, DaoN. phenka yAtsu (hyusTana), DaoN. nAyala kvIna (laMDana), DaoN. zimona zoravona (laMDana) jinhoMne mujhe nyurAlojI kI zikSA dI hai, una sabako nata mastaka praNAma karatA huuN| aMta meM paramakRpAlu paramAtmA sabhI kA kalyANa kare aisI zubhecchA saha... 14 sitambara, 2008 Do. sudhIra vI. zAha rASTrIya hindI dina ema. DI., DI. ema. (nyUrolojI) ahamadAbAda

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gujarAtI dUsare saMskaraNa ke avasara para..... __ 20 agasta, 2000 ke dina gujarAta ke mAnanIya gavarnarazrI ke karakamaloM dvArA isa pustaka kA vimocana kiyA gayA thA aura sirpha 6 mahinoM meM yaha dUsarA saMskaraNa Apake sAmane peza kara rahA huuN| mastiSka aura jJAnataMtu kI bImArI ke bAre meM marIjoM ora unake parivAra ke logoM tathA jijJAsu vyaktioM ko gujarAtI meM yogya mUlabhUta jAnakArI dene ke hetusara likhA gayA yaha pustaka apane uddezya meM adhikatara saphala bhI huA hai / isa pustaka kA mukhya hArda bImAriyoM ke samayasara aura yogya upacAra ke sAtha sAtha samajhadArIpUrvaka ke prayatnoM se bImArI ko rokanA hai / isake uparAMta DaoNkTara aura marIja ke saMbaMdhoM meM jyAdA uSmA lAne kA prayAsa bhI isa pustaka ke mAdhyama se saphala huA hai| vizeSakara yaha pustaka samAja tathA samAja ke pratyeka vyakti ke dainika vyavahAra, abhigama (attitude) aura dinacaryA (lifestyle) meM yogya sudhAra lAne meM pathadarzaka sAbita hogA to mujhe saMpUrNa tRpti kA ehasAsa hogA / mujhe pAThakoM kA suMdara pratisAda milA hai isalie maiM unakA AbhAra vyakta karatA huuN| kucha salAha-sUcana aura TippaNiyA~ bhI milI hai| janarala prekTisa karane vAle mere cikitsaka mitroM kI ora se bhI pUchatAcha hotI rahI hai / isake bAda socA ki kucha saMzodhana ke sAtha dUsarA saMskaraNa prakAzita kiyA jAe / mere guruvara zrI DaoN. guNavaMtabhAI ojhA sAhaba ne pustaka saMpUrNatayA par3hakara kucha Avazyaka salAha-sUcana die aura usake anusAra maiMne naye saMskaraNa ke bAre meM draDha nirdhAra kiyaa| yaha pustaka likhane kA samaya kaise milA isa bAre meM loga savAla karate hai| prathama saMskaraNa ke vimocana ke samaya maiMne apane pravacana meM spaSTa batAyA thA ki sirpha prabhu kI preraNA aura aMtara kI karuNA se yaha saphalatA mujhe milI hai| kabhI-kabhI rAtri ke 12.30 baje taka baiThakara taiyArI kI hai / merI saujanyazIla dharmapatnI cetanA ke suMdara TAima-menejamenTa aura snehI zrI upendrabhAI divyezvara ke pholo-apa kA yaha pariNAma hai / yaha saba paribala isa samaya bhI kAma kara ge| satata hotI rahatI pUchatAcha ko dhyAna meM rakhakara isa saMzodhita saMskaraNa meM eksa-re Adi se mastiSka kI jA~ca - nyUro reDiyolojI, brena hemareja

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evaM mUvamenTa DisorDarsa aura mastiSka kI zastrakriyA - nyUrosarjarI saMbaMdhita prakaraNa kA samAveza kiyA gayA hai / isake uparAMta lakavA aura nyUropathI evaM mastiSka ke saMkramaNa ke prakaraNoM ko nayesara se vistArapUrvaka nirupita kiyA gayA hai| aura jahA~ AvazyakatA lagI, vahA~ naI davA aura upacAra kI paddhatiyA~ kA bhI samAveza kiyA gayA hai / logoM ko paryApta jAnakArI mile isakA khAsa dhyAna rakhA gayA hai / isa saMskaraNa meM guruvarya zrI DaoN. guNavaMtabhAI ojhA sAhaba ne salAhasUcana ke sAtha mArgadarzana diyA hai / aura pustaka saMbaMdhita apanA pratibhAva vyakta kiyA hai| isalie maiM unakA bhI aMtaHkaraNa se AbhAra vyakta karatA ha~ / nyaro-reDiyolojI prakaraNa kI madada se DaoN. hemaMta paTela (ema.DI. reDiyolojI)ne sI.TI. skena, ema.Ara.AI. ke bAre meM suMdara jAnakArI dI hai / isalie maiM unakA bhI AbhArI hU~ / isake uparAMta nyUrosarjarI prakaraNa meM vizeSa jAnakArI dene vAle DaoN. parimala tripAThI kA bhI AbhAra vyakta karatA huuN| prathama saMskaraNa ke jaise hI isameM bhI merI dharmapatnI cetanA zAha ne suMdara TAima menejamenTa kiyA aura usameM vizeSa rasa lekara salAha-sUcana bhI diye hai / snehI zrI upendra divyezvara ne satata anusaraNa kara isa saMskaraNa ke prakAzana meM sakriya rasa liyA hai jise maiM saharSa svIkAra karatA huuN| isake uparAMta sIniyara DaoNkTaroM, zubhecchakoM, mitroM aura vivecako ne isa saMskaraNa meM salAha-sUcana dekara mujhe satata protsAhana aura preraNAbala diyA hai, isalie ve bhI AbhAra ke pAtra haiM / zrI mudreza purohita (sUryA oNphaseTa) ne bhI isameM rasa lekara suMdara mAvajata aura sahakAra se isa pustaka kA dvitIya saMskaraNa taiyAra kiyA hai / maiM unakA bhI AbhArI hU~ / sAtha hI sAtha isa pustaka ke prerakabala mere marIz2a bhI kaise bhulAyeM jA sakate hai ? aMta meM ikkIsavIM zatAbdi meM sabhI kA svAsthya uttama rahe aisI paramakRpAlu paramAtmA se prArthanA karatA huuN| Do. sudhIra vI. zAha ema. DI., DI. ema. (nyUrolojI) 'mahAzivarAtri' saMvata 2057, mahAvada terasa tA. 21 pharavarI, 2001 ahamadAbAda.

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gujarAtI dUsare saMskaraNa stAvanA bhojana ke pUrva opeTAijara kA jo mahatva hai aisA hI mahatva pustaka par3hane se pahale prastAvanA kA hotA hai| donoM kA kAma bhUkha ko udIpta karanA, utsukatA jagAnA aura sabala pUrvabhUmikA racita karanA hai / isa saMdarbha meM samajhadArI paidA karane ke lie prastAvanA par3hanA jarUrI hai / bImArI Ae taba svAbhAvika hai ki marIz2a aura usake saMbaMdhI bar3I musIbata aura duvidhA meM par3a jAte hai / aba kyA hogA? kucha anacAhA to nahIM banegA? jIvanabhara kI parataMtratA to nahIM A jAegI? aise kitane hI prazna marIz2a aura unake saMbaMdhIoM ko ulajhAe rahate hai / bImArI kI asara kramazaH dikhAI detI hai, taba kI bAta alaga hai; paraMtu lakavA jaisI bImArI hamale ke rUpa meM acAnaka AkramaNa kareM taba marIz2a aura kuTuMbIjanoM ke jIvana meM asthiratA A jAtI hai aura kitane hI vicalita kara dene vAle praznArtha cihna ubhara kara sAmane A jAte hai / bImArI ke bAre meM ajJAnatA aura mukhyataH usake bAre meM galata aura bhrAmaka mAnyatAyeM aura 'mujhe kucha hogA to nahIM ?,' 'maiM kabhI bImAra to nahIM paDhUMgA?' aise AMtarika bhaya paristhiti ko jyAdA kharAba kara dete hai| usameM marIz2a aura unake kuTuMbIjanoM kA koI doSa nahi hotA kyoMki apanI zikSaNapaddhati aura sAmAjika saMracanA meM Arogya kI dekharekha kisa prakAra karanI cAhie aura usakA rakSaNa kaise karanA aura bImArI ke bAre meM samagra jAnakArI, gaMbhIra bImAriyoM kA prAraMbhika lakSaNa-cihna kaise hote hai aura use dhyAna meM na le to kaisA duHkhada pariNAma A sakatA hai va bImArI lAgU par3a jAe taba usake lie Avazyaka mAnasika-Arthika Ayojana ke bAre meM skUla-mahAvidyAlayoM meM yA anya kisI mAdhyama dvArA sIkhane kA koI saMgaThita, buddhigamya aura pariNAmalakSI prayatna huA nahIM hai aura isake bAreM meM kucha bhI samajhAyA - sikhAyA nahIM jAtA / (vartamAna samaya meM apane rASTra ke kula bajaTa kA eka pratizata hissA hI svAsthya rakSaNa ke lie diyA jAtA hai / ) gain Education International

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bImArI lAgU paDe taba DaoNkTara ke pAsa daur3ane se acchA hai ki bImArI hI na ho aura ho jAya to prAraMbhika stara para hI samajhakara yogya upacAra se use dUra karane kI sUjha sAmAnya manuSya aura kathita par3he-likhe vyaktioM meM kyoM nahIM hotI hai ? usake bAre meM apanI dekharekha saMsthA, samAja jAgati saMsthA apanI jimmedArI nibhAtI hai yA nahIM ? samAcArapatra aura sAmayika bImAriyoM ke bAre meM vAcakoM ko mAhitagAra karane ke prayatna karate rahate haiM paraMtu kitanI bAra usake ulTe pariNAma dekhane ko bhI milate hai / kisI vartamAnapatra yA sAmayika meM ArogyalakSI lekha ke lie niSNAta cikitsaka ko kAyamI saMpAdaka yA salAhakAra niyukta kiyA gayA ho aisA Apane sunA yA dekhA hai ?! aisI paristhiti meM vividha rogoM ke bAre meM mAhitI-pustikA upalabdha karavAI jAeM to eka bar3I samAja sevA mAnI jAegI / isalie hI mazahUra nyUrophijiziyana DaoN. sudhIrabhAI vI. zAha kA likhA huA 'mastiSka aura jJAnataMtu kI bImAriyA~' nAma kA yaha pustaka eka AzIrvAda samAna hai aisA kaheM to usameM koI atizayokti nahIM hogI / jaba purAnI bImArI phira se ubhare aura naI bImArI phaila cUkI ho to aise vakta para jo cikitsaka ko marIz2a aura usake kuTuMbIjanoM kI ciMtA ho aura jinake hRdaya meM marIjoM aura sAmAnya janatA kA hita basA ho vahI cikitsaka hI apanI vyasta dinacaryA meM se pustaka likhane ke lie samaya nikAla sakatA hai aura rAtri ko jAga kara bhI apanA kAma pUrA karatA hai / isase bhI vizeSa vaha apane jeba se Arthika kharca karake use prakAzita karatA hai / 'maiM akelA kyA kara sakatA hU~?' aise nakArAtmaka, nirAzAvAdI vicAra ke viruddha 'cala akelA' ke siddhAMta ko apanAte DaoN. sudhIrabhAI ne isa dizA meM prathama kadama rakhA hai| isa pUrvabhUmikA ko samajhane ke bAda aba pustaka kI bAta karate hai / itanA to ni:saMkoca kahanA hI par3egA ki marIz2oM, unake parivArajanoM aura samagra janasamudAya ko mastiSka-jJAnataMtra kI vividha bImAriyoM ke bAre meM

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Avazyaka jJAna parosane meM vizeSajJa DaoN. sudhIrabhAI ko saMtoSajanaka saphalatA milI hai| bhojana kI vividha vAnagI pauSTika hone ke sAtha sAtha supAcya aura svAdiSTa bhI honI caahie| isa prakAra lekhaka ko bhI isa bAta kA dhyAna rakhanA par3atA hai / DaoN. sudhIrabhAI kI yaha pustaka ko par3hane ke bAda lagatA hai ki isa bAta kA pUrA dhyAna rakhA gayA hai / prastutIkaraNa kI saralatA, jAnakArI kI pracuratA, likhane kI lokabhogya zailI aura bhASA para pakar3a ke kAraNa pustaka adbhuta aura suMdara bana pAyA hai / anAvazyaka pAMDitya kA bojha nahIM hone ke kAraNa sAmAnya mAnavI ko samajha na AnevAlI jaTila bImAriyoM ko sahajatA se nirupita kiyA gayA hai, jo eka bar3I siddhi mAnI jAegI / aise to lagabhaga sabhI prakaraNa kuzalatA aura sakSamatA se likhe gaye haiM phira bhI mUrchA, lakavA, smRtibhraMza, vAI aura tanAva ke prakaraNa sarvopari hai| isake sAtha sAtha yaha bhI khAsa batAnA cAhU~gA ki yaha koI sAmAnya pustaka nahIM haiN| paraMtu lekhaka kA vividha bImArI ke bAre meM anubhava aura unake jJAna kA paripAka hai / isake uparAMta sAmAnya janatA ke lie lekhaka kI asAmAnya anukaMpA, bodha, ciMtA aura zubha bhAvanA kA pratibiMba hai / gujarAta meM, zAyada bhAratabhara meM, isa viSaya se saMbaMdhita sAmAnya prajA ko sparza karanevAlI yaha prathama pustaka hai / yaha pustaka jitane prema se likhI gaI hai utane hI prema se marIjoM, unake parivArajanoM, cikitsaka tathA nasiMga vyavasAya ke sadasyoM tathA gujarAta va anya prAMtoM meM tathA paradeza meM basane vAlI jAgRta, buddhijIvI prajA ko use saharSa svIkAra kara lenA caahie| DaoNkTara sirpha paisA kamAnA jAnate hai, isa prakAra kI TIkA-TippaNI karanevAle mahAnubhAvoM ko unakA abhiprAya badalanA par3egA aisA merA mAnanA hai| marIz2oM ke Arogya kI vividha prakAra se salAmatI aura zreya kI ciMtA nahIM hotI to isa pustaka ko likhane ke lie DaoN. sudhIrabhAI para kisIne dabAva nahIM DAlA thA phira bhI unhoMne svayaM hI isakI javAbadArI uThAkara zubha bhAvanA se prerita hokara suMdara, saphala aura upayogI pustaka prasiddha kiyA

Page #17
usake lie maiM unheM hArdika abhinaMdana dete hue AnaMda kA anubhava karatA huuN| phira bhI bhojana kI ekapakSIya prazaMsA karane kA koI artha nahIM hai| antataH to bhojana kI isa vAnagI ke svAda ko cakhane ke bAda hI vAcaka ko usakI guNavattA sunizcita karanI hai| maiM to apanI tarapha se itanA hI kaha sakatA hU~ ki Apa nirAza nahIM hoMgeM balki Apako kucha milane kI paritRpti jarUra hogii| makarasaMkrAMti di. 14-1-2001 ahamadAbAda - 380 007 ___ DaoN. guNavaMtarAya jI. ojhA ema. DI.

Page #18
anukramaNikA .......... .......... .. ... . . . cetAtaMtra saMbaMdhita prAraMbhika mAhitI (Information about Nervous System) ... 2 mastiSka kI reDiyolojI kI jA~ca (Neuroradiology). mUrchA (Coma)................ mirgI ke daure (Epilepsy) ... pakSAghAta-lakavA ( perelisisa) (Stroke) mastiSka meM raktastrAva (Brain Hemorrhage) .. AdhAzIzI aura anya siradarda evam varTigo (Migraine, other headaches & vertigo)............ mUvamenTa DisorDarsa evam DisToniyA (Movement disorders & dystonia) ... kaMpavAta (Parkinsonism).... smRtibhraMza-matibhraMza; aura yAdadAsta bar3hAne ke upAya (Dementia & tips to improve memory)................ 11 nidA-vikAra aura upacAra (Sleep Disorders).. ........................ 129 12 mastiSka kI saMkramita bImAriyA~ (CNS Infections) .................................... 143 13 eIDsa (cetAtaMtra para usakI asara) (AIDS-its effects on Nervous system)................ 163 105 ... .. .. . . ..... .. ... .. .. ... ... 10 115

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.... 171 ....211 .44 14 mastiSka meM honevAlI gAMTha (Brain Tumour)... 15 seribrala pAlsI (Cerebral Palsy).... .... 179 16 karor3arajju ke roga (Myelopathy).... .. 187 17 malTipala sklerosisa (Multiple Sclerosis) ... ...197 18 moTara nyUrona DisIja (Motor Neuron Diseases)... 205 19 nyUropathI (Neuropathy). 20 mAyastheniyA grevisa (Myasthenia Gravis) 225 snAyu kI bImAriyA~ (Myopathies) ... ....... ............. 231 22 tanAva-Tenzana (Stress) ................. 243 mastiSka kI zastrakriyA (Neurosurgery)......... 253 dIrgha samaya taka upayoga kI jAne vAlI nyUrolojI kI davAI saMbaMdhita mAhitI (Neurological Medicines to be used for longer duration).............. ................. 263 25 aspatAla meM bhartI kie hue marIz2a saMbaMdhita jarUrI sUcanAeM / (Tips for a hospitalised patient) ... marIz2a ke lie mAhitI mArgadarzikA Patient Information Guide..... 283 1 23 .. 271

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cetAtaMtra saMbaMdhita pAra (Informatio mAhitI ystem) mastiSka, karoDarajju aura usameM se nikalane vAlI cetAe~ aura snAyuoM tathA anya avayavoM ke sAtha unakA saMkalana - isa saMpUrNa kAryaracanA ko cetAtaMtra yAnI ki "narvasa sisTama' (Nervous System) kahA jAtA hai| manuSya anya prANiyoM se viziSTa aura utkRSTa hai, usakA ekamAtra kAraNa manuSya kI cetAtaMtra kI racanA aura usakI paddhati hai / mukhyataH mastiSka kA korTeksa (mastiSka kI bAhara kA halke bhUre (Grey) raMga kA paDa) ativikasita aura jaTila hotA hai| hAlA~ki manuSya ke anya aMga anya prANiyoM jaise yA unase nimnastara ke hote hai, paraMtu korTeksa kI vajaha se unheM ananya buddhicAturya, tarkazakti, zabdazakti aura smaraNazakti prApta huI hai| isa korTeksa meM lagabhaga 100 araba nyUronsa (cetakoSikA) hote haiM / eka aMdAja anusAra sAmAnya manuSya apane mastiSka kA sirpha 3 se 5 pratizata upayoga karatA hai| madhyama manuSya mastiSka kA lagabhaga 5 se 10 pratizata upayoga karatA hai, paraMtu jIniyasa yAni vilakSaNa manuSya mastiSka kA vizeSa upayoga karatA hai| isa para se jAna sakate hai ki manuSya apane mastiSka kA jitanA adhika sadupayoga kareM, vaha utanA adhika sarvopari bana sakatA hai / vayaska manuSya ke mastiSka kA vajana lagabhaga 1200 se 1400 grAma jitanA hotA hai / isa taraha hamArA mastiSka zarIra ke kula vajana kA mAtra eka se do pratizata hissA hI hotA hai / lekina zarIra ko milanevAlI prANavAyu kI lagabhaga 25 pratizata ApUrti aura glUkoz2a kI 70 pratizata ApUrti mastiSka ko Avazyaka hotI hai / nimnastara ke karoDarajjuvAle prANiyoM ke pAsa mastiSka jaisA vikasita aMga nahi hone kI vajaha se unake kArya preraNA AdhArita hote hai| isalie unameM saMvedanA nahIM hotI hai, jaise ki makkhI Adi / bar3e mastaka vAle adhika

Page #21
mastiSka aura jJAnataMtu kI bImAriyA~ buddhizAlI hote hai aisA nahIM hai, kada ke pramANa se jyAdA mastiSka kI racanA adhika mahatvapUrNa hotI hai| mastiSka kI bAhara kI sapATI halke bhUre (Grey) raMga kI hai jise korTeksa (Cortex) kahA jAtA hai / aura aMdara kA bhAga - hissA sapheda raMga kA hotA hai use vhAiTa meTara (White matter) kahA jAtA hai| mastiSka khopar3I meM surakSita DhaMga se saMbhAlA huA hai aura gharSaNa na ho aura kucha aMza taka rakSaNa ho isalie usa para tIna prakAra ke AvaraNa hote haiM / jise 'menenjijha' kahA jAtA hai, vaha hai - AG SA Cerebrum' Pituitary Gland piTyuITarI graMthi Cerebrum - bar3A mastiSka D - DyUrA meTara A - erekanoiDa meTara SA - saba erekanoiDa spesa AG - erekanoiDa grenyulezana c - choTA mastiSka cc - korpasa kelojhama Lv - leTarala venTrikala V3 - tharDa ( tIsarA) venTrikala v4 - phortha (cauthA) venTrikala AS-ekviDakTaopha silviyana

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1 - cetAtaMtra saMbaMdhita prAraMbhika mAhitI (Information about Nervous System) 3 dura mater (bAhara), arachnoid mater (bIca meM) aura pia mater (aMdara) / isake saMkramaNa (inphekzana-cepa) ko meninjAiTisa kahA jAtA hai, jaise ki TI.bI. meninjAiTisa / mastiSka ke aMdara kI thailiyoM ko ventricles kahA jAtA hai / do lateral ventricles, eka third ventricle aura eka fourth ventricle, isa prakAra kula cAra thailI hotI haiM / ina thailiyoM meM rahanevAle pAnI jaise pravAhI ko C.S.F. (serIbro spAInala phluIDa) kahA jAtA hai| vaha mastiSka se karor3arajju ke aMdara bIcobIca eka sire se dUsare sire taka hotA hai / usake alAvA vaha mastiSka aura karor3arajju ke bAhara ke AvaraNa meM bhI hotA hai / usa vajaha se mastiSka meM honevAlA saMkramaNa yA brena hemareja vagairaha ke bAre meM karor3arajju meM se pAnI nikAlakara Lumbar Puncture dvArA AsAnI se jAnA jA sakatA hai| isa C.S.F. kA kArya mastiSka meM cayApacaya (metabolism) meM madada karane se lekara mastiSka meM gharSaNa ghaTAne taka kA hai| mastiSka ke koSa ke atyAdhika mahatvapUrNa aura jaTila kArya kI vajaha se use adhika poSaNa aura prANavAyu kI jarUrata par3atI hai| isalie use rakta kI teja aura adhika ApUrti milanI caahie| yadi rakta aura prANavAyu kA bhramaNa korTeksa meM pAMca minaTa se jyAdA samaya taka ruka jAe yA baMdha ho jAya to usakA kArya hamezA ke liye baMda ho jAtA hai; aura manuSya kI jIvanalIlA samApta ho sakatI hai / * mastiSka ko tIna hissoM meM vibhAjita kiyA jA sakatA hai: (1) khopar3I ke bar3e bhAga ko rokane vAlA bar3A mastiSka (cerebrum) / jisake do hisse haiM, dAyA~ aura bAyA~ / ina donoM ke bIca saMkalana karatA huA kaoNrpasa kelojhama hotA hai| (2) choTA mastiSka (Cerebellum) jo khopar3I ke pichale hisse meM hotA hai, vaha bhI dAyeM aura bAyeM do hissoM meM hotA hai| usakA mukhya kArya zarIra kA saMtulana banAye rakhane kA hai|

Page #23
mastiSka aura jJAnataMtu kI bImAriyA~ (3) donoM mastiSka ke bIca ko jor3atI paTTI yA kar3I ko brenasTema kahA jAtA hai / jisameM mid brain, pons (majjAsetu) aura medulla oblongata (laMbamajjA) hote hai / yaha karor3arajju meM sIdhe taura meM parivartita ho jAtA hai / Cerebellum Cerebrum - C.v. Cerebrum - bar3A mastiSka C - choTA mastiSka CC - korpasa kelojhama GP - globasa peliDsa Put puTAmena LN - lenTiphorma nyUkliyasa H- hipokempasa IC - inTarnala kepsyUla c.c. L.N. S.P. I.C. 1 - insyUlA - ponsa P M- meDyUlA PL - perAiTala loba TL - Temporala loba LV - leTarala venTrikala 3V - tharDa venTrikala SP- sepTama pelusiDama kAryaracanA kI dRSTi se bar3A mastiSka cAra hissoM meM hotA haiM : (1) phranTala (Age kA hissA) loba (Frontal) (2) perAiTala ( bagala kA upara kA ) loba (Parietal) (3) Temporala (bagala kA nIce kA ) loba (Temporal) (4) oksipiTala ( pIche kA) loba (Occipital)

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1 - cetAtaMtra saMbaMdhita prAraMbhika mAhitI (Information about Nervous System) 5 dAhinA mastiSka zarIra ke bAyeM aMgoM kI kAryazIlatA ke lie jimmedAra hotA hai| isa prakAra bAyA~ mastiSka dAhine aMgoM aura vizeSataH bhASA dvArA abhivyakti kI kSamatA ke lie jimmedAra hotA hai / phranTala loba adhikAMzataH viruddha dizA ke hAtha-paira ke halana-calana aura manuSya ke vyaktitva aura vyavahAra ke lie jimmedAra hotA hai| perAITala loba zarIra kI viruddha dizA kI saMvedanA kA vizleSaNa karatA hai tathA gaNita Adi zaktioM ke sAtha jur3A hotA hai / Temporala loba aura limbika sisTama mAnava kI yAdadAsta aura svAbhAvika mUlabhUta vRttiyA~ (instincts), saMvedanA (emotions) aura kucha vyaktioM ke matAnusAra sixth sense jaisI gUr3ha (perAITala loba) (phanTala loba) / (mastiSka kA vANI kendra bhAga-2) mastiSka kA vANI kendra bhAga-1). (oksipiTala loba) (Temporala loba) ___(majjAsetu) (laMbamajjA) (choTA mastiSka) mastiSka (karoDarajju) zakti kA sthAna ho sakatA hai / zravaNazakti kA sarvopari kendra bhI vahA~ hai| oksipiTala loba draSTi aura mastiSka kA vizleSaNa kendra hai / dAhine hAtha se kAma karanevAle (likhanA, khAnA aura pheMkanA Adi) vyakti kA bAyA~ mastiSka prabhAvI hotA hai aura usameM mukhyataH bhASA aura dUsare anya mahatva ke kendra hote haiM / isa kAraNa isa (bAyA~) mastiSka ko Teknikala breIna (tAMtrika mastiSka) kaha sakate hai / dAhinA mastiSka saMvedanazIlatA, sarjanAtmakatA Adi ke sAtha jur3A huA hotA hai| yaha samajhane kI bAta hai ki vicakSaNa loga dAhine mastiSka kA vizeSa upayoga karate haiN|

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mastiSka aura jJAnataMtu kI bImAriyA~ mastiSka meM mana kahA~ hotA hai usa bAre meM koI ekamata nahIM hai / eka matAnusAra pratyeka koSa meM mana hai / anya matAnusAra Temporala loba, limbika sarakiTa meM yA piniala graMthi meM mana kA prasthApana kiyA gayA hai / vAstava meM to mana kA koI eneTomikala - bhautika prasthApana nahIM hai / lekina vaha eka bAyokemikala - jaivika - rAsAyaNika aura ilekaTromegneTika jaTila prakriyA hai / usake bAre meM yathAyogya jJAna manuSya ko upalabdha nahi huA hai, yaha tabIbI vijJAna kI eka maryAdA hai / jo bAta mana ke bAre meM kahI jAtI hai vaha AtmA ke bAre meM bhI kaha sakate hai / 6 isake uparAMta mastiSka meM thalamus aura basal ganglia nAmaka mahatvapUrNa koSa kendra hote hai jise ekasTrApirAmiDala sisTama kahate hai, aura usameM honevAle rAsAyanika asaMtulana kI vajaha se pArkinsonijhama (Parkinsonism) (kaMpavA) yA usake viparIta koriA (Chorea), DisToniA (Dystonia) jaise roga hote hai| isakI vistRta jAnakArI cepTara 8 aura 9 meM dI gaI hai / usI prakAra hAipothelemasa eka mahatvapUrNa aMga hai jo simpetheTika (sympathetic) aura perAsimpetheTika cetAtaMtra kA mahattama aMkuza rakhanevAlA sthAna hai / yaha taMtra anaicchika snAyuoM aura sTresa Adi bhautika kriyAoM ke sAtha jur3A hai / hRdaya kI dhabakAra, AMkha kI putalI, blaDaprezara, zvAsocchavAsa Adi aneka atyAdhika mahatvapUrNa kriyAoM kA niyamana isa prakAra kI narvasa sisTama karatI haiM, jo svayaMsaMcAlita hai / aMtaHsrAvI graMthioM kA mAsTara kaMTrola uccatama niyamana sthAna piTyuTarI graMthi hai aura vaha mastiSka meM hai / vaha zarIra kI tamAma hormonasisTama kA adbhuta niyamana karatI hai / isake uparAMta mastiSka aura cetAtaMtra meM saMdeza kA AdAna-pradAna karane ke lie DopAmina, noraeDrinAlina, gAbA, siroTonina, esiTAila kolina, enDorphina, ensephelina jaise mahatvapUrNa nyUroTrAnsamITara aura unake risepTara kA adbhuta neTavarka prasthApita huA hai /

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1 1 - cetAtaMtra saMbaMdhita prAraMbhika mAhitI (Information about Nervous System) 7 mastiSka meM se pratyeka bAju se bAraha (yAni kI bAraha jor3a) cetA-raga (Nerves) nikalatI hai / use krenIala narsa (Cranial Nerves) kahA jAtA hai / vaha atyaMta mahatvapUrNa kAma karatI hai / jaise kI gaMdha, draSTi, cahere ke snAyu aura jivhA kA halanacalana ityAdi / prathama cetA ko olfactory nerve kahate hai, jo gaMdha saMbaMdhita jAnakArI mastiSka ko detI hai / dUsarI cetA ko optic nerve kahA jAtA hai, jo draSTi saMbaMdhI jJAna mastiSka ko pahu~cAtI hai / aura usakA udbhava sthAna A~kha kI reTinA (paradA) hai / use nukasAna ho to draSTi kI bImArI hotI hai, aMdhatva bhI A sakatA hai| tIna, cAra aura chaha: naMbara kI cetA ko kramazaH okyulomoTara (Oculomotor), TrokalIara (Trochlear) aura ebDayusansa (Abducens) kahA jAtA hai / yaha tIna cetAe~ A~kha kI goTIoM ko ghumAnevAle snAyuoM ko cetAnvita karatI hai / jinameM se eka bhI nasa ko asara ho to A~kha tirachI TeDhI ho jAtI hai aura eka ke badale do-do (Dabala) drazya dikhAI de aisA bhI ho sakatA haiM / pAMca naMbara kI cetA ko TrAijeminala (Trigeminal ) kahA jAtA hai, usake kAma meM takalIpha ho to mu~ha - jabar3e ke snAyu kamajora ho jAte hai athavA mastiSka para kI saMvedanA kA yogya pRthakkaraNa nahIM hotA hai yA atyaMta vedanA hotI hai / use TrAijeminala nyUrAljiA kahA jAtA hai, (dekheM prakaraNa 7) / jihvA para se svAda kI jAnakArI isa nasa ke tahata mastiSka ko pahu~catI hai / sAta naMbara kI cetA ko phesiyala (Facial) narva kahA jAtA hai / usakA lakavA ho to mu~ha TeDhA ho jAtA hai / usa tarapha kI A~kha baMda nahIM ho sakatI hai / isa pracalita bImArI ko 'belsa pAlsI' (Bell's Palsy) ke nAmase jAnA jAtA hai / -

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. . mastiSka aura jJAnataMtu kI bImAriyA~ ATha naMbara kI raga (vestibulocochlear) vesTIbyulo kokalIara hai / use kSati pahu~ce to baharApana athavA zarIra ke asaMtulana kI bImArI hotI hai| varTigo (cakkara AnA) sAmAnyata: usa cetA meM honevAlI gaDabaDa se hotA hai / nava aura dasa naMbara kI raga ko kramazaH (Glossopharyngeal) glosopherinjIala aura vegasa (Vagus) kahA jAtA hai, jisakA mukhya kAma khurAka ko nigalanA aura svarapeTI ke snAyuoM ko yogya DhaMga se kAryarata karanA hai| mukhyataH vegasa nasa zarIra kI aneka anaicchika kriyAoM para niyaMtraNa karatI hai, usa vajaha se vaha Autonomic nervous system kA mahatvapUrNa aMga hai / gyAraha naMbara kI raga gale ke svaicchika snAyuoM para niyaMtraNa karatI hai, jaba kI bAraha naMbara kI Hypoglossal (hAyapoglosala) Nerve jihvA ke snAyuoM kA yogya halanacalana karatI hai / / yaha bAraha rageM mastiSka meM yogya aura nizcita sthAna se nikalatI hai aura niyata mukAma para pahu~catI hai| jo raga saMvedanA vahana karatI hai, use Sensory nerve kahate hai aura vaha nizcita aMga (jaise ki kAna - A~kha) meM se nikalakara mastiSka meM pahu~catI hai / jabaki mastiSka meM se jo AjJA snAyuoM para le jAtI hai (jaise ki A~kha ke snAyu, mu~ha ke snAyu) use motor nerve kahA jAtA hai / ___zarIra ke halana-calana kI gatividhiyA~ tIna cetAsamUha (Systems) se hotI hai / jo cepTara 8 meM vistRta tarIke se batAI gaI hai / mastiSka ko eneTomI (zArIrika racanA) kI dRSTi se samajhane ke bAda usakI vizeSatAoM ke bAre meM jAne / yaha vizeSatA hI mAnava ko sabhI prANiyoM meM sarvopari banAtI hai| mastiSka ke koSo meM eka prakAra kA sUkSma vidyutapravAha nikalatA rahatA hai jisameM eka sAtatya hotA hai, laya hotI hai / yaha eka vidyutakIya prakriyA hai / ___ yaha pravAha rAsAyanika DhaMga se eka koSa meM se dUsare koSa meM pahu~catA hai aura saMpUrNa narvasa sisTama meM nyUroTrAnsamITara aura risepTara kA

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1 - Fancier waifera orifete Haferit (Information about Nervous System) 9 ajIba sA neTavarka hai, jo sekaMDa ke 1000 ve bhAga meM eka jAnakArI ko eka bhAga se dUsare bhAga taka pahu~cA sakatA hai / yaha eka rAsAyanika prakriyA hai / mastiSka ke koSa anya koSoM ke jaise hI apane cayApacaya ko saMbhAlate hai / yaha eka jaivika (bAyolojikala) prakriyA hai / vicAra, buddhi, vivekazIlatA, yAdadAsta aura sarjanAtmakatA jaise ativikasita upakaraNa - avadhAna mastiSka ko mile hue hai aura usake sAtha sAtha hamadardI, krodha, pasaMda-nApasaMda aura prema jaisI saMvedanazIlatA apane mastiSka ko milI hai / mukhyataH AhAra, nidrA, bhaya jaisI mUlabhUta svAbhAvika vRttiyAM (instincts) mastiSka ko upalabdha hai / dRSTi, svAda, gaMdha, sparza aura zravaNa jaisI jJAnendriya mastiSka meM tainAta hai| bhASA ke dvArA hama eka dUsare ke sAtha saralatA se vicAroM kA AdAnapradAna kara sakate hai / hama jise 'mana' kahate hai vaha bhI mastiSka kA hI bhAga nahIM hai kyA? hAlAMki bhautika rUpa se hRdaya (dila) chAtI meM hotA hai / paraMtu kavi jisa saMvedanAtmaka hRdaya kI bAta karate haiM usake bAre meM socane se aisA lagatA hai ki vaha sacamuca to mastiSka kI hI bAta karate hai| mAnavasarjita kisI bhI supara kampyUTara meM kabhI bhI hama aisI ummIda rakha sakate hai ? Azcarya isa bAta kA hai ki apane mastiSka ke bAre meM apanA mastiSka hI soca sakatA hai, vizleSaNa kara sakatA hai, hAlA~ki hameM kisane banAyA hai, isakI kalpanA bhalIbhA~ti hama kabhI kara nahIM pAte haiM / mastiSka meM paidA hone vAle vidyuta-taraMgoM ko I.I.jI. (E.E.G.) dvArA jAnA jA sakatA hai| mastiSka ke pichale hisse meM se jAgRta avasthA meM A~kha baMda kara ke jisa vidyutakIya prakriyA ko mahasUsa kiyA jA sakatA hai use AlphAtaraMga kahA jAtA hai / usakI taraMga saMkhyA 8 se 13 Hz hotI hai / eka dama Age ke phranTala korTeksa para se sAmAnyataH bITA taraMga 14 se 40 Hz jitanI hotI hai /

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10 mastiSka aura jJAnataMtu kI bImAriyA~ thITA taraMga 4 se 7 Hz kabhI-kabhI Temporala bhAga meM milatI hai, aura baccoM meM vaha adhika vikasita hotI hai / DelTA ekTiviTI - yaha vayaska vyakti meM jAgRta avasthA meM hamezA ebanormala hotA hai aura kabhI-kabhI nidrA meM vaha baccoM meM dekhA jAtA hai / aise to sAmAnyataH DelTA prakriyA mastiSka kI kisI bImArI kI nizAnI hotI hai| jinako vivaraNa pasaMda hai, unake lie nimna gadyAMza kAphI rasaprada rhegaa| prAthamika ghaTaka - cetAkoSa aura cetAoM kA saMyojana jaise ki batAyA gayA hai, cetAtaMtra meM mastiSka, karor3arajju, usameM se nikalane vAlI cetAe~ aura snAyuoM ko saMdezA pahuMcAne vAlI nasoM kA samAveza hotA hai (Central and Peripheral Nervous System) / manuSya ke mastiSka kA vajana lagabhaga 1200 se 1400 grAma hai, paraMtu usameM lagabhaga 100 araba cetakoSikAe~ hotI hai| cetakoSikAoM kI saMkhyA bhale hI AkAzagaMgA meM rahe tAroM jitanI ho, lekina sirpha vohI mastiSka kI jaTilatA ko darzAtI nahIM hai / isa jaTilatA meM cetAkoSoM kI vividhatA kA bhI mahatvapUrNa yogadAna hai, jisake bAre meM prasiddha nyUrAeneTomisTa remana vAya. kejala ne sahI hI kahA hai ki "the mysterious butterflies" | cetakoSikA mastiSka kA prAthamika ghaTaka hai / cetakoSikA ke tIna mukhya bhAga hai - koSa aura koSakendra, DenDrAITsa - jo anya cetAkoSikAoM se saMdezA lAte haiM aura ekjhona - jo anya cetAkoSikAoM ko saMdeza pahu~cAte hai| nyUrona uttejita hokara vidyutIya taraMgoM dvArA dUsare nyUronsa Cell Body | ko saMdeza pahu~cAte hai, jise ekzana poTenziyala kahate hai| yaha saMdeza taraMgo kI taraha ekjhona para Age baDhate hai aura do koSoM ke bIca ke jor3a - sAyanepsa Dendrites

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1 - Etancia Fafera urifah Hiletit (Information about Nervous System) 11 para rAsAyaNika saMdeza ke rUpa meM parivartita hote hai / jaba taraMgeM prisAyanepTika nyUrona ke ekjhona para pahu~catI hai, vahA~ nyUroTrAnsamiTara (rAsAyaNika padArtha) kA srAva hotA hai, jo Age prasArita hotA hai aura vaha posTasAyanepTika membrena meM risepTara se jur3atA hai| jisakI vajaha se Ayana cenaleM khulatI hai aura posTasAyanepTika cetAkoSikA meM ekzana poTenziyala utpanna hotA hai / saMkSipta meM, isa taraha se cetAkoSikAe~ saMdeza kA AdAna pradAna karatI hai| Chemical synapse dendrite neuro V detstrite 1660 Hansmitorg G synapik THA vesicle prasteynoptics Teceptor cell - - Homethin ax.an cell body .... ... Resi mayesi sheath mastiSka meM vividha prakAra ke nyUroTrAnsamiTara pAe gae hai / aura isa vividhatA kA mastiSka ke kArya meM kAphI yogadAna hai / isa stara kA sAyanepTika levala kA pRthakkaraNa mukhyataH mAnasika aura mastiSka rogoM meM kAphI upayogI hai, jo dimAga ke kAryoM para prakAza DAlatA hai| socane aura kisI vizeSa prakAra ke vartana ke rAsAyaNika AdhAra kA vistRta adhyayana, cetAoM ke saMgaThana ke vividha staroM kI vistRta jAnakArI prApta karane se ho sakatA hai, jo kI mastiSka se lekara vividha staroM se hotI huI aNuoM taka pahuMcatI hai| isase hama ye bhI samajha pAte haiM ki hama jo bhI socate haiM, jo bhI zabda bolate haiM, jo bhI vartana karate haiM, vo hara eka bAta dimAga se paidA hotI hai, aura hara eka kA sAre zarIra ke sabhI taMtro aura

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mastiSka aura jJAnataMtu kI bImAriyA~ koSoM para kucha na kucha asara-prabhAva hotA hI hai / isIlie acche se acchA socanA cAhie, acchA bolanA cAhie aura zreSTha kalyANakArI vartana hameM karanA cAhie / cetA saMgaThana ke vividha stara : | vartana Behaviour | taMtra Systems jAlAkAra vinyAsa Networks cetA Neurons sAyanepsa Synapses | rAsAyaNika padArtha Molecules janIna Genes ina sabhI saMzodhanoM ke stara para mukhya AviSkAroM kI vajaha se jo anusaMdhAna hue hai, usa se cetA vijJAna druta gati se UparI stara para ubharA hai, jo ki eka tarapha - manocikitsA se lekara ANvika cetA vijJAna (molecular neurobiology) aura cetA janIna vidyA (neuro-genetics) taka vistRta hai| yaha saba saMzodhana mAnasika aura nyUrolojikala rogoM kI sAravAra meM bahuta upayogI ho rahe haiN| itanA samajhane ke bAda mastiSka aura cetAtaMtra ke rogoM ke vargIkaraNa ke bAre meM dekhate hai / (1) mastiSka kI cetanA meM vikSepa-badalAva AnA : (Altered Consciousness) komA (behozI) ityAdi

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1- cetAtaMtra saMbaMdhita prAraMbhika mAhitI (Information about Nervous System) 13 (2) mastiSka meM adhikatara vIja pravAha paidA honA : epilepsI (3) mastiSka meM rakta kI pUrti baMda honA : sTroka - perelisisa mastiSka meM rakta kI nalI kA phaTanA : hemareja (raktasrAva) (4) mastiSka jakhma : injarI, TromA (jakhma) jaise ki kaMkazana aura kanTyU jhana (5) mastiSka meM gAMTha honA : breina Tyumara (6) mastiSka ke saMkramita roga : meninjAiTisa, parU kI gAMTha (7) mastiSka ke vAirasa ke roga : ensephelAiTisa, eIDsa (AIDS) (8) mastiSka ke vhAiTa meTara ke roga : DimAIlineTiMga DisIja, udAharaNa - malTipala skle rosisa (M.S.) (9) mastiSka meM poSaNa se saMbaMdhita tathA aMta:srAva yA cayApacaya ke roga : meTAbolika ensephelopathI (10) janma se hI vikalAMgatA ke kAraNa mastiSka kI bImAriyA~ janInoM se vahana hote vArasAI roga (11) mastiSka koSoM kI vikRti-vinAza se hone vAle roga : pArkinsonijhama, Aljhemara DimenziyA tathA anya aisI bimAriyA~ (12) karor3arajju ke roga (13) nyUropathI arthAt jJAnataMtuoM ke roga (14) snAyu ke roga (15) mAyestheniA grevisa Adi

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mastiSka aura jJAnataMtu kI bImAriyA~ mastiSka ke uparyukta rogoM ko nyUrolojikala DisaorDarsa kahe jAte haiM / isakA upacAra nyUrolojisTa yA koI bhI sakSama phijiziyana kara sakatA hai / mana kI bImAriyA~ yA roga ko sAikiyATrika DisaorDarsa kahate haiM / jisameM mukhyataH Diprezana, enkajhAiTI, sAikosisa, nyUrosisa, parsanAliTI problema aura manojAtIya roga ityAdi zAmila hai| ina sabhI bImAriyoM kA nidAna niSNAta sAyakiyATrisTa ke pAsa karavAnA caahie| sAmAnyataH sAikiyATrika bImAriyoM meM sI.TI. skana, I.I.jI. aura lambara paMkcara ityAdi jA~ca kA pariNAma normala hotA hai| kaI bAra donoM alaga alaga roga meM ekasamAna cihna A sakate haiM, jaise ki manuSya kI prakRti meM badalAva AyA ho to hama mAna lete hai ki Diprezana huA hai, lekina yaha breina Tyumara (phanTala yA korpasa kelojhala Tyumara) bhI ho sakatA hai / aisA ho to nidAna meM gaMbhIra bhUla ho sakatI hai / isalie marIja kA vistRta tabIbI itihAsa pUchakara vigatapUrNa zArIrika jA~ca karanA pratyeka mAnasika kesa meM jarUrI hotA hai / kabhI zaMkA ho to do jA~ca - sI.TI. skena, I.I.jI karavAnA adhika lAbhadAyI hai / lekina jaldabAjI meM mAnasika bImAriyoM kA lebala lagAnA galata hai aisA kaha sakate hai / saubhAgya se aisI viDaMbanA zAyada hI paidA hotI hai| isa prakAra sira meM hone vAlA hara prakAra kA ghAva; jaise ki sar3aka durghaTanA, U~cAI se girane para coTa laganA, sira meM kisI zastra se huA ghAva - ina sabameM adhikatara tAtkAlika upacAra kI jarUrata par3atI hai| jisameM samaya vyaya na karate hue marIja ko turaMta hI sArvajanika yA niji aspatAla meM le jAkara tAtkAlika nyUrosarjana dvArA TrITamenTa kI vyavasthA karanI cAhie /

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1- cetAtaMtra saMbaMdhita prAraMbhika mAhitI (Information about Nervous System) 15 mastiSka ke viSaya meM itanI sAmAnya jAnakArI prApta karane ke bAda aba anya prakaraNa meM mastiSka kI ina sabhI prakAra kI bImAriyoM ke saMdarbha meM savizeSa samajhAne kI koziza kareMge / antataH eka sabase mahatvapUrNa bAta : anubhava se eka bAta to nizcitarUpa meM ubhara AtI hai ki marIjoM ko ThIka karane ke lie DaoNkTara kA sahI nidAna aura samayasara kA ilAja aura yogya davAI kA saMyojana anivArya hai hI, lekina unameM aura bhI kaI mahatvapUrNa bAteM hai jinheM durbhAgyavaza vartamAna upacArapaddhati meM mahatva nahIM diyA jAtA ___marIja ko zIghratA se aura saMpUrNataH svastha hone ke lie usakI DokTara ke prati zraddhA, vizvAsa, hakArAtmaka abhigama aura niyamita va sAdagIyukta jIvanazailI ati mahatvapUrNa hai / isake alAvA DokTara kI marIja ke prati hamadardI, DaoNkTara kI apane vyavasAya ke prati pratibaddhatA - niSThA tathA vorDa meM narsiMga sTApha dvArA vyavasthita dekharekha aura aspatAla kA vAtAvaraNa ityAdi bhI utane hI mahatvapUrNa bhUmikA nibhAte haiN| uparAMta, parivArajanoM kI marIja ke prati uSmA aura dekharekha, prArthanA-duA, ghara kA sAmAjika mAhola aura bImArI saMdarbha yogya jAnakArI bhI marIja ke Arogya meM sudhAra lAne ke lie mahatvapUrNa hai| ina saba para dhyAna denA Avazyaka hai /

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mastiSka aura jJAnataMtu kI bImAriyA~ (surkhiyA~) * vayaska manuSya ke mastiSka meM 100 araba koSikAeM (Neurons) hai aura mastiSka kA vajana 1200 se 1400 grAma hotA hai aura...... sAmAnyataH Ama AdamI mastiSka kA 3 se 10 pratizata upayoga karatA hai aisA mAnA jAtA hai / mastiSka ke baDA mastiSka (Cerebrum), choTA mastiSka (Cerebellum) aura beIna sTema (Brain Stem) aise tIna mukhya bhAga hote haiM / aura 12 cetA mastiSka ke donoM bAju se nikalatI haiM / bAyeM bAju kA mastiSka zarIra ke dAyeM bAju kA saMcAlana karatA hai aura dAyeM bAju kA mastiSka bAyeM bAju kA saMcAlana karatA hai / * yadi rakta aura prANavAyu kA bhramaNa mastiSka meM 5 minaTa se jyAdA samaya taka ruka jAe yA saMpUrNa baMda ho jAe to manuSya kI mRtyu ho sakatI hai / * mastiSka ke nIce sthita pITyuITarI graMthi zarIra ke saba hormonsa sisTama kA niyamana karatI hai / mastiSka ke koSoM meM eka prakAra kA layabaddha vidyuta pravAha nikalatA hai jisakA abhyAsa iijI (EEG) nAma ke TesTa se kiyA jA sakatA hai|

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mastiSka kI reDiyolojI kI jA~ca (Neuroradiology) sAmAnyataH mastiSka yA anya rogoM kA ilAja DaoNkTara marIja ke bAharI avalokana, roga ke cihna aura pUchatAcha Adi dvArA karate haiM / kabhI roga ke kAraNoM ko jAnane ke lie zarIra ke aMdara kaisI, kahA~ aura kitanI takalIpha hai yaha samajhanA jarUrI ho jAtA hai / usa vakta reDiyolojI-nyUroreDiyolojI kA upayoga kiyA jAtA hai, jisameM skrIniMga, eksa-re, sonogrAphI, sI.TI.skena aura ema.Ara.AI. Adi kA upayoga hotA hai| * eksa-re (kSa-kiraNe) : zarIra ke aMdara jhAMkane vAlI ina eksa-re (kSa-kiraNeM) "camatkArI kiraNoM' kA saMzodhana 1895 meM jarmanI ke mi. ronTajana ne kiyA thaa| usake bAda cikitsAkSetra meM ina kiraNoM kA adhika se adhika kalpanAzIla tarIke se upayoga hotA rahA hai, jo mAnavajIvana ke lie eka mahAna AzIrvAda siddha huA hai / / sUryaprakAza, kSa-kiraNeM, mAIkroveva aura reDiyotaraMga ye sabhI vaijJAnika dRSTi se vidyutacumbakIya taraMga haiM / usameM pharka mAtra ina taraMgoM meM rahane vAlI zakti kA hai / reDiyo aura Telivijana kI taraMgoM meM adhika zakti nahIM hotI, isalie apane cAroM ora asaMkhya taraMga prasArita hone ke bAvajUda bhI hama jIvana jI sakate haiM / kSa-kiraNoM kI UrjA prakAza se 10-15 hajAra gunA adhika hai| ata: vaha vastu ke ArapAra jA sakatI hai| prakRti kA ye karizmA hai ki hamArI A~khoM ko kevala sUryaprakAza hI dikhatA hai| sAmAnya eksa-re kI madada se mastiSka ke bAhya AvaraNa kA eka parimANiya citra prApta hotA hai, jisase kisI cIja kI gaharAI kitanI hai yaha nahIM jAna sakate / udAharaNa, mastiSka ke aMdara gAMTha ho to vaha nizcita kisa jagaha hai aura kitanI gaharAI meM hai, yaha kahA nahIM jA sktaa|

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mastiSka aura jJAnataMtu kI bImAriyA~ * sI.TI. skena (C. T. Scan) : eksa-re kA upayoga zarIra ke vibhinna avayavoM kA citra prApta karane hetu kiyA jAtA hai / lekina hamArI carcA mastiSka ke rogoM meM eksa-re Adi ke upayoga saMdarbha meM hai / hamane pichale prakaraNa meM dekhA ki mastiSka khopaDI meM surakSita rUpa se hai / jisase sAmAnya eksa-re dvArA hamArI khopaDI ke bAharI AvaraNa kI jAnakArI mila sakatI hai| magara mastiSka ke aMdara ke bhAga aura saMracanA Adi kI spaSTa jAnakArI nahIM mila sktii| isa samasyA kA hala briTiza vaijJAnika hoMsaphilDa dvArA banAI gaI sI. TI. skena mazIna se huaa| sI.TI.skena (C.T. Scan) yA keTa skena arthAt kompyUTeDa ekSiala TomogrAphI (Computed Axial Tomography). sI.TI.skena meM bhI eksa-re kA hI upayoga hotA hai, paraMtu yahA~ kampyUTara kI madada se triparimANiya ginatI dvArA zarIra ke pratyeka aMga aura usake ghaTaka kA citra (chabI) liyA jA sakatA hai| mastiSka ke aMdara gAMTha kahA~ hai, yaha jAnane ke lie mastiSka kA breDa kI slAIsa jaise kAlpanika hisse karake hara eka hisse kA vividha kone se eksare liyA jAtA hai / usake bAda kampyUTara kI madada se ginatI karake mastiSka kA triparimANiya (thrI-DAimenzanala) citra taiyAra kiyA jA sakatA hai, jisase gA~Tha kI gaharAI aura kada Adi nizcita tarIke se jAne jA sakate hai / isa prakAra sI. TI. skena dvArA mastiSka ke bhItara ho rahI sUkSma kSati-kharAbI kA bhI patA cala sakatA hai / sI. TI. skena kI madada se chabI kisa prakAra lI jAtI hai, vaha nirdiSTa citra dvArA samajhA jA sakatA hai / * sI. TI. skena mazIna sI. TI. skena kI mazIna ghanAkAra (Cubical) bakse kI taraha hotI hai, jise genTrI (Gantry) kahA jAtA hai| isa ghanAkAra ke bIca meM vartulAkAra Tanala jaisA karIbana-2 phiTa jitanA hissA hotA hai / marIja ko upara-nIce, dAyeM-bAyeM, Age-pIche ho sake vaise sTrecara jaise

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2 - mastiSka kI reDiyolojI kI jA~ca (Neuroradiology) Working of CT Scan ( sITI skena kI kAryapraNAli ) X-ray Tube (eksa-re Tyuba ) 'DiTekTara) TV Monitor Detector 19 ( TI.vI. 1 monITara) Computer ( kampyUTara ) Tebala para leTAyA jAtA hai / zarIra ke jisa hisse kI jA~ca karanI hai usa bhAga ko isa Tanala ke madhya bhAga meM lAyA jAtA hai / eksa-re Tyuba vartulAkAra Tanala ke madhya bhAga meM ghUmatI hai, jisa ke tahata mastiSka yA dUsare avayavoM ke vividha kone se chabI lI jA sakatI hai / yaha chabI DiTekTara para pratibiMbita hotI hai aura kampyUTara kI sahAya se nizcita ginatI karake Age nirdeza kiyA hai vaise breDa kI slAisa kI taraha avayavoM ko kampyUTara ke moniTara para dekhA jA sakatA hai aura lesara kaimare kI sahAya se usakI chabI lI jA sakatI hai / yaha prakriyA meM lagabhaga 15 - 30 miniTa kA samaya lagatA hai / isa daurAna marIja ko sthira avasthA meM leTe rahanA cAhie / naye adyatana mazIna se to kevala do minaTa lagate hai / sAmAnyataH eksa-re kI 14 " x 17" kI philma meM 20 chabI lI jAtI hai, jisakA tajajJa reDiyolojisTa dvArA arthaghaTana kiyA jAtA hai aura usakI riporTa taiyAra hotI hai / sI. TI. skena se mastiSka, karoDarajju, phepharDe se peTa taka ke avayavoM kI saMpUrNa jAnakArI mila sakatI hai / isalie jisa hisse kA skena cAhie usake anusAra sUcanA likhanI paDatI hai | sI. TI. skena se kisI prakAra kA darda nahIM hotA, kevala kucha samaya ke lie marIja ko sthira avasthA meM leTanA paDatA hai /

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20 mastiSka aura jJAnataMtu kI bImAriyA~ Gantry Generator 125 Table sI. TI. skena mazIna mastiSka ke roga, jaise ki gAMTha aura saMkramaNa meM khAsa taraha kI davAI (Contrast Agent) raktavAhinI meM suI se dI jAtI hai / isase bImArI ke daurAna rakta ke paribhramaNa kA patA bhI cala sakatA hai| yaha AyoDInayukta (lodinised Contrast) davAI jaba raktavAhinI dvArA dI jAtI hai taba adhikatara zarIra meM garamI lagane kA yA ulTI hone kA ehasAsa hotA hai / paraMtu eka yA do minaTa meM apane Apa saba ThIka ho jAtA hai / isaliye Contrast C.T. Scan ke liye sAmAnyataH 3 ghaMTe taka khAlI peTa rahane kI salAha dI jAtI hai| marIja ko elarjI, asthamA, kiDanI yA thAiroIDa kI takalIpha ho use riekzana hone kI sambhAvanA rahatI hai| aise kesa meM nona-Ayonika DAI ke upayoga se riekzana rokA jA sakatA hai| garbhavatI mahilA ko apanI sthiti DaoNkTara ko pahale se batAnA jarUrI hai| sI. TI. skena kA reDiyezana ke sivAya koI khAsa duSprabhAva nahIM hotA, isalie marIjoM ke mitroM yA saMbaMdhiyoM ko sI. TI. rUma meM upasthita nahIM rahane dete hai.aura marIja ke zarIra ke anya aMgoM ko pUrI taraha se DhA~kA jAtA haiM / sI.TI. skena aba mastiSka kA prAthamika jAMca kA mAdhyama bana gayA hai / bhArata ke jile stara ke lagabhaga hara zahara meM yaha suvidhA upalabdha hai / sAmAnyataH eka bAra sI.TI. skena karavAne para lagabhaga rU. 1500 se 2000 taka kharca AtA hai /

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2 - mastiSka kI reDiyolojI kI jA~ca (Neuroradiology) ema. Ara. AI. (M.R.I. ) sI.TI. skena dvArA cetAtaMtu, mastiSka ke aMdara kA bhAga (vhAiTa meTara) aura karoDarajju jaise aMgoM kI mahatvapUrNa jAnakArI maryAdita mAtrA meM mila sakatI hai / san 1972 meM DAmADiyana nAmaka vaijJAnika ne saMzodhana kiyA ki cuMbakIya pravAha mAnavazarIra kI jAMca ke liye upayoga meM liye jA sakate haiN| kampyUTara ke AdhunikaraNa se zaktizAlI cuMbakIya pravAha dvArA mastiSka kI chabI lI jAtI hai, jise megneTika rejhonansa imejiMga (Magnetic Resonance Imaging) (ema.Ara.AI.) ke nAma se jAnA jAtA hai / mastiSka kI gAMTha, lakavA, vhAITa meTara kA roga aura janmajAta vikalAMgatA, cetAtaMtra ke malTipala sklerosisa jaise roga, AMkha aura kAna ke aMdara ke atyaMta sUkSma bhAga Adi kI jAMca aura nidAna ke liye ema. Ara. AI. atyaMta mahatvapUrNa sAbita huA hai 1 1 ema.Ara.AI. kI mazIna eka nalAkAra megneTa hotI hai / jisake madhya meM marIja ko sulAne ke liye Tanala hotI hai / isa megneTa kI cuMbakIya kSamatA pRthvI ke cuMbakIya kSetra se eka hajAra gunA adhika hotI hai / isa mazIna kI kSamatA usake TeslA (Tesla ) dvArA taya hotI hai / sAmAnyataH 0.2T, 0.3T, 0.5T, 1.08, 1.5T ke mazIna hote haiM / TeslA adhika ho usa mazIna kI kAryakSamatA, bArIkI aura raphtAra adhika hotI hai / aba 3.0T ke pAvaraphUla mazIna A jAne ke bAda bArIka aura spaSTa nidAna bahuta jaldI se (kucha hI minaToM meM) ho jAtA hai / uccastara ema. Ara. AI. mazIna 21

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22 mastiSka aura jJAnataMtu kI bImAriyA~ ke mazInoM meM megneTika philDa banAe rakhane ke liye heliyama (Helium) gesa kA upayoga hotA hai, yaha vajaha se ema.Ara.AI. mazIna ko vAtAnukUlita rakhanA paDatA hai|| ema.Ara.AI. bhI sI. TI. skena kI taraha mastiSka, karoDarajju, peTa ke avayava, kir3anI, phephaDeM, hRdaya aura snAyu jaise vividha aMgoM kI dhyAnapUrvaka vistRta jAnakArI ke liye upayoga meM liyA jA sakatA hai / marIjha ke jisa hisse kI jAMca karanI hai use mazIna ke madhyabhAga meM rakhakara marIja ko sulAyA jAtA hai / yahAM eksa-re kA upayoga nahIM kiyA jAtA hai lekina reDiyotaraMga aura tIvra cuMbakIya kSetra kA upayoga hotA hai, jisase reDiezana kA Dara nahIM rhtaa| zarIra meM adhika mAtrA meM pAnI ke hAiDrojana proTonsa hote hai ("H" of H2O) / ema.Ara.AI. ke siddhAMta anusAra reDiyotaraMga aura cuMbakIya kSetra kI sahAya se yaha proTonsa uttejita hote hai aura greDiyanTsa (Gradients) kI sahAya se use prasthApita sthiti meM lAyA jAtA hai| pratyeka koSikA meM rahe vibhinna proTona kI saMkhyA aura reDiyo signala ke AdhAra para kampyUTara kI Adhunika ginatI kI sahAya se use atyaMta cIvaTapUrvaka alaga kiyA jAtA hai / use lesara ke merA kI sahAya se 14" x 17" kI phoTo philma para pratyeka kone se chabI khIMcI jA sakatI hai| yaha vajaha se mastiSka ke vhAiTa meTara aura gre-meTara saralatA se alaga kara sakate hai / eka phoTo pleTa meM lagabhaga 16 se 20 chabI AtI hai aura pUre ema.Ara.AI. daurAna aise 4 se 5 sikvansa liye jAte hai / pratyeka sikvansa 5 se 8 minaTa taka calatA hai / isa prakAra 30 se 45 minaTa meM mastiSka ke vibhinna kone se (x,y,z AdhAra) 80 se 100 chabI khIMcI jAtI hai, jisake AdhAra para tajajJa reDiyolojisTa arthaghaTana karake riporTa dete hai / Adhunika cikitsAzAstra meM marIjoM ke lie yaha eka adbhuta bheMTa kahI jA sakatI hai|

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2- mastiSka kI reDiyolojI kI jA~ca (Neuroradiology) ema.Ara.AI. jAMca daurAna mazIna ke greDiyanTsa kI AvAja AtI rahatI hai; lekina kAna meM rUI, iyara plaga yA iyara phona ke upayoga se vaha kama lagatI hai / kaI bAra isa kamare meM saMgIta bhI rakhA jAtA hai / kucha marIja baMda nalAkAra meM sone se gabharAte hai, jise klosTrophobiyA (Claustrophobia ) kahate haiM / aise marIja ko nIMda kI davAI dI jAtI hai / naye saMzodhana anusAra ema. Ara. AI. mazIna ke megneTa kI DijAina khulI hotI hai ( opana megneTa) jisase ghabar3AhaTa kama hotI hai / ema.Ara.AI. meM bhI kucha rogoM ke lakSaNa jAnane ke lie khAsa davAI (Contrast) dI jAtI hai, jisakA duSprabhAva bahuta kama hotA hai / 1 ema.Ara.AI. kI jA~ca sI. TI. skena kI tulanA meM ucca stara ki hotI hai / pahalI bAta yaha hai ki yahAM eksa-re kA upayoga hotA nahIM hai| garbhAvasthA daurAna kI yaha jA~ca sI.TI. skena se bahuta kama nukasAna kAraka hotI hai / sI.TI. skena ke saMdarbha meM hamane Age dekhA ki usameM kevala tirache (Axial), breDa kI slAisa jaise kaTsa milate haiM, jabaki ema. Ara. AI. meM triparimANiya (x, y aura z) arthAt saMpUrNa ghanatva kI jAnakArI milatI hai / ema. Ara. AI. se karoDarajjuspAInalakorDa ati bArIkI se dekhI jA sakatI hai / atyaMta karoDarajju kI ema. Ara. AI. 23

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___mastiSka aura jJAnataMtu kI bImAriyA~ zaktizAlI cuMbakIya kSetra ke kAraNa ema.Ara.AI. kamare meM ghaDI, kreDiTa kArDa, pena, mobAIla aura aMgUThI jaisI dhAtu kI cIjoM ke sAtha praveza karanA niSedha hai / jinake hRdaya meM pesamekara lagA ho yA zarIra meM aisA koI ilekTronika upakaraNa lagA ho, unakA ema.Ara.AI. nahIM kiyA jA sakatA hai / naye saMzodhana ke pariNAmasvarUpa Diffusion aura Perfusion ema.Ara.AI. sahaja banA hai / yaha vajaha se mastiSka ke jisa hisse meM rakta kA paribhramaNa kama ho, usakA minaToM meM hI zIghratA se nidAna ho sakatA hai aura tAtkAlika upacAra se pakSAghAta jaisI bImArI se bacA jA sakatA hai| phaMkzanala ema.Ara.AI. (f.M.R...) eka aisA nayA saMzodhana hai ki jisase mastiSka meM hotI hala-cala, yAdadAsta, vANIzakti aura saMvedanAe~ Adi ke utpattisthAna ko hama vargIkRta kara sakate hai / isakA mahatvapUrNa lAbha sarjarI aura reDiyotherepI ke plAniMga meM hotA hai / isa uttpatisthAnoM ko bacA kara sarjarI karane se marIja ko kAyamI vikalAMgatA se bacAyA jA sakatA hai| ema.Ara.AI. kA kharca sAmAnyataH ru. 5000 se 7000 taka hotA hai aura aba bhArata ke bar3e zaharoM meM ema.Ara.AI. kI suvidhA upalabdha hai| * enjiyogrAphI ( Angiography) enjiyogrAphI arthAt rakta le jAne vAlI zirA aura dhamanIoM kI jA~ca / hRdaya kI enjiyogrAphI se sAmAnyataH pratyeka vyakti paricita hotA hai / mastiSka kI naliyoM kI bhI isa prakAra se jA~ca kI jAtI mastiSka ke aneka roga, jinameM rakta kI nalI kaThina (Thick) ho jAnA, yA isakI divAla meM kSAra jamA honA, nalI kA balUna ho

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2 - mastiSka kI reDiyolojI kI jA~ca (Neuroradiology) I jAnA (Aneurysm ), naliyoM kA ulajhanA (A.V. Malformation) Adi ke nidAna ke lie DijiTala sabasTrekzana enjiyogrAphI (DSA) takanika se mastiSka kI enjiyogrAphI hotI hai / sabase pahale jAMgha meM rahI rakta dhamanI meM nalI (ke theTara) rakhI jAtI hai, jise rakta ke pravAha ke sAtha Age baDhAyA jAtA hai| eksa-re aura kampyUTara moniTara kI sahAya se use mastiSka kI nalI taka pahuMcAyA jAtA hai / usake pazcAta usameM vizeSa prakAra kI davAI (konTrAsTa mIDiyama Contrast dye) iMjekzana dvArA dI jAtI hai| yaha davAI jaise jaise Age bar3hatI hai, vaise jIvaMta prasAraNa kI taraha usakI jAMca hotI hai / jarUrata par3ane para alagaalaga kone se eksa-re dvArA dhamaniyoM ko saralatA se dekhA jA sakatA hai / DijiTala sabasTrekzana enjiyogrAphI meM prathama mastiSka kI chabI, eksa-re lete hai / usake pazcAta davAI (Contrast) dene ke bAda eksa-re liyA jAtA hai / isa prakAra mastaka aura mastiSka ke vividha bhAga kI chabI lI jAtI hai, tathA usake pazcAta nalikAoM kI tulanApUrvaka bArIkI se jAMca karake nidAna kiyA jAtA hai| -- mastiSka ko rakta pahuMcAnevAlI gale meM se pasAra hotI dhamanI (keroTiDa ArTarI) kaThina (Thick ) hotI ho yA usameM kSAra jamA ho jAe to use balUna kI sahAya se phulA kara yaha kSAra toDA jA sakatA hai, jise keroTiDa anjiyoplAsTI kahate hai / 25 hRdaya kI enjiyogrAphI kI taraha mastiSka kI enjiyogrAphI meM bhI kucha sAmAnya magara anivArya khatarA hotA hai, paraMtu isa khatare kA bhI upacAra ho sakatA hai / kisI khatare ke binA bhI naliyoM kI jAMca kI jA sakatI hai / jaise ki kalara Dopalara, sI. TI. enjiyogrAphI, ema.Ara.AI. enjiyogrAphI, inase upalabdha jAnakArI DSA kI tulanA

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26 mastiSka aura jJAnataMtu kI bImAriyA~ - [ (A S RT CCAVBALT CCA ema.Ara.AI. enjiyogrAphI - - meM 5 se 10 pratizata kama hotI hai / kalara Dopalara kI madada se gale kI keroTiDa ArTarI saMdarbha khUba saralatA se sarala sonogrAphI tahata jAnakArI mila sakatI hai, jisake dvArA dhamanI kA parIgha, rakta cApa, rakta kSAra kI mAtrA dekhI jA sakatI hai / ema.Ara.AI. anjiyogrAphI meM, ketheTara kI sahAya binA dhamanI aura zirAoM kI bahuta hI bArIkI se jAMca ho sakatI hai, aura vaha bahuta hI zIghratA se naliyoM kI prAthamika jAMca kA sthAna le rahI hai / isa jAMca ke liye bhI marIjoM ko ama.Ara.AI. kI taraha Tebala para leTanA hotA hai / sITI anjiyogrAphI aura bhI acchA pariNAma detI hai /

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2 - mastiSka kI reDiyolojI kI jA~ca (Neuroradiology) 1 vijJAna, TeknolojI aura kampyUTara ke AdhunikIkaraNa kI sahAya se reDiyolojI meM bahuta hI jalda naye saMzodhana A rahe hai / peTa skena (PET Scan Positron Emission Tomography) kI sahAya se kucha rogoM kI vizeSa jAnakArI Aja mila sakatI hai, jisase marIja kA atyaMta acche tarIke se upacAra ho sakatA hai, lekina yaha saralatA se upalabdha nahIM hai / SPECT Scan tahata mastiSka kI cayApacaya kI jAnakArI aura mastiSka kI kAryadakSatA kI jAnakArI mila sakatI hai, jisakI pahu~ca khUba bar3hatI jA rahI hai / mastiSka kI gAMTha, saMkramita bImAriyA~ aura anya viziSTa rogoM meM spaSTa nidAna ke lie MR SPECTROSCOPY nAmaka vizeSa jA~ca kA vyApa Ajakala bar3hatA jA rahA hai / - eksa-re aura vi-kiraNeM (Radiation) kI khoja mAnava svAsthya ke uparAMta anya kSetra meM bhI adhika mahatva kI hai / aba taka eksare kA upayoga karatI vibhinna khojoM ko 15 jitane nobela prAIja mile haiM / mAnava jIvana meM eksa-re ke pradAna kA yaha mApadaMDa mAnA jAtA hai / naI khoja aura saMzodhana Aja bhI ho rahe hai / hama ummIda karate haiM ki naI TeknolojI kA adhika lAbha mAnava zarIra, svAsthya aura sukha ke lie adhika se adhika upalabdha ho / 27

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28 mastiSka aura jJAnataMtu kI bImAriyA~ (surkhiyA~) * sITI skaina mastiSka ke rogoM ke nidAna meM prAthamika jAMca bana gayA hai| ema.Ara.Ai. skena viziSTa jAnakArI evaM sUkSma jAnakArI ke lie hai| * mastiSka ke pIchevAle hisse kI jA~ca meM, evaM mastiSka ke aMdara ke bhAga kI tapAsa meM tathA karoDarajju meM hue rogoM ko pahacAna ne meM ema.Ara.AI. kI tapAsa sITI skena se jyAdA upayogI hai| * mastiSka meM rakta le jAnevAlI zirA aura dhamanIoM kI jAMca ko enjiyogrAphI kahate haiM / yaha sITI skena evaM ema.Ara.Ai. aura DI.esa.e. se kI jAtI hai / isase bhI bahuta sAre rogoM kA nidAna ho sakatA hai / * kalara Dopalara kI madada se gale kI sonogrAphI dvArA mastiSka ko khUna pahu~cAne vAlI keroTiDa ArTarI kI saralatA se jAnakArI mila sakatI hai / / peTa-sITI skaina reDiyolojI meM sabase Adhunika TesTa hai| lekina yaha saralatA se upalabdha nahi hai / jaivikarAsAyaNika prakriyA jAnane ke lie peTa aura spekTa bahuta upayogI hai| * AnevAle dinoM meM naI TeknolojI ke vikAsa ke kAraNa nyUrolojikala rogoM ke nidAna meM jyAdA suvidhA hogii|

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O murcha (coma) mUrchA ke kucha mahatvapUrNa kAraNa (gAMTha) (vAskyU lara roga) ( rakta kI nalikA meM jhuramuTa) (mastiSka kI kI IjA) (saMkramita roga) (janmajAta aura AnuvaMzika roga) komA (behozI), mUlataH grIka bhASA se liyA gayA zabda hai / behozI, ardhabehozI, mUrchA, taMdrA, pralaMba ati nidrA-yaha sabhI mastiSka aura zarIra ke alaga-alaga stara kI saMvedanAtmaka avasthA darzAne ke lie upayoga kiye jAnevAle zabda hai / cikitsA vijJAna kI bhASA meM komA kI vyAkhyA denI ho to yaha kahA jA sakatA hai ki mastiSka isa sthiti meM A jAtA hai ki jahAM usakI satarkatA naSTa ho jAtI hai| zarIra ke aMdara yA bAhara kI koI bhI saMvedanA kA pratibhAva nahIM denA yA AMtarika AvazyakatA kA anubhava baMda ho jAnA use komA kahate hai / yaha sthiti thoDI, adhika yA mRtyuparyaMta cale to marIja ko komA pezanTa kahA jA sakatA hai / komA zabdane jitanA Dara paidA kiyA hai, vaha ItanA khataranAka nahIM hai / sAtha hI sAtha isa bImArI ko sahajatA

Page #49
mastiSka aura jJAnataMtu kI bImAriyA~ se nahIM lene kI khAsa salAha hai / Adhunika jIvana kI vyastatA aura tanAva ke kAraNa bar3hatA huA blaDaprezara, DAyAbiTIsa tathA sar3aka durghaTanA kI vajaha se, saMkramaNa hone se, gAMTha tathA anya aneka kAraNoM se komA kabhI bhI, kisI ko bhI ho sakatA hai / * kAraNa - sUci : (1) sar3aka durghaTanA : breina TromA (mastiSka kA) : kankazana, kanTyUjhana, hemareja (sabaDyUrala, eksTrADyUrala) (2) mastiSka meM rakta ke paribhramaNa ke roga : thrombosisa (dhamanI yA zirA meM rakta jama jAnA) embolijhama, hemareja, saba-erekanoIDa hemareja / (3) mastiSka ke saMkramita roga yA inphekzana : jaharI (viSama) malerIyA, meninjAiTisa, TI.bI., vAyarasa ensephelAiTisa, eIDsa evam anya oporyunisTika (taka milate honevAle) roga, phangasa, peresAiTa inphekzana, siphilisa Adi / / breIna TyUmara : kensara kI (prAImarI yA sekanDarI) gAMTha jaise ki glAyomA yA meTAsTesisa; sAdhAraNa gAMTha jaise ki meninjiomA; ina saba meM sira darda, cakkara AnA, mirgIke daure, ulTI honA, eka yA donoM tarapha ke aMgo meM pakSAghAta kA asara honA jaise cihna hote haiM / DokTarI jA~ca aura sI.TI. skenaema.Ara.AI. dvArA pUrNa nidAna ho sakatA hai / meTAbolika roga : jisameM DAyAbiTika komA Adi mukhya hai| isameM marIja kI jIvanazailI, mAnasika tanAva aura vyastatA Adi pramukha bhUmikA nibhAte haiM / oNksijana kI kamI, zarIra meM zarkarA kA aniyaMtrita pramANa (baDhanA-ghaTanA), livara, kiDanI aura zvAsa ke roga Adi se vibhinna aMgo kI kAryakSamatA ko viparIta asara hone se mastiSka kI kAryakSamatA kama ho jAtI hai aura marIja komA meM calA jAtA hai /

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31 3 - mUrchA (Coma) (6) poSaNa kI kamI yA DihAIDrezana hone se bhI komA ho sakatA hai / zarIra ke upayogI tatva jaise ki viTAmina bI-1, bI-12 Adi dravya bahuta kama hone se bhI komA ho sakatA hai / soDiyama ghaTane se honevAle komA ko hAiponeTrImika komA kahA jAtA hai / (7) hormonsa asaMtulana : thAIroiDa, perAthAIroiDa, aDrinala, piTyUITarI graMthiyoM meM se hormonasrAva bar3hane ghaTane se komA ho sakatA hai I ( 8 ) mirgI : epilepsI (vAI) ke eka se adhika hamale ke bAda / (9) aljAImara DisIjha : aMtima sTeja meM roga praveza karane ke daurAna / (10) jahara ( poIjhana ) : AtmahatyA yA hatyA ke liye upayoga honevAlA o. pI. poijhanIMga yA bhArI dhAtue~ (hevI meTalsa) jaise ki Arsenika, leDa, pArA, nIMda kI goliyoM kA ovaraDojha / ( 11 ) nazIleM dravya : madirA, heroIna, taMbAku Adi / (12) sAikojenika komA: isameM marIja hakIkata meM komA meM nahIM hotA Glassgow Coma Scale : san 1974 meM DaoN. Tesar3ela aura DaoN. jeneTa ne glAsago nAmaka zahara meM marIja kI jAgRkatA ( behozI) kA mApadaMDa nakkI karane ke lie glAsago komA skela nAmaka sarva svIkRta paddhati kA AviSkAra kiyA / jisameM mUlabhUta tIna saMjJAoM kA vizleSaNa kiyA gayA hai / jo isa prakAra hai : 1. A~khoM kA pratibhAva 2. 3. halanacalana kA pratibhAva vAcA kA pratibhAva

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32 mastiSka aura jJAnataMtu kI bImAriyA~ isakA nyUnatama skaoNra 3 aura mahattama skaoNra 15 hai / yaha skaoNra agara 8 se nIce ho to dardI kI hAlata gaMbhIra mAnI jAtI hai / ___komA (behozI) ke dardI kI paristhiti ko jAnane ke lie aura usakI sthiti meM sudhAra yA bigAr3a huA, vo samajhane ke lie yaha bahuta hI sarala aura asarakAraka paddhati hai / usameM mAmUlI asaMdigdhatA jarura hai, phira bhI yaha sarvamAnya hai / komA ke marIja kA upacAra saMpUrNa dhyAna se, paddhatipUrvaka (sisTemeTika) kiyA jAtA hai / yaha vajaha se marIja kI hisTrI, palsa, Temparecara, zvAsa, AMkha kI jA~ca aura cetAtaMtra kI jA~ca karake usake zarIra tathA mastiSka ke kaI khAsa TesTa kiye jAte hai / isa lie rakta kI vividha prakAra kI jA~ca, ema.Ara.AI., sI. TI. skaina, I.I.jI. aura jarUrata par3ane para kamara meM se pAnI bhI khiMcA jAtA hai, jo nidAna pazcAta ke upacAra meM ati mahatvapUrNa sAbita ho sakatA hai / marIja komA meM se jaba kabhI breinaDetha (glAsago komA skela 3) kI paristhiti meM A jAtA hai, taba yaha ghoSita karane se pahale sAvadhAnI rakhanI paDatI hai / yaha saMjoga meM nizcita mApadaMDa ke AdhAra para hI breInaDetha jAhira kiyA jAtA hai / yU~ ki marIja kI asalI mRtyu to hRdaya baMda par3ane ke bAda hI ghoSita hotI hai, paraMtu, beInaDetha ke bAda mastiSka kI satarkatA kadApi vApasa nahIM AtI haiM / isa liye aise marIja kA hRdaya baMda paDane se (mRtyu se) pahale kir3anI Adi aMgo kA dAna karane se kisI anya vyakti kI jiMdagI bacAI jA sakatI * upacAra : komA ke upacAra ke mukhya mudde nimna nirdiSTa hai : (1) paristhiti kI gaMbhIratA ke anusAra marIja ko I.C.U. meM dAkhila karake ghaniSTha upacAra zuru karavA deM /

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3 - mUrchA (Coma) 33 (2) oNksijana, zvAsocchvAsa, rakta paribhramaNa, blaDaprezara jaise mahatvapUrNa kAryoM ko jaldI se niyaMtrita karanA cAhie / (3) kAraNa tatkAla patA nahIM cale aise komA meM turaMta hI glUkoja, B, viTAmina aura Nalorphine Injection pahale diye jAte hai| (4) rakta ke vividha riporTa ke bAda bhI AvazyakatA rahe to I.I.jI., sI.TI.skaina, lambara paMkcara dvArA komA ke kAraNa / kAraNoM ko jAnakara usakA upacAra jalda hI zuru kiyA jAtA hai, jaise ki mastiSka kA saMkramaNa ho to enTIbAyoTika, TI.bI. (kSaya) kI davA, thrombosisa ho to rakta patalA karane kI davA Adi kA upayoga hotA hai| (5) zarIra meM DihAIDrezana huA ho to raktavAhinI meM (I.V.) pravAhI diyA jAtA hai, yA phira esiDa-beIjha saMtulana bigaDA ho to usakA upacAra zreSTha tarIke se kiyA jAtA hai / pUrNa kelarIvAlA AhAra dekara poSaNa saMtulita kiyA jAtA hai| yakRta, kiDanI Adi aMgo ke kharAba hone se komA huA ho yA DAyAbiTisa aura thAIroiDa Adi kI samasyA ho to usakA tatkAla upacAra kiyA jAtA hai / jaise ki vAyarasa se yakRta acAnaka bigar3a gayA ho (Acute liver failure) to anya upacAra ke sAtha ena-esiTAila sisTina aura meniTola diyA jA sakatA hai / agara yakRta zarAba ke sevana se dhIre dhIre bigar3a gayA ho (Chronic liver failure) to ela-onithina ela-espArTeTa (Heparnerz) diyA jAtA hai aura donoM hI prakAra meM lekyulojha enimA diyA jAtA hai / jaba marIja kI paristhiti sudharatI hai taba livara TrAnsaplAnTa ke lie bhI suyogya kesa meM socA jA sakatA hai /

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34 (8) mastiSka aura jJAnataMtu kI bImAriyA~ (7) mirgI AtI ho yA soDiyama Adi dravya kA stara kama ho gayA ho to usakI davA dekara tAtkAlika upacAra zuru kiyA jAtA hai| kaI bAra koI nazIlI davAI kA sevana yA nIMda kI davAI kA jyAdA Doz2a yA jaharI kemIkala kA duSprabhAva komA kA kAraNa ho sakatA hai / isalie khUna aura pizAba meM ina davAIyoM kA pramANa (Toxic Drug screening) jAnanA komA ke anirNita keso meM bahuta jarurI hai| marIja ko komA meM le jAnevAlI sTrakcarala aura meTAbolika kaMDizana ke bIca bhI aMtara hai / breIna TyUmara, lakavA aura acAnaka durghaTanA ke kAraNa hue breIna hemareja kA sTrakcarala kAraNoM meM samAveza hotA hai / jisameM marIja ke mastiSka para zArIrika pratikUlatA kA sIdhA asara hotA hai / usake viruddha meTAbolika komA meM mastiSka ko choDakara zarIra ke anya bhAga para prathama asAmAnyatA dikhatI hai / yahA~ roga pahale zarIra meM anya aMga meM hotA hai / jisakA asara bAda meM mastiSka para hotA hai| hAlA~ki komA ke 2 se 8 pratizata kesa aise bhI hote hai jisameM marIja kA komA meM jAne kA kAraNa patA nahIM cltaa| anapekSita yA asahanIya sira darda hotA hai to use lAparavAhI se na lete hue jA~ca karA lenA hitakAraka hai / lakave ke marIja ko tatkAla aspatAla meM bhartI karavAnA cAhiye, jisase samaya baca sakeM aura sI.TI. skaina kara ke anya TrITamenTa kI jA sake / lakavA aura usake kAraNa se komA pezanTa kI bar3hatI saMkhyA taba ghaTegI jaba bI. pI., DAyAbiTIsa kA upacAra yogya tarIke se kiyA jAe aura jIvanazailI meM sudhAra ho, vajana kama ho /

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35 3 - mUm (Coma) pichale kucha samaya meM komA pezanTa kI saMkhyA bar3hane kA kAraNa bI.pI., DAyAbITIsa, tambAku , zarAba, saDaka durghaTanA, nazIle padArtha, poIjhaniMga aura eIDsa kI baDhatI mAtrA hai / kucha davAIyoM ke duSprabhAva se bhI komA ho sakatA hai, jaise ki insyulina kI mAtrA jyAdA ho jAe to rakta meM zarkarA-zugara kama ho jAtI hai aura marIja behoza ho jAtA hai| komA meM jAnevAle marIjoM kA ThIka ho jAne kA koI niyata samaya nahIM hotA, pratyeka marIja ke kesa meM vaha alaga-alaga ho sakatA hai| kucha marIjoM meM ekasamAna agocara adrazya prakAra ke kisse unakI taMdrAvasthA meM pAye gaye haiM, jise Near-Death Experience kahate hai| komA se mukta honevAlA marIja phirase komA meM jA sakatA hai / komA pezanTa kI dekha-bhAla aura use durasta karane meM davAiyoM ke sAtha marIja kI dekhabhAla, khurAka, prArthanA aura prema-bharI sAravAra bhI camatkArika asara kara sakatI hai / marIja ke upacAra ke sAtha DokTara kI sAtvikatA tathA marIja kI acetana avasthA meM bhI pradIpta rahA usakA manobala acche hone meM mahattvapUrNa rahatA hai / / do dina, saptAha, mahInoM yA laMbe samaya taka komA meM jAne ke bAda ThIka hue marIja saMjogavaza duSprabhAva ke rUpameM kabhI kabhI gUMge bhI ho sakate hai, koI yAdadAsta bhI kho beThate hai aura kucha breinaDetha kI ora bhI cale jAte haiN| komA ke kesa meM mRtyu kA pramANa ausatana 10 se 20 pratizata hai|

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36 mastiSka aura jJAnataMtu kI bImAriyA~ -(sukhiyA~) * zarIra ke aMdara yA bAhara kI koI bhI saMvedanA kA pratibhAva nahi denekI avasthA yA AMtarika AvazyakatA ke anubhava baMda ho jAnekI avasthAko komA (pralaMba behozI) kahate hai| mastiSka ke roga ke alAvA behozI ke vividha kAraNa hote hai, jaise ki kiDanI-livara kI gar3abar3a se hue meTAbolika roga, poIjhanIMga, DIhAiDrezana, hormonsa asaMtulana, solTa (soDiyama) kI gar3abar3a / / yaha marIz2o ko sAmAnyataH Ai.sI.yu. meM bhartI kiyA jAtA hai| behozI kA kAraNa DhU~Dhane meM tabIba kI kSamatA kI kasauTI hotI hai / Ayojanabaddha aura tAtkAlika sAravAra se kaI jAneM baca sakatI hai aura nukasAna bhI kAphI kama ho sakatA hai /

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mirgI ke daure (Epilepsy) yaha eka taraha epilepsI arthAt bArabAra par3anevAle mirgI ke daure athavA cakkara khA kara gira jAnA athavA phiTa kA A jaanaa| eka hI bAra par3ane vAle mirgI ke daure ko epilepsI nahIM kahA jAtA kA mastiSka kA roga hai, jisameM mastiSka meM kucha hI dera ke lie vidyutIya taraMgeM adhika utpanna hone se zarIra meM kampana aura jhaTake mahasUsa hote haiM / lagabhaga 100 meM se eka vyakti ko epilepsI kI bImArI ho sakatI hai / isa hisAba se hamAre deza meM lagabhaga eka karor3a loga isa bImArI se pIDita hai, lekina eka niSkarSa ke anusAra 100 meM 4 vyaktiyoM ko unake jIvana meM eka bAra to mirgI AI hI hotI hai, jaise ki bukhAra meM mirgI AnA / epilepsI ke 70 se 75 pratizata mAmaloM meM yaha bImArI bacapana se hI hone kI jAnakArI milI hai / usa samaya isake ucita upacAra ke abhAva meM marIja ko bhaviSya meM zArIrika va mAnasika kSati bhI pahuMca sakatI hai epilepsI ke marIja ucita upacAra leM, to svastha - sAmAnya jIvana jI sakate haiM / 50 pratizata marIjoM ko to davA lene ke bAda do se tIna varSoM meM isa bImArI se haMmezA ke lie mukti mila jAtI hai / epilepsI ke mukhya kAraNa : (1) bacce ke janma samaya kA ghAva athavA oNksijana kI kamI | (2) sar3aka durghaTanA yA anya prakAra kA mastiSka ghAva | (3) mastiSka kI gAMTheM yAnI breIna TyUmara / (4) mastiSka meM rakta kA kama paribhramaNa (5) mastiSka kA bukhAra, mastiSka meM saMkrAmaka roga honA (jaise ki TI. bI. yA nyUrosisTisarakosisa ) (6) vaMzAnugata kAraNa (Genetic)

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38 mastiSka aura jJAnataMtu kI bImAriyA~ (7) rAsAyaNika tattva kA asaMtulana (Nat, K+, Ca+2, Mg+2 ityAdi) (8) cayApacaya kI gar3abar3a (9) rakta meM cInI kI mAtrA meM kamI AnA / (10) Upara darzAe kAraNoM meM koI eka bhI lAgU na ho, aise mAmale meM bhI epilepsI pAI jAtI hai / (Idiopathic) mirgI ke mukhya tIna prakAra haiM : (1) vistRta - vistRta prakAra kI mirgI (janaralAijDa sIjhara) janaralAijDa sIjhara pArziyala sIjhara (2) sImita - AMzika prakAra kI mirgI (pArziyala sIjhara) (3) anirNita (Unclassified) (4) sTeTasa epIlepTIkasa ina tInoM prakAra kI mirgI ke upa prakAra : (1) janaralAijDa sIjhara : (a) grAnDamAla epilepsI arthAt pUre zarIra kI mirgI (Tonic-clonic Seizures) : isa prakAra meM vyakti behoza ho jAye, kabhI cIkhe, muMha se jhAga nikale, zarIra meM jhaTake lageM, kaI bAra jIbha kucale, to kabhI kapar3oM meM mala-mUtra bhI ho jAtA hai / isa prakAra kI mirgI ko bar3I mirgI kahate haiM / hoza meM Ane ke bAda sAmAnyataH marIja kucha dera ardhacetana avasthA yA taMdrA meM rahatA hai athavA so jAtA hai| kucha samaya ke lie pakSAghAta ho sakatA hai| kaI bAra mirgI Ane ke pahale marIja ko saMketa-cetAvaNI mila jAtI hai, jise aurA ( Aura) kahate haiN|

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39 4. mirgI ke daure (Epilepsy) (ba) peTiTamAla (ebasansa) : isa prakAra kI mirgI meM marIja kucha paloM ke lie kSubdha, stabdha, avAcaka, zUnyamanaska aura vikSipta ho jAtA hai, jaise ki blaikaAuTa ho gayA ho / isake do prakAra hai (1) Typical (2) Atypical (ka) mAyoklonika sIjhara : isa prakAra kI mirgI meM marIja ko hAtha-paira meM kSaNika jhaTake lagate haiM aura hAtha kI vastu gira jAtI hai, marIja hoza meM rahatA hai / (Da) isake alAvA Tonika, klonika aura eTonika aise kucha prakAra janaralAIjDa sIjhara meM Ate haiM / (2) pArsiyala sIjhara ke do upa prakAra : (a) simpala pArziyala sIjhara : isa prakAra meM marIja cetana avasthA meM hotA hai aura zarIra kA eka tarapha kA aMga khiMcatA hai athavA jhanajhanAhaTa hotI hai, Adi / | __ (ba) kompleksa pArziyala sIjhara : jaba simpala pArziyala sIjara jaise lakSaNoM ke sAtha marIja kSaNika hoza bhI kho de, to use kompleksa pArsiyala sIjhara kahate haiM / isa prakAra meM marIja kSaNa bhara ke lie hoza gaMvA detA hai, to kabhI vicitra vyavahAra karatA hai aura phira turaMta hoza meM A jAtA hai / isa paristhiti ko choTI mirgI bhI kahate hai| (3) anirNita (Unclassified) (4) sTeTasa epIlepTIkasa (Status epilepticus - continuous seizures) jaba marIz2a ko mirgI ke daure lagAtAra Adhe ghaMTe se bhI jyAdA samaya taka cAlU rahe yA bArabAra Ate mirgI ke daure ke bIca dardI behoza rahe, usa gaMbhIra paristhiti ko sTeTsa epIlepTIkasa kahate hai| ye meDikala imarajansI hai / dardI ko tatkAla najadIka

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40 mastiSka aura jJAnataMtu kI bImAriyA~ ke aspatAla meM I.C.U. meM bharatI karake sAravAra zurU kara denI bAvajUda bhI 15 - 20 pratizata dardI cAhie / saghana sAravAra ke kI mauta ho sakatI hai / sAikojanika sIjhara : hisTIriyA : mirgI jaise hI lakSaNoM vAlA anya eka roga hIsTIriyA hai / yaha eka mAnasika roga hai aura isameM mastiSka meM takalIpha nahIM hotI / yaha roga vizeSakara mahilAoM meM pAyA jAtA hai / mAnasika roga ke cikitsaka ke upacAra se isa roga se mukta huA jA sakatA hai / phebAila kanvaljana arthAt bukhAraprerita mirgI : kabhI-kabhI choTe baccoM ko bukhAra meM sAmAnya mirgI A jAtI hai| sAmAnyataH baccA pAMca varSa kA hone ke bAda aisI mirgI svayaM khatma ho jAtI hai / isameM mastiSka meM kisI taraha kI hAni nahIM pahuMcI hai, isakI puSTi kara lenI cAhie / jinheM bukhAra meM mirgI AtI ho, aise baccoM ko bukhAra hI na Ae, isake prati pUrI sAvadhAnI baratanI caahie| turaMta hI perAsITAmola jaisI davAeM tathA klobAjAma nAmaka davA de denI caahie| gudA meM rakhI jAne vAlI Dir - 2, Juniz yA anya koI davA aisI mirgI rokane kA saTIka upAya hai aura mirgI zuru hogI bhI, to isase turaMta ruka bhI jAtI hai / ye davA bAraha ghaNTe bAda punaH dI jA sakatI hai| yA phira dA~ta yA jIbha ke Upara Midazolam nAmaka davAI, Dropara yA siriMja se turaMta DAlane se mirgI ke dore ko rokA jA sakatA hai / aisI mirgI rokanA jarUrI hai; kyoMki bArabAra mirgI Ae to bhaviSya meM kompleksa pArziyala athavA janaralAijDa sIjhara ke daure zuru ho sakate hai / ( 1% dardI meM)

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41 4 . mirgI ke daure (Epilepsy) epilepsI kA daurA arthAt mirgI Ae, taba ina bAtoM ko avazya dhyAna meM rakheM : 1. marIja ko eka karavaTa sulA kara kapar3e DhIleM kara deM / jIbha dAMto ke bIca na A jAe, isake lie muMha meM dhIre se rumAla yA goz2apIsa rakheM, paraMtu isake lie bhI bahuta jora na lagAeM / turaMta tabIbI salAha kA intejAma kareM / marIja ko ghAva lage athavA bArabAra mirgI Ae, to cikitsakIya salAha lenI cAhie / jarUrata par3ane para nasa meM Lorazepam yA Diazepam ke iMjekzana kI vyavasthA kareM, athavA marIja ko tatkAla aspatAla meM dAkhila kreN| * epilepsI ke marIja svastha-sAmAnya jIvana jI sakate haiM, vivAha kara sakate haiM aura mahilA marIja garbha bhI dhAraNa kara sakatI haiN| garbhAvasthA ke daurAna mirgI kI kucha davAoM ke upayoga se, hone vAle bacce ko adhikAMzataH koI hAni nahIM pahuMcatI, jaise ki kArbAmejepina, lemoTrijina aura lIvATIrAsiTAma / paraMtu yadi davA baMda kara dene se mirgI Ae, to isameM oNksijana nahIM milane se bacce ko hone vAlA nukasAna adhika kharAba sAbita hotA hai| ata: garbhavatI ko davA avazya lenI cAhie / epilepsI kI jA~ca : jA~ca ke lie mirgI kI vistRta riporTa taiyAra karanI cAhie / jisane mirgI dekhI ho, usa vyakti se sabhI jAnakAriyAM ekatra karanI cAhie / phira mirgI kA prakAra, upacAra kI paddhati va roga ke bAre meM adhika jAnakArI ke lie mastiSka kA grApha (I.I.jI.), mastiSka kA phoTo (arthAt sI.TI.skaina) aura Avazyaka ho to ema.Ara.AI. nAmaka skaina bhI honA caahie| isake alAvA rakta kI jAMca, mastiSka va sIne ke eksa-re jaisI anya jAMca ko bhI yathocita zAmila karanA cAhie /

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mastiSka aura jJAnataMtu kI bImAriyA~ epilepsI kA upacAra : epilepsI kA kAraNa jAna kara usakA yogya upacAra honA jarUrI hai| isake alAvA isa roga ko aniyaMtrita hone jaisI paristhiti se dUra rahanA cAhie / ataH jAgaraNa, tanAva, bhUkhe rahane yA adhika mAnasika athavA zArIrika zrama ko TAlanA cAhie / isake alAvA ucita davA lambe samaya taka lene se yaha roga nizcita hI kAbU meM kiyA jA sakatA hai| davAI acAnaka baMdha nahi karanI cAhie / niyamita phaoNlo-apa bahuta jarUrI hai, jaba jarura paDe to turaMta saMparka karanA cAhie / mirgI kI mukhya davAeM : (1) phinobArbiTona : udA. gArDinAla, biTAla (2) phenIToina : udA. epToina, DAileMTina, epsolina (3) kArbomejepina : udA. jena, jepTola, TegrITAla, mejheTola kArbATola, (4) vAlaproyeTa : udA. vAlaperina, eMkoreTa, epileksa, ToraveTa kArbomejepina aura vAlaproyeTa meM aba naI TeknolojI ke anusAra slA-rilIja (dhIre va lambe samaya taka prabhAvI rahane vAlA) phormUlA bhI milatA hai, jaise ki TegreTAla-sI.Ara., vAlprolasI. Ara. Adi / isase dina bhara davA kA rakta meM pramANa samAna banA rahatA hai aura dina meM do hI bAra davA lenI par3atI hai / vAlproyeTa kA nayA kSAra DAyavAlaproyeTa (e.g. velensa) aba jyAdA pracalita hai| mirgI kI mukhya davAoM ke duSprabhAvoM ke bAre meM prakaraNa 24 meM vistRta jAnakArI dI gaI hai / roga ke lakSaNa va prakAra ke AdhAra para cikitsaka ucita davA taya karate hai| pichale kucha varSoM meM isa roga ko lekara kaI nae saMzodhana hue haiM, roga nivAraka naI davAIyA~ bhI khojI gaI haiM / naI zodhoM ko

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4 - mirgI ke daure (Epilepsy) davAIyoM tathA sarjarI ina mukhya do bhAgoM meM vibhAjita kiyA jA sakatA hai, jisameM : naI davAoM ( seMkanDa janarezana) meM gAbApeMTIna, lemoTrijina, vigAbeTrIna, TIAgAbIna, phelbemeTa, TopIrAmAiDa ullekhanIya haiM / ye davAIyA~ amarIkA ke epha.DI.e. (pheDarala Dragsa othoriTI) dvArA kar3e parIkSaNa se gujarI hone ke kAraNa bAjAra meM mirgI kI davA ke rupa meM svIkRta huI haiN| sAmAnyataH ye davAIyA~ apekSAkRta mahaMgI haiM / pahale batAI gaI mukhya davAIyoM kA pariNAma na mile to prabhAva sambaddha hI ina davAoM kA upayoga kiyA jAtA hai / adhikAMzataH ina davAoM kA duSprabhAva kama hotA hai / phira bhI kucha mAmaloM meM vicitra duSprabhAva pAe jAte haiM / jaise ki TopIrAmAiDa se karIba 2 pratizata marIjoM ko gurde meM patharI hotI hai| ina davAIyoM ke bahuta lambe samaya ke duSprabhAvoM ke lie abhI kama anubhava hai, lekina garbhAvasthA meM ye davAIyA~ kadAcita surakSita (Safe) haiM arthAt janma lene vAle bacce para ina davAIyoM kA burA asara nahIM ke barAbara par3atA hogA, aisA pAyA gayA hai / isa taraha suyogya mAmale meM jaba mukhya davA saphala na ho athavA usase duSprabhAva hotA ho to naI davAIyoM kA upayoga avazya karanA caahie| bilkula naI davAIyoM meM mukhyataH oksakAi~jepina (jhenokasA, seljika), lIvATIrAsiTAma (ToralIvA) tathA jhonIsemAIDa (jhonIsepa, jhonIgrAna) hai / ye davAIyA~ abhI kAphI naI hai / inheM tharDa janarezana davAIyA~ bhI kahA jA sakatA hai / svAbhAvika taura para ina davAIyoM kA anubhava kama hai, paraMtu aba taka ye prabhAvI pAI gaI hai| inake duSprabhAva bilkula mAmUlI haiM, aura kucha purAnI davAIyoM kI jagaha ye ArAma se le legI, aisA lagatA hai / jaise ki kArbomejepina ke sthAna para oksakAi~jepina / jaba mukhya davAIyA~ yogya vaijJAnika mArgadarzana (Guidelineprotocol) ke anusAra upayoga kara cuke hoM aura davAIyoM kA yogya saMyojana (Polytherapy), yogya mAtrA meM, yogya samaya taka upayoga

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44 (2) mastiSka aura jJAnataMtu kI bImAriyA~ karane ke bAvajUda bhI mirgI kA jarUrI niyamana na ho, to use aniyaMtrita mirgI (Refractory Epilepsy-Intractable Epilepsy) kahate haiM / yaha taya karane se pahale nimna bAtoM kI jAMca kara lenI cAhiye : (1) yaha roga mirgI kA hI hai na ? (Diagnostic Error) milatA julatA koI roga jaise sinkopa, hisTIrIyA yA zakkara kama honA Adi to nahIM hai na ? mirgI kA prakAra ThIka se taya huA hai na? mirgI kA koI kAraNa khojane meM to bhUla nahI huI hai na ? ina bAtoM kA punaH vizleSaNa kara ke taya karanA caahiye| isase sambandha yogya davA, yogya mAtrA meM dI to gaI hai na ? jisa prakAra kI mirgI ho usa prakAra kI davA dI jAtI hai / galata davA (Inappropriate drug) se mirgI aniyaMtrita bhI ho sakatI hai| jaise ki kArbomejepina dene se mAyoklonika prakAra kI mirgI aniyaMtrita ho sakatI hai / ayogya Doja-mAtrA yA ayogya saMyojana to nahIM hai na ? rakta meM davA kA pramANa sambaddha vyakti meM ThIka se banA huA to hai na? isake alAvA marIja kI yogya jAMca ho cukI hai yA nahIM? jaise ki I.I.jI., sI.TI. skaina aura ema.Ara.AI. Adi dvArA jAMca kara yogya kAraNa kA patA to lagAyA gayA hai na ? (4) isI prakAra marIja tarapha se koI parezAnI to nahIM hai na? marIja vAstava meM yogya davA niyamita letA hai yA nahIM ? koI anya hI mAnasika yA zArIrika bImArI to nahIM hai na ? anya koI davA anya roga ke liye calatI ho, to usake kisI viparita prabhAva se mirgI baDhatI to nahIM hai na ? mastiSka meM kisI taraha kI gAMTha, janmajAta khAmI yA aisI koI gar3abaDI to nahIM hai na ? jarUrata paDane para viziSTa prakAra kI I.I.jI., vIDiyo I.I.jI., Deptha ilekTroDa se I.I.jI., spekTasTaDI aura ema.Ara.AI. karAnA paDatA hai| (3)

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4 - mirgI ke daure (Epilepsy) uparokta kAraNoM kA yogya dhyAna rakhA gayA ho aura ina kAraNoM ke nahIM hone kI puSTI ho jAnA, isa caraNa ke liye ati mahattvapUrNa hai, kyoMki ye kAraNa adhikatara TAle jA sakate hai aura isase mirgI kA suyogya niyamana ho sakatA hai / isake bAvajUda aura vaijJAnika mArgadarzana meM do alaga-alaga mukhya davAIyoM (monotherApI) kA pratyeka chaha mAha kA yogya Doja kA korsa tathA kama se kama eka saMyojanayukta davA (polItherApI) kA 6 mAha kA korsa ( jarUrata par3ane para aise do korsa) AjamAne ke bAvajUda yadi hara mahIne eka se do bAra daure do varSa taka paDate raheM, to use " aniyaMtrita mirgI" kahanA cAhie, aisA eka sAmAnya mata hai / hAlA~ki yaha lebala pratyeka marIja ke lie alaga honA cAhiye / marIja ke sAmAjika, Arthika va rojagAra ke paribala tathA marIja kI umra, usake mAnasika va zArIrika lakSaNa athavA khAmiyoM ko dhyAna meM rakha kara hI marIja kA aniyaMtrita mirgI (Refractory Epilepsy) se pIr3ita hone kA nidAna karanA cAhiye / mirgI ke tamAma marIjoM meM karIba 15 se 22 pratizata marIja aise hote haiM / aise marIjoM ke lie nirdiSTa kadama (steps) uThAe jA sakate haiM : 1 45 (A) naI davAIyA~ AjamAI jA sakatI hai / sAmAnyataH mukhya davAiyoM ke alAvA vizeSa davA ke rUpa meM (Add-on drug) sekanDa athavA tharDa janarezana kI davA cikitsA vizeSajJa yogya prakAra kI mirgI meM upayoga karate hai / kabhI-kabhI naI davA ko mukhya davA (First line drug) ke rUpa meM upayoga kiyA jA sakatA hai / (B) oNparezana : jaba davAIyoM ke tahata pariNAma nahIM mile aura mirgI ke kAraNa ke rUpa meM koI ilekTrikala yA sTrakcarala phokasa ( kendra bindu) mila jAe, to yogya sarjarI dvArA mirgI samasyA ko hala kiyA jA sakatA hai / mirgI kI sarjarI ke kSetra meM pichale dazaka meM atyaMta saMtoSajanaka pragati huI hai aura isake phalasvarUpa jina mAmaloM meM mirgI kA kendra (focus) milA ho, aise oNparezana ke lie yogya

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46 mastiSka aura jJAnataMtu kI bImAriyA~ marIjoM meM 30 se 35 pratizata marIjoM kI mirgI pUrNataH niyaMtrita ho jAtI hai| aise oNparezana hamAre deza meM tathA videza meM bhI hote haiM aura ye vizeSa jokhimakArI bhI nahIM hai / vibhinna seMTaro meM 20 hajAra se 2 lAkha rUpaye taka kA kharca ho sakatA hai| hAlAMki aise seMTara hamAre deza meM unakI jarUratoM ke mukAbale kAphI kama haiM / mirgI ke liye nimna oNparezana upalabdha hai / kisa mAmale meM kaunasA oNparezana kiyA jAe, yaha to epilepsI seMTara ke anubhavI nyUrolojisTa-nyUrosarjana kI TIma hI taya karatI hai / (pRSTha - 258) (a) Resective Surgery (b) Functional Surgery (a) Resective Surgery kATachAMTa karanA (1) mAikroskopika Disekzana (2) Temporala loba sarjarI (3) eksTrA Temporala sarjarI (4) lIjanekTomI (5) lobekTomI (6) malTI lobAra sarjarI (7) hemI sphiarekTamI Nonresective/Functional Surgery (1) korpasa keloz2oTomI (2) malTIpala sabapAyala TrAMsekzana (3) sTIriyoTekaTika prosIjara (4) AyonAijiMga reDiezana (5) kamIsaroTomI (b)

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4 - mirgI ke daure (Epilepsy) (c) sTimyulezana - Stimulation - uttejita karane kI prakriyA (1) vegasa narva sTimyulezana (2) thelemika sTimyulezana (3) serIbelara sTimyulezana (d) koSa pratyAropaNa - selaTrAnsplAnTa (Cell Transplant) (C) vegasa narva sTimyulezana - (VNS ) : san 1980 meM Joseph Zarbara dvArA khojI gaI aura karIba 8 se 10 lAkha rUpaye kI lAgata se hone vAlI yaha viziSTa prakAra kI sarjikala prosIjara hai, jisameM kampyUTara paddhati se ilekTrika rUpa se vegasa narva (mastiSka se nikalatI 10 naMbara kI cetA) ko uttejita kiyA jAtA hai, jisase mirgI ke daure 50 pratizata se bhI kama ho jAte haiM / usake sAtha davA bhI le sakate hai / daurA par3ane kI jAnakArI (jise aurA kahate hai) ho jAtI ho, to marIz2a svayaM hI ilekTroDa ko uttejita kara aisI mirgI ko baMda bhI kara sakatA hai / isa paddhati kI vyApakatA bar3hatI jA rahI hai / yaha surakSita paddhati hai / isake mApadaMDa badale jA sakate haiM / jina marIjoM kA sarjarI ke lie yogya kesa na ho, jisameM mirgI kA udbhavasthAna kendra (focus) nahIM huA ho athavA jo sarjarI ke liye pratIkSA rata hoM, una sabhI meM yaha paddhati kAphI acchI hai| khAsakara jisa mAmale meM davAIyA~ vizeSa upayogI nahIM sAbita huI hoM, unameM isa prakAra kA upacAra upayogI hai| (D) kiTojenika DAyeTa : 80 pratizata carabIyukta bhojana se mirgI kA pramANa kAphI hada taka kama hotA hai| aisI zodha ke bAda yaha paddhati pracalita huI hai| yaha paddhati vizeSakara aniyaMtrita mirgI vAle baccoM meM upayogI pAI gaI hai, jisase karIba 30% bacce mirgI se mukta hue pAe gae hai aura itane hI 30% anya marIjoM kI mirgI meM bhI kamI pAI gaI hai| isa prakAra kA bhojana lenA zuru meM baccoM ko kaThina lagatA hai aura kucha rogoM meM to yaha diyA hI nahIM jA sakatA hai, paraMtu dhIre-dhIre bacce AdI ho jAte haiN|

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48 mastiSka aura jJAnataMtu kI bImAriyA~ lagabhaga 1 se 2 varSa taka DaoNkTara kI dekharekha meM aisA bhojana lene se acchA pariNAma mila sakatA hai / isameM mAtA-pitA ko mahattvapUrNa bhUmikA nibhAnI hotI hai| sarjarI yA VNS jaisI yaha kharcIlI paddhati nahIM hai / marIja ko zuru meM 2 se 3 saptAha taka cikitsaka kI dekharekha meM aspatAla meM rakhanA hitakara hai| yogya mAmale meM isa prakAra kA upacAra AjamAyA jA sakatA hai / niHsaMdeha hai ki samaya bItane para naI zodha, naI paddhatiyAM (jaise TArageTeDa Draga DilIvarI), naI sarjikala paddhati, sela TrAnsaplAnTa Adi dvArA mirgI ke marIja kA bhaviSya badala jAegA / mirgI ke marIja ko nirAza hone kI jarUrata nahIM hai / / mirgI pracalita roga hone ke kAraNa itanI carcA Avazyaka lagI hai / yaha carcA meDikala rUpa se pUrNa nahIM hai, maiM yaha bAta dhyAna meM lAnA cAhatA huuN| mirgI sambaMdhI kucha bhrAMtiyAM abhI bhI haiM / isase kaI bAra marIja ucita upacAra se vaMcita raha jAtA hai : (1) mirgI mAnasika bImArI hai / yaha satya nahIM hai / (2) mirgI ke daure ke daurAna marIja ke hAtha meM lohe kA TukaDA dabA kara rakhanA yA pyAja athavA jUte (cappala) sUMghAnA / yaha mAnyatA galata hai / vAstava meM adhikAMzataH eka se pAMca miniTa meM mirgI kA daurA svayaM hI zAMta ho jAtA hai| (3) mirgI vaMzAnugata hai / sAmAnyata: yaha vaMzAnugata nahIM hai, kintu mAtA-pitA meM se kisI eka ko bhI mirgI ho, to bacce meM mirgI hone kI saMbhAvanA bar3ha jAtI hai / (4) mirgI ke marIja ke liye TaoNnika acche / yaha eka gumarAha karane vAlI mAnyatA hai /

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4- mirgI ke daure (Epilepsy) (5) eka bAra mirgI huI, to hamezA rahegI / nahIM, aisA nahIM hai / 70 se 75 pratizata mAmaloM meM davA lene se zata pratizata rAhata hotI hai / kucha ko jiMdagI meM eka hI bAra daurA paDatA hai / * epilepTika marIja bilkula sAmAnya ( normala ) haiM / unake prati nakArAtmaka ravaiyA - abhigama nahIM rakheM tathA yaha dhAraNA nahIM banAeM ki yaha marIja khAmIyukta hai / 49 aise marIjoM ko roga kAbU meM Ane ke bAda bhI kucha varSa taka DrAiviMga nahIM karanA cAhiye, aura svimiMga tathA Aga se dUra rahanA cAhiye / juliyasa sIjara, nepoliyana, oNlpheDa nobela, vinseMTa vAna goga, jaoNnTI roDsa jaisI vikhyAta hastiyoM meM yaha roga thA, phira bhI ve unake kSetra meM saphala rahe / isa taraha sAmAjika va vyAvasAyika Adi gatividhiyoM meM mahAnatA prApta karane meM mirgI koI bAdhA nahIM banatI / mirgI ke marIja kI sarvAMgI madada ke liye, 'epilepsI averanesa phorama' ahamadAbAda meM kAryarata hai, jisameM roga kI jAnakArI, Arthika suvidhA, grupa- kAryakrama Adi rakhe jAte hai / marIja tathA parijanoM ko mAnasika sAMtvanA dene va samAja meM unheM svIkRti dilAne vAlI gatividhiyAM cikitsA vizeSajJoM kI dekharekha meM kI jAtI haiN| isake alAvA rASTrIya stara para iMDiyana epilepsI sosAyaTI tathA iMDiyana epilepsI esosiezana jaisI AMtararASTrIya mAnyatAprApta saMsthAeM bhI kAphI sakriya hai / ahamadAbAda, bambaI, dillI jaise bar3e zaharo meM usakI zAkhAe~ kAryarata hai /

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50 mastiSka aura jJAnataMtu kI bImAriyA~ sakhiyA * mastiSka meM acAnaka vidyuta taraMgo kA asaMtulana ho jAne se zarIra meM jhaTake Ate hai, jisako mirgI kahate hai| vizva ke karIba 1 pratizata logoM ko (5 karor3a se jyAdA) yaha roga hai / * 70-75 pratizata mAmale meM yaha bimArI bacapana se hotI hai| mirgI vividha prakAra kI hotI hai, usake anusAra alaga alaga prakAra kI davA dI jAtI hai / * khAsa karake marIz2a yadi strI ho to epIlepsI hai yA hisTIrIyA hai, usakA phaisalA jA~ca karane para kiyA jA sakatA hai| mirgI eka nyurolojikala bImArI hai, hisTIrIyA mAnasika bimArI hai| usakI jAnakArI unake AptajanoM ko honI cAhie / mirgI kI davA DokTara ke sUcanA anusAra mukhyataH do yA tIna sAla yA jyAdA lenI paDatI hai / davA kA duSprabhAva ho yA to strI marIz2a meM garbhAvasthA ho to DokTara ko yaha batAnA caahie| kyoMki esI paristhiti meM davA badalanI paDatI hai / * mirgI ke kucha haThile kesameM acchI taraha oparezana bhI kiyA jA sakatA hai / * naI-naI davAIyAM, sarjarI, naye saMzodhana kI teja raphatAra se mirgI ke dardI kA bhaviSya AzAspada ho gayA hai|

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pakSAghAta-lakavA (perelisisa) - Stroke pakSAghAta (Stroke) (breIna aTeka) apane deza meM pracalita roga hai| mRtyu ke kAraNoM meM hRdayaroga, kensara aura sar3aka durghaTanA ke bAda pakSAghAta (Stroke) eka mahatvapUrNa kAraNa hai / sTroka do prakAra ke hote haiM - (1) rakta kama milanA - (Brain Ischemia) (2) breIna hemareja honA (Brain Hemorrhage) isa roga ke viSaya meM janajAgRti aura usakI jAnakArI Ama janatA meM atyaMta kama hai vaha eka du:khada bAta hai| vizeSataH isa roga ke bAre meM khataranAka kAraNoM kI sahI jAnakArI se hRdayaroga kI taraha isase bhI bacA jA sakatA hai / sAvadhAnI ke cihna jAna leM to bar3e hamale se bacA jA sakatA hai / isa bImArI hone ke bAda turaMta ilAja aura upacAra mileM to isase vikalAMgatA se bhI bacA jA sakatA hai aura aisA hone para vaiyaktika, kauTuMbika, Arthika, sAmAjika aura rASTrIya hita bRhada pramANa meM bane rahe to eka bar3I sevA mAnI jaaegii| yahAM pakSAghAta (breIna eTeka yA sTroka) kI ati vistRta jAnakArI dene kA yahI prayojana hai| apanI carabI aura mIThAzayukta khurAkapaddhati, AlasI jIvana, kasarata kI kamI, peTa para jamI carabI, vaMzAnugata (resiyala) kAraNa, rakta meM adhika mAtrA meM carabI... ina sabhI ko lekara pUre vizva meM bhAratIya aura usameM khAsa karake gujarAtIyoM meM hRdayaroga aura pakSAghAta kA pramANa adhika hai| Upara batAye mutAbika sTroka meM pramukha cihna pakSAghAta (perelisisa) ho sakatA hai| jisameM eka bAju kA aMga / kabhI donoM bAju ke aMga nAkAma bana jAte haiM / isameM vizeSataH bolane kI, samajhane kI yA dekhane kI zakti para asara hotI hai| sTroka ke prathama prakAra breIna izcemiA/thrombosisa meM mastiSka kI kucha dhamanIoM meM rakta ke

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52 mastiSka aura jJAnataMtu kI bImAriyA~ paribhramaNa meM rukAvaTa hone se mastiSka ke koSoM meM poSaNa aura oNksijana kI kamI ho jAtI hai, phalasvarUpa ye koSa kAma karanA baMda kara dete he / aura yaha samasyA zurU hotI hai / sTroka ke dUsare prakAra breIna hemareja ke bAre meM vizeSa bAteM hama AnevAle cepTara meM dekheNge| kucha nasIbavAle logoM ko kSaNika pakSAghAta kI asara 24 ghaMTe ke aMdara saMpUrNata: calI jAtI hai, jise cikitsA kI bhASA meM TI.AI.e. (Transient Ischemic Attack) kahate haiM / hAlAMki aise marIjoM meM se 30 pratizata ko AnevAle pAMca varSa meM bar3e pakSAghAta kA asara ho sakatA hai / isaliye kSaNika pakSAghAta ko bhI cetAvanI samajha kara sAvadhAnI rakhanA hitakArI hai| ___ pakSAghAta ke prakAra aura usase hone vAlI asara kI tIvratA, mastiSka ke kisa bhAga ko kitanI kSati pahu~cI hai, isake dvArA niSNAta DaoNkTara taya karate haiM / agara mastiSka meM bAyeM bhAga meM asara hogA to dAyeM bhAga meM pakSAghAta kA asara dikhAI detA hai, jisameM vANI kI kSamatA bhI kama ho jAtI hai / isI prakAra mastiSka ke dAyeM bhAga meM asara hogA to zarIra ke bAyeM bhAga para pakSAghAta kA asara dikhatA hai| miDala serebala ArTarI 7 - MCA bA. enTiriyara serebala ArTarI - enTiriyara komyunikeTiMga ArTarI / inTarnala (keroTiDa ArTarI) (mastiSka meM rakta pahuMcAnevAlI mukhya nalikAoM meM rakta pravAha baMda hone se pakSAghAta ho sakatA hai)

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5 - pakSAghAta-lakavA (perelisisa) - STROKE ____ mastiSka ko rakta mukhyataH cAra dhamaniyAM pahuMcAtI hai| gale meM Age ke bhAga meM donoM tarapha kI do keroTiDa nalikAeM aura pIche ke bhAga kI keroTiDa ArTarI - 3 INTERNAL CAROTID A. keroTiDa - ArTarI - 4 besIlara ArTarI (dhorI nasa) (dhamanI) varTibala / varTibala ArTarI - 1/ ArTarI - 2 mastiSka ko rakta pahuMcAtI mukhya nalikAeM do varTibrala nalikAeM mastiSka ko lagAtAra rakta pahuMcAtI hai| pIche kI do nalikAeM milakara besIlara ArTarI banatI haiM, jise hama sAmAnyataH dhorI nasa ke nAma se jAnate hai, jo sabase mahatvapUrNa nalikA hai| mastiSka kI dhamaniyAM athavA mastiSka ko rakta pahuMcAne vAlI raktavAhinI kI dIvAra aMdara se sthUla hone se yA rakta jama jAne se mastiSka meM rakta paribhramaNa ko kSati pahuMcatI hai| kucha minaTa ke liye hRdaya baMda hone se bhI mastiSka ko nukasAna pahuMcatA hai| kabhI-kabhI zirA meM rakta jama jAne se bhI pakSAghAta ho sakatA hai| __ baDhatI umra ke sAtha zarIra kI kSatigrasta dhamaniyoM ke AMtarika stara meM vRddhi hotI hai, pariNAmasvarUpa rakta paribhramaNa meM rukAvaTa hotI hai yA kama ho jAtA hai / isa paristhiti ko ArTarIosklerosisa-othero sklerosisa kahate hai|

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54 mastiSka aura jJAnataMtu kI bImAriyA~ breIna izcemiyA meM mastiSka ke koSoM ko do prakAra se kSati ho sakatI hai / eka, rakta kI snigdhatA bar3hane se rakta jama jAtA hai (thrombosis)| dUsarA, jamA huA rakta hRdaya meM se yA anya sthAna se rudhira (rakta) meM pravAhita ho kara mastiSka kI anya dhamanI meM (Artery) ruka kara rakta paribhramaNa ko rokatA hai, use aimbolijhama kahate haiM / lagabhaga 20 pratizata marIjoM meM mastiSka kI nasa blaDaprezara baDha jAne se yA anya kAraNa se phaTa jAya to bhI pakSAghAta hotA hai, jise breIna hemareja kahate haiM / pakSAghAta jaise hI lakSaNa anya kisa bImArI meM ho sakate haiM? mastiSka kA saMkramaNa, beInaTyUmara, mavAda kI gAMTha, malTipala sklerosisa, hisTIriyA, sira kA ghAva Adi meM eka tarapha yA donoM tarapha kA pakSAghAta ho sakatA hai, kintu vaha yaha pakSAghAta (sTroka) se bhinna hotA hai aura vaha anya lakSaNoM se pahacAnA jA sakatA hai| pakSAghAta (sTroka) hone ke jimmedAra khataranAka kAraNa : (1) bar3hatA huA raktacApa arthAt hAI blDaprezara (2) madhuprameha arthAt DAyAbiTIsa (3) rakta meM bar3hatA huA carabI (pheTa) kA stara (4) bar3hatA vajana (obesiTI) (5) dhUmrapAna, tambAku yA zarAba kA sevana (6) hRdayaroga (IHD), vAlva ke roga yA aniyamita nADI (jaise ki Atrial Fibrillation-AF) (7) purAnA pakSAghAta yA TI.AI.e. (8) garbhanirodhaka goliyoM kA sevana (9) saMgharSayukta jIvanazailI, sTresa, ArAmadAyaka jIvana kA atireka aura vyAyAma kI kamI (10) vaMzAnugata - jineTika

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55 5 . pakSAghAta-lakavA (perelisisa) - STROKE (11) rakta ghaTakoM saMbaMdhita bImArI, jo rakta ko ghaTTa kareM (12) ku cha zArIrika roga jaise ki kolejana DisIja, enTikArDiyolIpina sinDroma (13) cayApacaya kI kucha takalIpha jaise ki hAyapara homosisTinemiA (14) kokeIna Adi Dragsa kI lata uparokta meM se adhikatara khataranAka kAraNa pakSAghAta aura hRdayaroga donoM bImAriyoM ko janma dete hai| niyamita yogya upacAra se ina kAraNoM ko kAbU meM liyA jA sakatA hai / isalie 40 varSa se Upara ke pratyeka vyakti ko niyamita cikitsaka jA~ca karavAnI cAhie / parivAra meM kisI sadasya ko hRdayaroga yA pakSAghAta huA ho to adhika sAvadhAnI rakha kara pakSAghAta rokane ke lie ucita kadama uThAne caahie| isake alAvA pakSAghAta kI bImArI ke anya saMbhavita kAraNoM kI jAnakArI jarUrI hai| zarIra meM saMkramita rogoM kI upasthiti, ilekTrolAiTa (soDiyama-poTeziyama) kI takalIpha, hImoglobina kI kamI, vAtAvaraNa-paryAvaraNa, pAnI kI kaThoratA Adi / ina sabhI kAraNoM ke saMdarbha meM vaijJAnika ekamatatA nahIM hai / eka bAta yaha bhI dhyAna meM rakhanI cAhie ki lagabhaga 40 pratizata marIz2oM meM koI bhI mahatvapUrNa kAraNa nahIM milatA jo ki pakSAghAta (athavA hRdayaroga) ke liye jimmevAra ho / pakSAghAta ke cetAvanI-cihna (TI.AI.e.) : (1) eka tarapha ke arthAt Adhe aMga meM azakti kA ehasAsa ho, eka tarapha ke hAtha-paira kAma karanA baMda kara deM yA sunApana yA jhanajhanAhaTa kA ehasAsa ho / (2) thor3I dera ke lie eka yA donoM AMkhoM se kama dikhAI denA /

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56 ____ mastiSka aura jJAnataMtu kI bImAriyA~ (3) thoDe samaya ke lie bolane yA samajhane meM takalIpha honA, duvidhA honA / (4) cakkara AnA, dhuMdhalA dikhanA, dugunA dikhanA, acAnaka sira darda honA, ulTI-DakAra AnA, donoM pairoM meM kamajorI honA, laDakhaDAnA, acAnaka kSaNika behoza honA, khIMca AnA yA gira jAnA; aisA kucha minaTa-ghaMTe taka rahe / aise lakSaNa kI ora bedarakArI bhaviSya meM pUre zarIra meM pakSAghAta kara sakatI hai, AvAja calI jAtI hai aura marIz2a behoza bhI ho sakatA hai| jiMdagI ko khatarA ho sakatA hai / pakSAghAta aura hRdayaroga rokane ke upAya : ArTarIoskle rosisa bahuta hI maMda gati se uttarotara bar3hane vAlA roga hai, jisameM Age batAe gayeM mahatvapUrNa kAraNa gati tathA kSati meM baDhotarI kara sakate hai / ise rokane ke lie pahale to vajana kA saMtulana banAe rakhe aisA sAttvika aura pauSTika bhojana lenA caahie| tambAku yA dhumrapAna baMda kara denA cAhie / blaDaprezara : breIna thrombosisa, breIna hemareja aura hArTa eTeka kA sabase bar3A kAraNa yahI hai / blaDaprezara niyamita jAMca karavAnA cAhie aura agara adhika mAluma par3e to ucita davAI lekara niyaMtrita rakhanA cAhie / pratyeka normala vyakti ko bhI niyamita jAMca karavAte rahanA jarUrI hai / usameM agara sira darda, cakkara, aMdherA laganA, becenI jaisA lage to jAMca khAsa karavAnI caahie| eka AdhArabhUta mAhitI (nezanala sTroka esosiezana) ke anusAra pratyeka vijiTa daurAna DaoNkTara ko apane marIz2a kA blaDaprezara dekhate rahanA cAhie, bhale hI marIz2a koI bhI anya bImArI ke upacAra ke lie kyoM na AyA ho ? aisA karanA cikitsaka kA pavitra pharja hai|

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5 - pakSAghAta-lakavA ( perelisisa ) - STROKE 57 blaDaprezara ke ucita upacAra aura niyamana se hRdayaroga, pakSAghAta aura kiDanI kI bImArI rokI jA sakatI hai / sisTolika (Upara kA) blaDaprezara lagabhaga 120 aura DAyasTolika (nIce kA) blaDaprezara 8085 rakhanA hI zreSTha upAya hai| kevala blaDaprezara ke sacoTa aura AjIvana niyamana se 40 se 50 pratizata pakSAghAta aura hRdayaroga nizcita hI rokA jA sakatA hai, aisA samaya-samaya para sAbita huA hai| isalie blaDaprezara ke niyamana ke bAre meM jitanA kahA aura samajhA jAe utanA kama hai| Ama janatA meM blaDaprezara ke viSaya meM aneka bhrama haiM, jaise ki (1) kucha marIja khuda ko blaDaprezara ho sakatA hai, ye mAnane ko taiyAra hI nahIM hote / unakA kahanA hai ki "mujhe sira darda nahIM hai, aura cakkara bhI nahIM Ate" Adi / kintu sabhI blaDaprezara ke marIjoM meM yaha lakSaNa nahIM dikhate haiM / blaDaprezara ke kucha marIz2oM ko koi bhI lakSaNa nahi hote / (2) kucha samaya taka davA lene para marIz2a aisA mAnane lagatA hai ki aba usakA blaDaprezara kaMTrola ho gayA hai / davAI cAlU rakhane ke sAtha mApane para prezara normala rahatA hai, isaliye vaha davAI banda kara detA hai / vaha aisA mAnatA hai ki usakA prezara hamezA ke lie ThIka ho gayA hai, kintu yaha eka ati bhayajanaka galataphahamI hai / davAI banda karane ke kucha samaya ke bAda blaDaprezara phirase bar3hane lagatA hai| aMta meM marIz2a pakSAghAta aura hRdayaroga kI takalIpha ke sAtha DaoNkTara ke pAsa pahu~catA hai / pratidina hama aisA dekhate hai, jisase atizaya duHkha hotA hai / DAyAbiTIsa : blaDaprezara aura DAyAbiTIsa eka dUsare ke bhAI jaise hai / vaha bhI mahAbhayaMkara roga hai / chupachupakara praveza karanevAlA yaha roga bahuta takalIpha detA hai / yaha roga ho to usakA svIkAra kara ke ucita upacAra dvArA usakA saMpUrNa niyamana ati Avazyaka hai / samaya-samaya para blaDasugara kI jAMca karavAte rahanA cAhiye, jisase blaDasugara kI mAtrA kI jAnakArI rahe / DAyAbiTIsa aura bI.pI. ke marIz2a ko davAI ke sAtha jIvanazailI tathA AhAra meM bhI bahuta parivartana lAkara sAvadhAnI rakhanI cAhie /

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58 mastiSka aura jJAnataMtu kI bImAriyA~ AhAra : pakSAghAta se bacane ke liye AhAra meM carabI kI mAtrA kama (20%) kara denA ati Avazyaka hai / ghI, makkhana, talI huI cIjeM, AIsakrIma, mIThAI kama kara denA cAhiye / bhAratabhara meM aura usameM bhI gujarAtIyoM meM AIsakrIma khAne kI mAtrA bahuta adhika hotI hai / use tyAgakara AhAra meM salADa, phala, sabjiyoM kI mAtrA bar3hA denA hitakara hai / niyamita vyAyAma : pratidina 30 minaTa calane se nizcita lAbha hotA hai / vajana ghaTAnA ho to 60-80 minaTa se jyAdA calanA cAhie / yogAsana aura zarIra ke anurUpa anya vyAyAma bhI kiyA jA sakatA hai / hapte meM pAMca dina to vyAyAma tabIbI salAha lekara karanA hI cAhiye / ciMtAyukta, saMgharSapUrNa jIvanazailI meM kamI kara ke AnaMdita jIvana jInA cAhie / irSyA, dveSa tathA nakArAtmaka soca dUra karake 'sarvamitra' bano / yaha acchA pariNAma degA aura pakSAghAta tathA hRdayaroga dUra rhegaa| mahilAoM ko garbhanirodhaka goliyoM kA upayoga kama karake, garbhanirodha ke liye dUsarI paddhatiyA~ apanAnI cAhie / jinako Age hRdayaroga yA lakavA eka bAra ho cukA ho, aise mariz2oM ko rakta patalA rakhanevAlI davAI, jaise ki espirina, klopIDojela, DAipAirIDemola, TIklopIDina Adi cikitsaka kI sUcanA aura objharvezana tahata lenI cAhiye / usase pakSAghAta yA hRdayaroga hone kI saMbhAvanA karIbana 13 se 45 % jitanI kama ho jAtI hai / ise sekanDarI privenzana kahate hai / kintu Age hRdayaroga yA pakSAghAta na huA ho phira bhI Upara batAyeM gaye anya khataranAka lakSaNa ho to unheM espirina Adi davAI denI yA nahIM denI cAhie usake lie ekamata nahIM haiM, kintu jinako jyAdA khatarA ho unheM yaha diyA jA sakatA hai|

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59 5- pakSAghAta - lakavA (perelisisa ) - STROKE rakta meM carabI kA pramANa (khAsa prakAra se kolesTarola yA ela.DI.ela. prakAra kI carabI) adhika ho aura / yA eca.DI.ela. prakAra kA kolesTarola kama ho, aise marIz2oM ko sImavAsTeTIna, aTorvAsTeTIna jaisI sTeTIna prakAra kI davAI niyata mAtrA meM laMbe samaya taka dene se hArTaeTeka tathA pakSAghAta kA nivAraNa (privenzana) kiyA jA sakatA hai, aisA vaijJAnika satya abhI bahuta svIkRti pA rahA hai / aisI davAoM ke upayoga se hArTa aura keroTiDa nalikA se saMbaMdhita jyAdAtara sarjarI yA enjiyoplAsTI se bacA jA sakatA hai, usameM do mata nahIM hai / nidAna : pakSAghAta, mastiSka kA roga hone se anubhavI phijiziyana athavA mastiSka roga niSNAta (nyUrophijizayana) ke pAsa binA vilaMba yogya upacAra lenA cAhie / yaha niSNAta, mastiSka ke kisa bhAga meM kitane aMza meM kSati pahuMcI hai, yaha jAnane ke lie sabhI Avazyaka zArIrika jA~ca tathA kucha saMlagna jA~ca karavAte hai / adhikatara mastiSka kA sI.TI. skena yA ema. Ara. AI. TesTa karavA kara upacAra kA yogya nirNaya liyA jAtA hai / pakSAghAta hone ke prAraMbhika samaya meM sI. TI. skena karavAne kA hetu marIz2a ko thrombo embolijama hai yA hemareja hai, vaha jAnane kA hai| sI. TI. skena meM hemareja turaMta hI dikhAI detA hai / thrombosisa ke kesa meM sI. TI. skena zuruAta ke kucha ghaMTe taka normala AtA hai / jisako hemareja nahIM hai yaha nizcita hone ke bAda pakSAghAta ke anya kesoM meM thrombosisa kA upacAra sAdhAraNa sI. TI. skena ke AdhAra para sAmAnya prakAra se tatkAla hI zurU kara diyA jAtA hai / jaba ki 12-24 ghaMTe ke bAda konTrAsTa DAI DAlakara dobArA sI.TI. skena karavAne se mastiSka ke kitane bhAga meM thrombosisa kA asara hai, yaha spaSTa jAnA jAtA hai jisase marIz2a ke bhaviSya ke bAre meM socA jA sakatA hai / kabhI-kabhI pakSAghAta jaise lakSaNa dUsarI kisI bImArI ke kAraNa ho to yaha bhI sI.TI. skena se jAna kara gaMbhIra bhUla se bacA jA sakatA hai / zreSTha aspatAloM meM sITI anjiyogrAphI aura sITI paraphyujana skena dvArA minaToM meM saMpUrNa nidAna milatA hai /

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mastiSka aura jJAnataMtu kI bImAriyA~ isake uparAMta rakta kI kucha vizeSa jAMca, bAyokemesTrI (zugara, kiDanI ke TesTa Adi), I.sI.jI. tathA anya Avazyaka jAMca dvArA marIz2a kI zArIrika sthiti samajhI jA sakatI hai| yogya samaya para rakta kI carabI kA TesTa kiyA jAtA hai / hRdaya kI jAMca meM 2D - iko (dviparimANiya Iko ) Adi dvArA roga ke kAraNa aura jAnakArI bhI upalabdha karAtI hai / 60 hamane Age dekhA ki jina khataranAka kAraNoM se pakSAghAta hotA hai, vahI kAraNoM se hRdayaroga bhI hotA hai / hRdayaroga to pakSAghAta se bhI jyAdA phailA huA hai / isaliye hI pakSAghAta ke marIz2oM meM hRdaya rogoM kI jAMca kA atyaMta mahatva hai, jisase hRdayaroga rokA jA sake / anya rUpa se to, pakSAghAta ke marIja kI mRtyu pakSAghAta ke kAraNa nahIM balki adhika pramANa meM hRdayaroga se hotI hai aisA vaijJAniko kA niSkarSa hai / choTI umra ke pakSAghAta ke marIz2oM ke bAre meM pahale sunizcita kara lenA cAhiye ke unheM blaDaprezara yA DAyAbiTIsa na ho / unakI viziSTa jAMca meM enTIkArDiyo - lIpIna TesTa, homosIsTIna TesTa Adi zAmila kie jAte hai / rakta nalikAoM meM kitanI kharAbI hai yaha jAnane ke liye keroTiDavarTibala Doplara tathA ema. Ara. enjiyogrAphI (kabhI-kabhI sI. TI. enjiyogrAphI, DI. esa. e. enjiyogrAphI) kiyA jAtA hai / kisa marIz2a ko kauna sI jAMca karavAnI hai, yaha DaoNkTara hI taya kara sakate hai / pakSAghAta upacAra kI vistRta jAnakArI : pakSAghAta kI asara yA cihnana dikhane ke bAda turaMta hI yogya aspatAla meM ucca phIjizIyana athavA nyUrolojisTa ke mArgadarzana anusAra upacAra zurU kara denA cAhie / vilaMba nukasAnakAraka hotA haiM / thrombosisa rakta kA jama jAnA

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5- pakSAghAta - lakavA (perelisisa) STROKE 61 aspatAla meM bhartI karAte samaya ho sake to jahAM suvidhA ho usa jagaha marIz2a kA sI. TI. skena karavAkara le jAnA adhika hitakAraka hai / marIz2a adhika gaMbhIra avasthA meM ho to tAtkAlika I.C.U. yA saghana upacAra kendra meM le jAnA cAhie | - gaMbhIra avasthA ke marIz2a ko pakSAghAta ke sAtha mastiSka meM sUjana lage to use behoza hone se bacAne ke lie sUjana ke upacAra kI davAIyAM I.C.U. meM denI cAhie / usakI dhar3akana, bI.pI. aura zvAsa Adi barAbara rakhane ke lie yogya kadama uThAne cAhie / mirgI Ae to use kAbU meM karanA cAhie aura blaDaprezara, DAyAbiTIsa Adi ho to usakA bhI tAtkAlika upacAra sAtha- sAtha meM zurU kara denA cAhie | pakSAghAta ke upacAra ke mukhyataH chaha kadama hai : (1) thromboliTika therApI (2) enTIthromboTika therApI (3) nyUroproTekTiva therApI (4) komplikezana hetu therApI (5) nyUrosarjarI (6) saporTiva therApI phijiyotherApI (1) thromboliTika therApI : nirvivAda satya hai ki thromboembolijhama se hue pakSAghAta ke kesa meM yadi ye ekadama nayA viziSTa upacAra, pakSAghAta hone ke 1 se 3 ghaMTe meM (aura jyAdA se jyAdA 6 ghaMTe taka ke samaya meM) diyA jAe to adhikatara kesoM meM : (ka) saMpUrNataH avaruddha nalikA khula jAtI hai / (kha) nalikA ke aMdara kI gAMTha (thrombasa) pighala jAtI hai; aura (ga) mastiSka ke koSoM kA nukasAna baMda ho jAtA hai aura usase hone vAle pakSAghAta aura usake duSpariNAma se marIz2a baca jAtA hai /

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62 mastiSka aura jJAnataMtu kI bImAriyA~ isameM mukhyataH saMzodhana thromboliTika therApI para huA hai, jisameM Ara.TI.pI.o. nAmaka auSadhi pakSAghAta hone ke sirpha 1 se 3 ghaMTe meM hAtha yA paira kI zirAoM meM diyA jAtA hai, jise inTrAvInasa thrombolisisa kahate haiM / yaha paddhati pramANa meM sarala hai jisameM adhika upakaraNa yA viziSTa anubhava kI AvazyakatA nahIM haiM / usase viruddha inTrAArTIrIyala paddhati meM keroTIDa yA varTibrala dhamanI meM Ara.TI.pI.o., yUrokAinejha yA proyUrokAinejha auSadhi DAyarekTa thrombosisa kI jagaha para pakSAghAta hone ke 1 se 6 ghaMTe meM (kabhI-kabhI 24 ghaMTe taka) diyA jAtA hai| yaha paddhati jaTila hai, usameM anubhavI TIma aura Adhunika upakaraNoM kI AvazyakatA hai / aise anya kaI auSadhiyA~ kA saMzodhana cala rahA hai| usake liye viziSTa upakaraNa (sI. TI. skena, onjiyogrAphI suvidhA) se susajja aspatAla honA cAhie / isa prakAra kA ilAja maha~gA hai (vartamAna meM karIbana 60 se 90 hajAra kharca ho sakatA hai) aura 4 se 7 pratizata marIjoM meM duSprabhAva ke rUpa meM breina hemareja hotA hai / lekina mRtyudara bar3hatA nahIM hai aura samagratayA socane ke bAda Aja ke vaijJAnika pramANoM ko dhyAna meM rakhe to yahI sabase zreSTha upacAra hai / videzoM meM pakSAghAta ke cihnoM ke bAre meM janajAgRti ati uttama hai, jisase adhikatara marIja 1 se 2 ghaMTe meM aspatAla meM dAkhila ho jAte hai / vahA~ Insyuransa prathA ati pracalita hai jisase yU.esa.e. tathA yUropa meM isa prakAra kI upacAra paddhati bahuta jalda sarvavyApaka ho rahI hai / ummIda rakhate hai ki hamAre deza meM bhI isa roga prati janajAgRti bar3he aura loga Insyuransa prathA ke bAre meM apanI soca hakArAtmaka kareM to adhika lAbha hogaa| inTrAArTiyala thombolisisa : isa paddhati meM paira yA hAtha kI nalikA meM se mastiSka kI nalikA-keroTIDa yA varTibrala ArTarI meMketheTara tahata gAIDavAyara pahuMcAyA jAtA hai / isake pazcAta DijITala sabasTrekazana enjiyogrAphI (DSA) dvArA kaunasI nalikA meM thrombosisa hai yA sTInosisa (avarodha) hai, vaha saMzodhita kiyA jAtA hai / yadi vahAM thrombosisa hai to DAyarekTa saMbaMdhita nalikA meM (ArTarI meM) auSadhi kA

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5- pakSAghAta - lakavA (perelisisa) STROKE prayoga ho to kaI bAra pariNAma acchA A sakatA hai / proyUrokAinejha, yUrokAinejha yA Ara. TI. pI. o. davAIyA~ sAmAnyataH upayoga kI jAtI hai / Ajakala bahuta adhika nayI auSadhiyAM bhI isa upacAra ke lie saMzodhita huI hai / - 63 yaha paddhati inTrAvinasa thrombolisisa se adhika asarakAraka hai, kyoMki davAI sIdhe taura para thrombosisa kI jagaha dI jAtI hai / yahAM duSprabhAva (Complication) bhI kama haiM, kyoMki niyata sthAna para hI davAI denI hotI hai, isa lie khUba hI kama mAtrA meM usakI jarUrata paDatI hai jisase hemareja hone kI saMbhAvanA bhI kama hotI hai / opareTara ke sAmane hI DSA ke tahata diye jAne ke kAraNa jamA huA rakta (gAMTha) turaMta pighala jAe to injekzana baMda bhI kiyA jA sakatA hai / gAMTha ko pighalAne meM takalIpha lage to gAIDavAyara dvArA gAMTha ke aMdara pahuMcakara gAMTha tor3ane kI koziza anubhavI opareTara kara sakate haiM / sAmAnyataH isa paddhati se zarIra meM anya sthAna para bhI duSpariNAma svarUpa hemareja nahIM hotA / isa paddhati kA mukhya lAbha yaha hai kI kaI bAra 6 se 24 ghaMTe ke bAda bhI gAMTha pighala sakatI hai / usake viruddha indrAvInasa paddhati meM sAmAnya niyama anusAra pakSAghAta hone ke sirpha tIna ghaMTe meM hI davAI denI hotI hai, isake bAda upacAra meM saphala hone kI saMbhAvanA kama hotI hai / inTrAvInasa paddhati meM khAsa mazIneM yA vizeSa anubhava yA bar3e aspatAla Adi kI AvazyakatA na hone se vaha choTe kendroM meM bhI ho sakatI hai, usameM sirpha Ara. TI. pI. e. davAI hI upayoga meM lAI jAtI hai / tArkika aura prayogAtmaka tarIke se yaha siddha huA hai ki pakSAghAtavAle marIz2a ko tAtkAlika rUpa se inTrAvInasa thrombolisisa zurU karavA kara bAda meM turaMta hI jahAM inTrAArTIyala paddhati upalabdha ho vaise baDe kendroM meM le jAe~, aisA karane se donoM paddhatiyoM kA lAbha marIz2a ko milegA aura pariNAma dugunA acchA A sakatA hai / isa viSaya meM itanA vistRta lekha janajAgRti ke liye hai / jisase pakSAghAta ke marIz2oM ko acchI taraha tAtkAlika sAravAra mila sake aura

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64 mastiSka aura jJAnataMtu kI bImAriyA~ vaha zreSTha ho to, marIz2a kI Ayu laMbI ho aura roga meM jalda hI acchA pariNAma mile to merA yaha vinamra prayatna saphala hogA / apane deza kI samasyAoM kI vajaha se yaha paddhati kitane logoM taka pahuMcegI aura kitane logoM ke lie camatkArI sAbita hogI, vaha to AnevAlA vakta hI batAyegA, lekina apane deza ke DaoNkTaroM ko isa viSaya meM yogya jAnakArI hai, aisA kaha sakate hai / aba taka saMzodhita sabhI auSadhiyAM 6 ghaMTe bAda pakSAghAta ko roka nahIM sakatI haiM, kyoMki utane samaya meM rakta aura oNksIjana kI kamI se mastiSka ke kaI koSoM kI mRtyu ho jAtI hai / (2) enTIthromboTika therApI : apane deza meM yaha therApI bahuta saralatA se upalabdha hai aura usakA dhyeya rakta nalikA meM huI gAMTha adhika Age baDhane se rokanA hai, jisameM hIperIna, lo molekyUlara hIperina jaisI enTI ko egyUlanTa davAI aura espirina, klopIDobrela, DAIpAIrIDemola, ebsIkSImeba jaisI enTIpleTeleTa grUpa kI davAI tathA enkorDa jaisI phAIbrInoliTika grUpa kI davAI upayoga meM AtI hai / aisA karane se nukasAna Age baDhane se rukatA hai paraMtu usake duSprabhAva se zAyada hemareja bhI ho sakatA hai, isaliye use yogya mAtrA meM, yogya TesTa tahata upacAra karanA cAhie / TIklopIDIna yA klopIDoz2ela davAI pakSAghAta ke prAraMbhika kesa meM koI khAsa upayogI nahIM lagI, paraMtu yaha davAI pakSAghAta dubArA hone se rokane meM nizcita hI kAmiyAba hai / I karIbana 10 se 15 pratizata marIjoM ko sTroka - ina- ivolyUzana nAmaka vicitra paristhiti hotI hai / vicitra isaliye kyoMki cihna zuru hone ke 2 se 4 dina taka davAI karane ke bAvajUda pakSAghAta bar3hatA hI jAtA hai, aura aMta meM AdhA zarIra niSkriya ho jAtA hai / aisA hone kI vaz2aha yaha hai kI pUrI nalikA kramazaH avaruddha ho jAtI hai aura enTithromboTika yA enTipleTaleTa davAI bImArI kI mAtrA ke sAmane jarUrI surakSA pradAna nahIM kara sakatI hai| davAI ke sAtha bhI pakSAghAta bar3hatA jAe~, vaha paristhiti marIz2a aura unake AptajanoM ke mana meM galataphahamI paidA

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65 5 - pakSAghAta-lakavA (perelisisa ) - STROKE kara sakatI hai| agara pakSAghAta bar3hatA jAe to hemareja nahIM hai, vaha jAnane ke lie dubArA sI. TI. skena se jAnakArI prApta kI jA sakatI hai| vizeSa meM thrombosisa ke kesa meM zuruAta ke thor3e dinoM taka kucha mAtrA meM blaDa-prezara sthira rakhanA cAhie, ekadama zIghratA se blaDa prezara kama nahIM karanA cAhie / B.P. zIghratA se kama kara dene para mastiSka ko rakta kama milane se pakSAghAta bar3ha sakatA hai| Upara kA (sisTolika) bI. pI. karIbana 200 aura nIce kA (DAyAsTolika) karIbana 110 ho taba taka blaDaprezara kI koI davAI (thrombosisa ke kesa meM pakSAghAta ke prAraMbhika 7 dina taka ) nyUrolojisTa DaoNkTara dete nahIM haiM (apavAdarUpa hai abhI abhI huA hArTaeTeka yA enjAinA ho yA koI viziSTa kAraNa lagatA ho) / (3) nyUroproTekTiva davAI : ____ pakSAghAta ke kesa meM saiddhAMtika tarIke se koSoM ko naSTa hone se bacAne ke lie (rakta aura oNksIjana sarakyulezana kI kamI se) aise kemikalsa pakSAghAta hone ke prAraMbhika 6 se 24 ghaMTo meM dene cAhie, jo koSoM ko lambe samaya taka poSaNa de sake yA oNksijana pahuMcA sake yA cayApacaya kI samasyA dUra kare yA koSoM ke AvaraNa ko surakSA de kara koSoM ko TUTane se roke / aisI karIbana 30 se 40 prakAra kI davAI (nImoDIpIna, sITIkolIna, pIrAsITAma, emake-801, eravejela) prayogAtmaka parIkSaNa meM se pAsa ho cUkI hai, lekina patA nahi kyoM hakIkata meM jaba yaha davAI marIz2o ko dete hai taba apekSita sudhAra nahIM hotA hai| usake kucha vaijJAnika kAraNa bhI hai, isa lie usameM saMzodhana kara nayI davAI vikasita kI jA rahI haiM / vaha agara zIghra hI dI jAe to koSoM ko rakta tathA oNksijana kI kamI hone para bhI bacAyeM jA sakate hai yA laMbe samaya taka jIvita rakheM jA sakate hai / Ajakala sITIkolIna aura iDArAvona (erevona) davAI jyAdAtara vaparAza meM hai| (4) komplikezansa : pakSAghAta ke hamale ke daurAna kucha marIz2o ko komplikezana hote haiM jo bImArI kI gaMbhIratA bar3hA dete hai, jaise ki mastiSka meM sUjana

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66 mastiSka aura jJAnataMtu kI bImAriyA~ AnA, behoza honA, mirgI AnA, bukhAra AnA, ceharA phIkA par3a jAnA, nyUmoniyA honA, zarIra meM pAnI bar3hanA yA ghaTanA, peTa phUla jAnA, pezAba baMda honA, aura zarIra meM soDiyama, poTeziyama kI mAtrA kama-jyAdA honA... ityAdi / phijiziyana ko pratidina dhyAnapUrvaka kesa dekhakara ina sabhI samasyAoM para dhyAna denA cAhiye, jisase kesa kA pariNAma acchA A sake, marIz2a jIvita rahe aura zIghratA se ThIka ho jAe / jaba marIz2a ko zvAsa meM takalIpha ho yA mastiSka kA sUjana adhika bar3ha jAne se vaha komA meM calA jAe taba use venTIleTara para rakha kara usakA jIvana bacAne kI koziza kI jA sakatI hai| (5) nyUrosarjarI : ____ pakSAghAta ke kucha kesoM meM (lagabhaga 2 se 5 pratizata) nyUrosarjana kI AvazyakatA rahatI hai, jo oparezana dvArA marIjoM kI jindagI bacA sake athavA mastiSka ke koSoM kI hAni kama kara sake / isameM krenIekTamI, DyUrAplAsTI, imarajansI ke roTiDa bAyapAsa yA embole kTamI Adi oNparezana hote hai / hemareja kI vajaha se honevAle pakSAghAta meM kabhI kabhI khopaDI kholakara rakta kI gAMTha nikAla lI jAtI hai (agara davAI se dardI kI sthiti meM pharka na ho aura hemareja nikAlA jA sake aisA ho to) / (6) saporTiva (AdhArarUpa) therApI : upacAra ke sAtha marIz2a ko pUrNa poSaNa aura pravAhI mile, usake zarIra ke dravya bane rahe aura yogya viTAminsa prApta ho, isakA dhyAna rakhanA caahie| yogya samaya para enTIbAyoTika dI jA sakatI hai / yaha saba saporTiva TrITamenTa kahI jAtI hai / pakSAghAta hone ke 1-2 dina meM DaoNkTara, phijiyotherepisTa ko bulAte haiN| vaha hAtha-paira tathA phephaDoM kA vyAyAma zuru karavAte haiM / pratidina 4 se 6 bAra 20 se 40 minaTa taka karane kI yaha kasarata marIz2a ke ristedAra ko svayaM hI sIkha kara marIja ko karavAnI caahie| isase aneka lAbha hote haiM / adhikAMza aMgoM kA halana-calana zIghratA se sudharatA hai aura chAtI meM kafa jamA nahIM hotA aura aMga sTipha (kar3aka) nahIM hote hai|

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5- pakSAghAta - lakavA (perelisisa) STROKE 1 eka bAra pakSAghAta kA prAraMbhika upacAra milane ke bAda meM pakSAghAta dubArA na ho isake lie enTIpleTaleTa grUpa kI davAI jaise ki espirina, klopIDojela, DAyapArIDemola aura TiklopIDIna ityAdi bahuta laMbe samaya taka dI jAtI hai / kisa marIz2a ko isameM se kauna sI davAI kitanI (eka yA do prakAra kI), kitanI bAra denI cAhie, vaha marIz2a kI prakRti aura roga punaH hone kI saMbhAvanA ko dhyAna meM rakhakara DaoNkTara taya karate hai / kucha marIz2a ko orala enTIko egyUlanTa davAI bhI (jo thor3I khataranAka bhI hai) denI paDatI hai ( udAharaNa... vorapherIna, esITroma ityAdi) / ucita kesoM meM gale kI rakta ko le jAnevAlI nalikAe~ (keroTiDa aura varTibala ArTarI ko) alTrAsAunDa takanIka DaoNplara se jAMca kI jAtI hai aura agara keroTiDa nalikA 60-70 % jitanI avaruddha lage to DI. esa. e. yA ema. Ara. e. jaise enjiyogrAphI dvArA usakI nizcitatA taya kI jAtI hai / enjiyogrAphI meM rakta le jAne vAlI yaha nalikAe~ 70 % se adhika mAtrA avaruddha lage to anubhavI nyUrosarjana yA vAskyUlara sarjana ke pAsa keroTiDa nalikA para sarjarI karake avarodha dUra kiyA jAtA hai / keroTiDa enDaArTarekTamI nAma se prakhyAta yaha sarjarI apane deza meM abhI videza jitanI pracalita nahIM hai, lekina kucha varSoM se usakA vyApa bar3hatA jA rahA hai aura unake acche pariNAma dekheM gae hai / yaha paddhati kA khatarA 1 se 2 pratizata se adhika nahIM honA cAhie / bAyapAsa sarjarI ke viruddha jisa prakAra hRdaya meM enjiyoplAsTI hotI hai, usI prakAra kaI kesoM meM aba ke roTiDa enjiyoplAsTIne enDa ArTarekTamI sarjarI kI AvazyakatA kama kara dI hai / sTenTa DAlakara enjiyoplAsTI karane se lambe arase taka pakSAghAta (sTroka) se baca sakate haiM / keroTiDa sTenTiMga 67

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68 mastiSka aura jJAnataMtu kI bImAriyA~ isa prakAra davAI, oparezana, vyAyAma aura pakSAghAta hone ke kAraNa jAnakara usakA upacAra (udAharaNa - blaDaprezara, DAyAbiTIsa) jaise vibhinna saMyojanoM se pakSAghAta kA tvarita aura niyamita upacAra ho sakatA hai / vizeSataH aise marIjoM kA mAnasika, sAmAjika, Arthika aura vyAvasAyika DhaMga se punaHsthApana ho to hI upacAra saMtoSakAraka huA hai aisA mAnA jA sakatA hai| jo marIjoM ko pakSAghAta ke bAda hAtha-paira kaDaka ho jAte haiM (spAsTisITI) aura aMga niyata sthiti meM jakaDa kara raha jAyeM (Fixed Position) aise marIjoM ko niyamita vyAyAma, aMga ko halakA karanevAlI davAI (lIyorIsAla, TIjAnIDIna, benjoDAyAjhepIna) yogya mAtrA meM de sakate haiM / hAtha-paira ke viziSTa paTTe (Splint) kA upayoga kara sakate haiM / vizeSa meM boTulInama ToksIna (boToksa/DIsporTa) nAmaka Adhunika iMjekzana dhyAnapUrvaka niyata mAtrA meM (yUniTsa), saMbaMdhita snAyu meM anubhavI nyUrolojisTa ke dvArA lene se nizcita lAbha hotA hai| uparAMta, vyAyAma dvArA aMgoM ko zithila banAkara aura bhI acchA lAbha lekara aMgoM ko lagabhaga saMpUrNa kAryarata banA sakate haiM / yaha iMjekazana, saMbaMdhita marIz2a ko lAbha pahu~cA sakegA yA nahIM, vaha jAnane ke lie aizavartha skora (Ashworth Score) tathA aise hI anya phijiyotherApI skora kI sahAyatA lI jAtI hai| yaha upacAra kharcIlA hone ke bAvajUda kaI kesoM meM atyaMta lAbhadAyI hotA hai / pakSAghAta ke marIja ke upacAra uparAMta Arogya ke saMpUrNa pahalUoM kI yogya samaja aura mArgadarzana dene ke sAtha-sAtha cetAvanI cihna (TI.AI.e.) prAthamika upacAra, tvarita upacAra kA mahatva Adi samajAnA cikitsaka kA pavitra kartavya hai| pakSAghAta ke marIjoM ke pArivArika DaoNkTara kI bhUmikA kitanI mahatvapUrNa hai, yaha saralatA se samajhA jA sakatA hai| marIz2a ko bhI svayaM apanI jIvanazailI meM badalAva lAnA cAhie / ArAmadAyaka jIvana chor3akara vyAyAma aura yoga karane cAhie / DaoNkTara kI salAha-sUcana anusAra yogya davA-upacAra karane cAhie aura sAmAnya jIvana apanAkara tanAva se dUra rahanA cAhie / manovalaNa meM Avazyaka hakArAtmaka badalAva lAne cAhie, yaha avazya lAbha karegA /

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5 - pakSAghAta-lakavA (perelisisa) - STROKE aMta meM, niyamita jIvana, mAnasika svasthatA, ucita mAtrA meM parizrama, niyamita vyAyAma tathA yogAsana aura Avazyaka davAI, khAsa kara blaDaprezara aura DAyAbiTIsa ke niyamana se pakSAghAta (aura hRdayaroga bhI) se bacA jA sakatA hai aura usake lie janajAgRti atyaMta Avazyaka hai / aisA hone se vyakti ko, parivAra ko, samAja ko aura deza ko honevAlI atyAdhika hAni (aneka prakAra kI) rokI jA sakatI hai| (isa saMdarbha meM bahuta hI jalda eka ativistRta Preventive Programme for Stroke and Heart Attack zuru karane ke lie socA hai|) (sukhiyA~ - * mastiSka ke koSoM meM poSaNa aura oNksijana kI kamI hone ke kAraNa koSa kAma karanA baMda kara dete hai, aura zarIra kA dAyAM yA bAyAM aMga nAkAma ho jAtA hai, use pakSAghAta kahate hai| mRtyu ke vividha kAraNoM meM hRdayaroga, kensara aura sar3aka durghaTanA ke bAda cauthA naMbara pakSAghAta hai| blaDa prezara, DAyAbiTIsa, kolesTarola, vyAyAma kA abhAva, medasvitA, AhAra meM carbIyukta ghaTakoM kA atireka, vyasana, vaMzAnugata kAraNa vagairaha pakSAghAta ke jimmevAra paribala hai / mastiSka meM rakta nalikAoM meM rakta pravAha kI kamI hone se kucha samaya ke lie (kSaNa, minaTa, 24 ghaMTe se kama) bolane meM takalIpha, hAtha-pAMva meM jhunajhunI, sunApana yA eka bAju lakave kI asara, dekhI jAe aura 24 ghaMTe ke aMdara marIz2a bilakula ThIka ho jAe to usako TI.Ai.e. ( Transient Ischemic Attack) kahate hai|

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70 mastiSka aura jJAnataMtu kI bImAriyA~ mastiSka kI rakta nalI meM rakta jama jAya to use Thrombosis kahate hai / jame hue rakta se koi nanhA kloTa ukhaDa kara mastiSka kI rakta nalI meM pahuMce use Embolism kahate hai / inasaba meM hemareja (Hemorrhage) sabase gaMbhIra paristhiti hai / jo kabhI kabhI jAnalevA ho sakatI hai / hemareja prAyaH nalI phaTane se hotA hai| / jyAdAtara pakSAghAta (80-85%) thombosIsa yA embolijhama se hote hai, bAkI ke hemareja se hote hai| * nidAna ke lie si. TI. skena, ema.Ara.AI., enjiyogrAphI, Dopalara vagairaha TesTa kie jAte haiM / * thrombosisa meM magaja ke koSoM kI mRtyu prathama chaha ghaMTe meM rakta aura oNksijana na milane se ho jAtI hai| isIlie jitanI ho sake utanI jaldI eka se tIna ghaMTe meM dardI ko aspatAla meM lAkara TrITamenTa karavAnI caahie| adyatana sAravAra paddhati thombolisisa hai, jisame r-tPA nAmaka davAI prathama tIna ghaNTo meM dI jAtI hai| isake alAvA enTIthomboTika therapI, nyUroproTekTiva therapI, komplikezana hetu therapI, nyUrosarjarI, saporTiva therapI, phijiyotherapI vagairaha pakSAghAta kI sAravAra ke mahatvapUrNa ghaTaka haiM /

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Hits # Tentang (Braln Hemorrhage) mastiSka kI naliyoM meM huI vikRti ke kAraNa hue perelisasa ke kesa meM karIbana 20 % breIna hemareja (mastiSka kA raktasrAva) ke kesa hote hai| anya thrombosIsa yA embolijhama se hote hai / mastiSka ke ati gaMbhIra roga ke rUpa meM mAne jAne vAle isa roga meM, sAmAnya bhASA meM kahA jAe to rakta kI nalikA phaTane se yA aise kisI kAraNa se mastiSka meM rakta kI jamAvaTa hotI hai, aura kSaNabhara meM isa meM se adhikatara marIja behoza ho jAte haiM aura isa bimArI meM mRtyudara bhI adhika hotA hai / * breIna hemareja ke mukhyataH do prakAra hai : (1) inTrAserebala hemareja : blaDa prezara bar3ha jAne se yA emAyalaoNiDa nAmaka dravya nalikAoM meM ikaTThA hone se (emAyaloiDa enjiopathI se) mastiSka meM hemareja hotA hai| (2) sabaerekanoiDa hemareja : rakta kI nalikA para aprAkRtika prakAra se phuggA (sekyulara enyuriz2ama) bana | beIna hemareja kara, usake phaTane se yA mastiSka kI rakta kI nalikAoM kA vicitra jhuramuTa (e.vI. mAlaphormezana) phaTane se hone vAlA hemareja / isake alAvA enTikoegyUlanTa nAmaka rakta kI jama jAne kI prakriyA maMda karane meM upayogI auSadhiyoM ke duSprabhAva se, sira ke ghAva, rakta patale par3a jAne kI bImArI, mastiSka meM kensara kI gAMTha phaTane se rakta ikTaThA hone se, mastiSka meM saMkramaNa hone ke kAraNa aura aise kaI anya kAraNoM se bhI breIna hemareja hotA hai /

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72 mastiSka aura jJAnataMtu kI bImAriyA~ (1) inTrAserebrala hemareja : blaDa prezara ke kAraNa mastiSka ke aMdara naliyoM ke phaTane se hemareja hotA hai / adhikAMza yaha hemareja mastiSka ke kaI sthAnoM para (jaise ki serebrama, puTAmena, thelemasa, seribelama) nizcita rUpa meM hote hue dekhA gayA hai, aura pezanTa ko jA~cate hI nyUro-phijiziyana ko patA cala jAtA hai ki hemareja mastiSka ke kisa bhAga meM huA hai| emAyaloIDa enjiopathI adhikAMza vayaska logoM meM pAye jAnevAlI bar3e mastiSka ke bhItara ke hemareja kI bImArI hai,jo kabhI-kabhI punaH bhI ho sakatI hai| ina sabhI hemareja kA tAtkAlika nidAna karane ke bAda, I.C.U. meM dekhabhAla zuru kI jAnI cAhie - mukhyataH bI.pI. ko niyaMtraNa meM lekara mastiSka ke sUjana kA yogya upacAra - samayasara mila jAe to hemareja ke kesa meM mRtyu kA pramANa nizcita hI ghaTAyA jA sakatA haiM, jo vartamAna samaya meM karIbana 50 se 60 % jitanA jyAdA hai / kucha marIjo meM - jinameM choTe mastiSka meM hue hemareja (serebelara hemareja) athavA bar3e mastiSka ke Temporala loba athavA puTAmena meM hue hemareja ke mAmale meM yogya samaya para nyUrosarjana dvArA sarjarI karavAne se bhI jindagI bacAI jA sakatI hai| paraMtu ina sabhI ke lie - roga ke prati jAgRti, tatkAla ilAja, tvarita upacAra aura niSNAta tathA zIghra nirNaya le sake aise nyUro-phijiziyana aura nyUrosarjana ke sAtha sAtha tamAma suvidhAoM (venTIleTara mazIna, oNparezana thiyeTara) se paripUrNa acchA aspatAla Avazyaka hai| cihna : ___kAma karate hue acAnaka jora se sira darda honA, ulTI honA, cakkara AnA, A~kho ke sAmane aMdherA chA jAnA (ye sabhI hAI blaDa prezara ke lakSaNa ho sakate hai) / mirgI AnA, laDakhaDAnA, lakavA honA aura kSaNabhara meM marIja behoza hone lage aura zvAsa tejI se calane lage - to ye sabhI sAmAnyataH braIna hemareja ke cihna hote hai /

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6 - mastiSka meM raktasrAva (Brain Hemorrhage) * nidAna aura tAtkAlika upacAra : sI. TI. skena athavA ema.Ara.AI. dvArA tatkAla jA~ca karavAnA atyaMta Avazyaka hai / sAtha hI hemareja kahA~ hai, kitanA rakta jamA huA hai, mastiSka meM sUjana hai yA nahIM tathA usakA kAraNa kyA ho sakatA hai ? aisI tathA anya jAnakArI bhI kaI bAra isa TesTa dvArA mila jAtI hai / jisa marIja kA zvAsa vyavasthita (normala) ho aura blaDaprezara atyaMta adhika na ho to. marIja ko aspatAla le jAne se pahale agara zahara meM sI. TI. skena kI suvidhA upalabdha ho to mastiSka kA sI. TI. skaina karavA ke aspatAla meM le jAnA adhika lAbhadAyaka hai, kyoMki kaI bAra hemareja kI AzaMkA ho to bhI sI. TI. skaina meM thrombosisa athavA gAMTha, sabaDyUrala hemareja yA mastiSka kA saMkramaNa jaisA koI nidAna nikale, to saMpUrNa TrITamenTa alaga alaga hotI hai / paraMtu marIja kI hAlata gaMbhIra ho to aspatAla meM tAtkAlika upacAra ke bAda sI. TI. skena karavAnA cAhie / kisI bhI prakAra ke gaMbhIra nyUrolojikala keso meM adhikAMza niSNAta DaoNkTara ko ghara bulAne kA Agraha rakhane meM samaya naSTa karane ke bajAya phemilI DaoNkTara kI sahAyatA se embyulansa dvArA marIja ko tAtkAlika aspatAla meM bhartI karanA Avazyaka hai, athavA ho sake to pahale sI. TI. skaina ke lie le jAe~, isa bAta ke prati pUrNa jAgRti bahuta Avazyaka hai| niSNAta DaoNkTara tAtkAlika ghara A sake to acchI bAta hai lekina sAmAnyataH unake Ane meM 2-4 ghaMToM kA ati mUlyavAna samaya naSTa ho jAtA hai aura pariNAmasvarupa upacAra meM hone vAle vilaMba se marIja ko kabhI bharapAI nA honevAlA nukasAna mastiSka meM ho jAtA hai| agara phemilI DaoNkTara bhI kadAcit zIghra na A sake to zreSTha upAya yaha hai ki marIja ko tAtkAlika najadIka ke acche aspatAla meM imarajansI vorDa meM le jAnA cAhie aura taba taka yogya DokTara ko bulAne kI vyavasthA kara lenI cAhie /

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mastiSka aura jJAnataMtu kI bImAriyA~ yaha bAta atyaMta vistAra se likhane ke pIche eka nizcita kAraNa yaha hai ki adhikAMza isase viruddha hI hote dekhA jAtA hai / imarajansI meDisina, kriTikala kera, yaha meDisina ke ekadama alaga aise suparasonika yA konkarDa vibhAga hai, jisameM sirpha mAnavatA ke saMdarbha meM eka-eka sekanDa bacAkara, niSNAta DaoNkTaro dvArA ati mahatvapUrNa nirNaya liye jAte hai / jindagI bacAne kI unakI TreniMga atyaMta hitakAraka hotI hai| yaha kAma isI prakAra hI honA cAhie jisameM koI bhI prakAra kI dalIla yA hastakSepa svIkArya nahIM hai / marIja ke ghara para jA~ca karate hue bI.pI. adhika mAlUma paDe to hemareja ke kesa meM bI. pI. tAtkAlika nIce lAne ke lie phemilI DokTara Avazyaka TrITamenTa karatA hai / thrombosisa vAle kesoM meM zuruAta meM blaDaprezara ekadama ghaTAnA nahIM cAhie / aisA karane se nizcita hI nukasAna hotA hai| phira bhI thrombosisa ke kesa meM blaDa prezara adhika bar3ha jAe yA sAtha meM hRdayaroga yA rakta patalA karane kI davAI cAlU ho to blaDaprezara ko normala karanA jarUrI hai| mastiSka kA sUjana adhika lagatA ho to ghara para hI tAtkAlika sUjana ghaTAne kA iMjekzana (meniTola, lesiksa) phemilI DaoNkTara de sakate hai, usa daurAna marIja ko aspatAla meM le jA sakate haiM / mirgI AtI ho to usakI TrITamenTa meM bhI dera nahIM karanI cAhie / sI. TI. skena uparAMta kabhI kabhI nidAna ke lie lambara paMkcara bhI kiyA jAtA hai| paraMtu agara mastiSka meM sUjana adhika ho to isa jA~ca se adhikatara marIjoM ko jyAdA takalIpha ho sakatI hai| (sIriyasa marIja ke kesa meM yaha nahIM karanA cAhie / ) aspatAla meM aise marIja ko svAbhAvikataH AI.sI.yu. (I.C.U.) meM hI rakhanA hitakAraka hai, jahA~ yogya upacAra ke sAtha lagAtAra moniTariMga kiyA jAtA hai / Avazyaka ho to enjiogrAphI Adi jA~ca yogya samaya meM karanI cAhie aura agara jarUrata par3e to Age batAe anusAra sarjarI

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6 - mastiSka meM raktasrAva (Brain Hemorrhage) 75 dvArA mastiSka meM se rakta nikAla liyA jAtA hai / rakta meM kSati hone se rakta patalA paDakara hemareja ho gayA ho to yogya kSatiyAM pUrNa kI jAtI hai / davA ke duSprabhAva (jinameM vArapherIna athavA esITroma davAI hRdaya ke vAlva ke kesa meM calatI hai) se agara hemareja huA ho to plAjamA aura rakta ke anya yogya ghaTaka dekara hemareja baMda karane kA prayatna kiyA jAtA hai / meDikala upacAra ke kaI duSprabhAva se hone vAlI yaha mukhya paristhiti hai / aise tathA blaDaprezara se honevAle hemareja ke kucha kesa meM novo sevana davAI (koegyulezana phekTara sevana) asarakAraka hai| enTIkogyuelanTa davAIyA~ : yaha davAI rakta jama jAne meM roka lAtI hai, vaha kucha kesa meM apane duSprabhAva svarupa hemareja kara sakatI hai| isalie yaha davA calatI ho to marIja ko prabhAva-duSprabhAva ke viSaya meM bArIkI se jAnakArI denA atyaMta Avazyaka haiM / prati 7 se 15 dina meM Prothrombin time/INR nAmaka blaDaTesTa karavA ke rakta kitanA patalA rahatA hai usakI niyamita jA~ca karanI paDatI hai / agara vyavasthita dhyAna rakhA jAe to hajAroM marIja kisI prakAra kI takalipha binA acchA jIvana vyatIta kara sakate haiM / insyulina jaisI mahatvapUrNa davAI se hajAro jiMdagI sudharatI huI dekhI gaI hai, vahI insyulina kI mAtrA adhika hone se zakkara kama ho jAne se aneka akasmAta mRtyu bhI ho jAtI hai, aisA ina bImAriyoM kI davAoM meM bhI hai / isalie blaDaprezara kA niyamana, mastiSka ke sUjana kI davAI, yogya nasiMga aura jo jaTilatA - komplikezana ho usakI davAI karane se tathA jarUrata par3e to sarjarI karavAne se aise inTrAserebrala hemareja ke marIja ko adhikatara bacAyA jA sakatA haiM / jiMdagI bacane ke bAda agara pakSAghAta raha gayA ho to vyAyAma tathA yogya davAI ke upacAra dvArA usa bhAga ko punaH kAryarata karane ke lie laMbe samaya taka prayatna cAlU rakhane cAhie / yaha bAta satya hai ki hemareja ke kesa meM mRtyu thrombosisa se adhika hai, lekina eka bAra jAna baca jAe to pakSAghAta meM sudhAra bhI thrombosisa ke marIja se adhika zIghra hotA hai /

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76 mastiSka aura jJAnataMtu kI bImAriyA~ (2) sabaerekanoIDa hemareja : yaha hemareja uparokta hemareja se ekadama alaga hai / isameM adhikatara marIjoM ko blaDaprezara nahIM hotA / adhikAMza marIja javAna hote hai aura unameM se adhikatara logoM ko rakta kI nalikAoM meM janmajAta kamajorI ke kAraNa gubbArA (Balloon) banA hotA hai (sekyulara enyurijhama) athavA rakta kI nalikAoM meM jhuramuTa hotA hai (jise e. vI. mAlaphormezana kahate haiM) / vo kucha umra meM acAnaka parizrama se yA svayaM hI phaTa jAtI hai, usameM se rakta mastiSka ke do AvaraNoM ereknAIDa aura pAyA ke bIca sabaerekanoIDa spesa meM phaila jAtA hai, use sabaerekanoIDa hemareja kahate hai / mahatvapUrNa bAta yaha hai kI eka anumAna anusAra pratyeka 100 vyaktiyoM meM ausatana eka vyakti ko mastiSka kI nalikAoM meM aise gubbAreM ho sakate hai aura janma se hI kamajorI hone ke bAvajUda vaha kaba bar3hegA, kaba phaTegA, yaha nizcita nahIM hotA hai aura jIvanabhara vaha na phaTe aisA bhI bahuta se keso meM hotA hai / agara yogya sAravAra na mile to, ekabAra phaTane se 100 meM se ausatana 45 se 60 marIja kI eka mahIne meM hI mRtyu ho jAtI haiM / itanA bhayAnaka hone ke kAraNa isa bImArI ko samajanA jitanA jarUrI hai utanA hI Avazyaka hai isakA yogya ilAja / vicitra bAta yaha hai kI adhikAMza marIja meM kisI prakAra ke pUrvacihna nahI hote aura acAnaka hemareja ho jAtA hai / lekina sira ke eka hI tarapha (jaise ki kevala dAeM tarapha kAna ke upara A~kha ke pIche) AdhAzIzI jaisA darda, jo dUsarI tarapha na jAe aura bIca-bIca meM AtA-jAtA rahe to niSNAta DaoNkTaroM ke eka samUha ke mata anusAra kama se kama ema. Ara. enjiogrAphI oNpha breIna TesTa karavA lenA cAhie / mastiSka ke isa TesTa dvArA mastiSka aura mukhyataH rakta kI nalikAoM ko kisI bhI prakAra kI invejiva prakriyA binA ausatana

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6 - mastiSka meM raktasrAva (Brain Hemorrhage) 95 - 98 % nizcitatA se aise gubbAre jise enyurijhama kahate hai, vaha hai yA nahIM yaha kahA jA sakatA hai / isakA kharca karIbana rU. 4 se 6 hajAra kA hai / aise sabhI keso meM isa TesTa karavAne ke bAre meM abhI sahamati nahIM hai / paraMtu mere anubhava aura matAnusAra mAtra eka hI tarapha rahanevAle AdhAzIzI ke darda meM yaha TesTa karavAnA lAbhadAyaka hai| isa roga ke cihna meM jo bAta sabase adhika dhyAnAkarSita karatI hai vaha yaha hai ki marIja ko jIvana meM pahale kabhI anubhava na huA ho aisA bhayaMkara sira darda hotA hai / koI koI ko sAtha meM mirgI bhI AtI hai aura mastiSka meM sUjana Ane ke kAraNa marIja kSaNika behoza bhI ho jAtA hai / sAmAnyataH marIja hoza meM Ane ke bAda dubArA behoza ho jAtA hai / pakSAghAta ho yA teja zvAsa, bI.pI. aura hRdaya Adi bigaDe to tAtkAlika athavA 14 se 30 dina meM marIja kI mRtyu ho jAtI hai / isalie jaba bhI marIja yaha kahe kI use itanA bhayaMkara siradarda kabhI jIvana meM nahIM huA hai aura sAtha hI uparokta eka bhI cihna ho to binA cUke nyUrolojIkala jA~ca karavA lenI cAhie, jisake pariNAmasvarupa samaya para ilAja hone se jiMdagI bacAI jA sakatI hai| * mastiSka nalikAoM kI jA~ca : enjiogrAphI nAmaka TesTa, isa taraha kI jA~ca kA mukhya mAdhyama hai| ema.Ara. enjiogrAphI isa prakAra kI jA~ca hai, jisa meM ema.Ara.AI. ke megneTa dvArA naliyoM kI jA~ca hotI hai| kisI prakAra kA ketheTara zarIra kI nasoM meM nahIM DAlA jAtA, ataH ise nona-invejhiva TesTa kahA jAtA hai / koronarI enjiogrAphI ke lie hamezA ketheTara kisI nalI meM DAlA jAtA hai, jisameM kucha khatare bhI hote hai / isameM aisA nahIM hotA / isa prakAra ke TesTa meM 90 se 95% jitanI nizcitatA se nirNaya ho sakatA hai, isalie ise skIniMga TesTa ke rUpa meM upayoga kara sakate hai| sabase bharosemaMda TesTa to kanvenzanala phora(4)-vesala enjiogrAphI athavA

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78 RT mastiSka aura jJAnataMtu kI bImAriyA~ sI. TI. enjiyogrAphI enTiriara seribala ArTarI meM gubbArA DijiTala sabasTrekzana enjiyogrAphI (DSA) ko kaha sakate hai / sI.TI. enjiogrAphI eka naI takanika hai, jisameM 4 mi.mi. se jyAdA kadavAle gubbAre (Aneurysm ) DSA jitanI kSamatA se dekhe jA sakate hai / enjiogrAphI meM enyurijama (gubbArA ) ho to turaMta hI dikha jAtA hai / aise 15 pratizata keso meM eka se adhika enyurijama hote hai / isa lie mastiSka kI cAroM naliyoM kI enjiogrAphI karanI cAhie / oNparezana kI AvazyakatA ho to sabhI enyurijama ko dhyAna meM lekara TrITamenTa karanA AsAna hotA hai / LT ACA enjiogrAphI meM isake alAvA rakta kI naliyoM kA jhuramuTa bhI dikhatA hai jise ArTerio-venasa mAlaphormezana (e.vI. mAlaphormezana) kahate haiM / isa prakAra ke marIjoM ko prAthamika rupa meM siradarda hone kI hisTarI - jAnakArI milatI hai| kaI bAra mirgI AtI hai yA kaI ko pahale se hI eka aMga kA pakSAghAta hotA hai|

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6 - mastiSka meM raktastrAva (Brain Hemorrhage) 79 SR e.vI. mAlaphormezana (AVM) sabaerakenoiDa hemareja ke kucha keso meM DI.esa.e. (enjiogrAphI) bhI normala AtI hai| isameM se kitane hI keso meM ekadama choTA enyurijama ho athavA rakta kI naliyoM kA ekadama choTA jhuramuTa (kripTika e.vI. mAlaphormezana) athavA nalI saMkucita huI ho (vAjhospAjhama) ho to enjiogrAphI normala AtI hai| isa kAraNa aise kesa meM sAmAnyataH 3 mahIne ke bAda dubArA enjiogrAphI karavAnI cAhie / isa ke pazcAt hI vizvAsapUrvaka kahA jA sakatA hai ki hemareja ke lie aisA koI kAraNa nahIM hai| aisI sthitimeM, use IDiyopethika sabaairakenoIDa hemareja kahate haiN| . duSprabhAva (Complications) isa bImArI meM ekabAra rakta kI nalI phaTa jAe to usake pazcAt eka mahIne meM dubArA kabhI bhI phaTa sakatI hai (jise Rebleeding kahate haiM) aura aise mAmale meM marIjha kA bacanA atyaMta duSkara ho jAtA hai| isI prakAra hemareja hone ke cAra se bAraha dina ke daurAna gubbAre ke bAda nalI sikuDa jAtI hai jise vesospAjhama (vasospasm) kahate hai| isameM pakSAghAta honA aura sabhAnatA kama hone jaise lakSaNa mukhya hai| davAI kI madada se prAyaH ise rokA jA sakatA hai| usake pazcAt rakta meM adhikatara soDiyama tattva kama ho jAtA hai (ise SIADH kahate haiN)| kabhI mirgI bhI A sakatI hai /

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80 mastiSka aura jJAnataMtu kI bImAriyA~ eka bAra dhyAnapUrvaka (vizvAsapUrvaka) ilAja hone ke bAda, sabhI suyogya keso meM mastiSka kI nalI kI sarjarI karake enyurijama ko klIpa kiyA jAtA hai| kabhI-kabhI usake cAroM tarapha snAyu kA AvaraNa banAyA jAtA hai, athavA Tephalona kA koTiMga kiyA jAtA hai| kabhI-kabhI gale meM keroTiDa ArTarI ko bA~dhakara bhI TrITamenTa kiyA jAtA hai / sarjarI ke jaise hI dUsarI sAravAra paddhati meM koIlsa (Colls) kA upayoga kiyA jAtA hai| isameM dhAtukI spriMga jaisI cIja se gubbAre ko bhara diyA jAtA hai, jisase gubbAre meM khUna jamA na ho / ye samagra prakriyA raktavAhinImeM Clot (gaThana) pedA karatI hai| ye prakriyA saMpUrNataH oparezana rahita (Noninvasive) hai / usakA kharca kitanI koIla (Coils) kA upayoga huA hai, usa para nirbhara hai; takarIbana 3 se 4 lAkha ho sakatA hai / ina sabhI ke dvArA Rebleeding pUrNarUpa se rokA jA sakatA hai aura mRtyudara kama kiyA jA sakatA hai| upara batAI sarjarI kA kharca karIbana rU. 1 lAkha se 1.5 lAkha AtA hai| sarjikala khatarA 1 se 5 pratizata hI hotA hai| sabhI ucca kendroM ke niSNAta nyUrosarjana ke pAsa aisI sarjarI saMbhava hai| e. vI. mAlaphormezana ke lie bloka risekzana athavA lAIgezana takanika upayoga meM lAI jAtI hai, athavA proTonabIma dvArA use jalAyA jAtA hai| Aja kala gAmA nAIpha kA upayoga adhika pracalita hai / jisa meM kobAlTa ke srota se gAmA nAipha dvArA kendrita kie gae gAmA kiraNoM se dhyAnapUrvaka ise jalA sakate haiM / jisameM sarjarI saMbhava na ho, vahA~ pleTinama koIliMga va embolAijezana kiyA jAtA hai / mastiSka ke bAharI bhAga meM Ae hue choTe yA madhyama kada ke e.vI. mAlaphormezana ke lie oNparezana hI zreSTha hai / mastiSka ke ati mahatvapUrNa sthAna meM yA mastiSka ke aMdarunI bhAga meM hote 3 mi.mi. aura usase kama kada ke e.vI.ema. ke lie sTirioTekTika reDiyo sarjarI (esa.Ara.esa. - gAmA nAIpha) zreSTha hai / jaba kI embolAIjezana se 15 se 20 pratizata marIjoM ko roga mukta kiyA jA sakatA hai| kabhI kabhI embolAIjezana kA upayoga baDI sarjarI ke lie rAha dekhate hue marIja meM kiyA jA

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6 - mastiSka meM raktasrAva (Brain Hemorrhage) sakatA hai / yaha takanika kA enyUrijama aura e. vI. mAlaphormezana donoM meM hI upayoga ho sakatA hai / (3) korTikala vInasa thombosisaH ___ mastiSka kI zirAmeM kabhI-kabhI rudhirakA pravAha baMda / zithila ho jAtA hai / kabhI mukhya zirAkA bhaMDAra (Venous sinus) avaruddha ho jAtA hai taba mastiSka kA khUna kA pravAha avyavasthita ho jAtA hai| hemareja aura thrombosisa donoM hI vikriyA hotI hai / joroM se saradarda honA, ulaTI honA, phITa (mirgI) AnA, behozI honA, pakSAghAtakA daurA paDanA, aura gaMbhIra ke so meM mRtyu taka honA, ye roga kI viziSTatA hai| kamanasIbI do bAta kI hai / jyAdAtara rogI meM nidAna bahuta dera se hotA hai / sAmAnya DaoNkTaroM kI bhI isameM jAnakArI kama paDatI hai| isameM nyUrolojI vizeSajJakI jarUra paDatI hai - khAsa karake vicitra prakAra ke saradarda meM (nyUrolojI) vizeSajJa kI salAha le ke agara jarurI hai to ema.Ara.AI., breIna (MRI) ema.Ara.AI vInogrAma (MRV) karavAnA cAhie / jyAdAttara kesa meM nidAna usameM pakar3A jAtA hai / dUsarI kamanasIbI ye hai ki sagarbhA bahanoM ko DIlIvarI ke pazcAt prathama eka se cAra hapte ke aMdara ye roga jyAdA hotA hai / choTe gA~vo meM ajJAnatA ke kAraNa aura meDikala suvidhA na milane ke kAraNa mRtyudara bhI U~cA rahatA hai / khUna gADhA (Thick) hone se (Hypercoagulable states), zarIra meM pAnI ghaTane se (Dehydration etc) zarIrameM kensara kI kahI utpatti hone se aura lupasa, hAipara homosisTInemiA, enTI phospholipiDa sInDroma...... Adi khUnakI vikRtioM se bhI ye roga hotA hai / saradarda ko - khAsa karake bar3hate jAte saradarda, ulaTI, mirgI ko najaraaMdAz2a na karanA cAhie / sagarbhAvasthAke pazcAta aise cihna yA mirgI Aye to turata dardIko acchI suvidhAvAlI aspatAla le jAnA cAhie / MRI (MRV) karavA lenA cAhie / khUna patalA karanevAlI davAI, (Heparin, Warfarin etc) dimAga ke sUjana kI davAI, mirgI, saradarda

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mastiSka aura jJAnataMtu kI bImAriyA~ ke cihna miTAnevAlI davAI vagairaha tAtkAlika sAravAra se rogI svastha ho jAtA hai / kabhI (Venous Thrombolysis) thrombolisIsa evaM sarjarI dvArA dardI bacAyA jA sakatA hai / para enTIko egyulanaTa (Warfarin, Acitrom) davAI aura phITakI davAI lambe samaya taka lenI paDatI hai / 82 surkhiyA~ rakta kI nalikA phaTane se, yA aise kisI kAraNa se mastiSka meM rakta kI jamAvaTa hotI hai, aura kSaNa bharameM dardI behoza ho jAtA hai, use breIna hemareja kahate hai / jyAdAtara kesa meM acAnaka blaDaprezara bar3ha jAne se hI brena hemareja hotA hai / ataH BP kI yathAyogya aura kAyamI sAvAra karanI jarUrI hai / * jora se saradarda honA, ulaTI honA, cakkara AnA, AMkho ke sAmane aMdherA chAnA, mirgI AnA, laDakhaDAnA yA lakavA honA, kSaNabharameM behoza honA aura zvAsa tejI se calanA yaha saba breIna hemareja ke cihna hai / * Upara ke koI bhI lakSaNa gaMbhIra rupa se najara AeM to dardI ke lie niSNAta DaoNkTara ghara para bulAne ke badale turaMta phemilI DaoNkTara kI sahAyatA se aspatAla le jAnA cAhie / sITI skena aura enjiyogrAphI nAmaka TesTa isa roga meM jAMca kA mukhya mAdhyama hai / aura kaI marIz2oM meM sarjarI kI bhI AvazyakatA rahatI hai / * korTIkala vInasa thrombosisa eka khataranAka roga hai, jisameM nidAna prakriyA jaTila hai / samayasara saradarda kI jA~ca aura sAravAra karanA bahuta Avazyaka hai /

Page #102
AdhAzIzI aura anya siradarda evam varTigo (Migraine, other headaches & vertigo) siradarda mastiSka ke rogo meM sarvAdhika honevAlA roga hai / yaha kahA jAtA hai kI hara eka vyakti ko kabhI-kabhI yA bAra-bAra siradarda hotA hI hai| adhikatara pratyeka vyakti ko kabhI-kabhI siradarda kA anubhava hotA hI hai, paraMtu kisI ko gaMbhIra siradarda bhI ho sakatA hai / eka pratizata vyakti ko siradarda mastiSka meM gAMTha ke kAraNa ho sakatA hai| kaI vyaktioM ko kucha dinoM yA mahInoM meM eka tarapha kA siradarda hotA hai, jo kI AdhAzIzI ho sakatA hai / agara pichale kucha dinoM se sira darda zurU huA hai to sabase pahale rojamarrA kI jIvanapaddhati; jaise kI kAmakAja, AhAra, ArAma Adi meM kisI prakAra ke badalAva ke kAraNa to aisA nahIM huA, yaha dekhanA jarUrI hai / agara kucha mahInoM se siradarda hotA hai to kisa kAraNa itane samaya pazcAt upacAra kI jarUrata paDI yahI bhI socanA cAhie | kaI mahilAoM ko garbhanirodhaka goliyoM ke sevana se bhI siradarda ho sakatA hai / blaDaprezara bar3hane se bhI siradarda ho sakatA hai / isalie siradarda ke sabhI marIjoM ko saMpUrNa zArIrika tathA mastiSka kI jA~ca karavAnI cAhie / agara siradarda ke sAtha kabhI behozI chAye, eka cIja do dikhAI de, mirgI Ae, laDakhar3AnA, cakkara yA aMdhakAra chAe to vizeSataH sAvadhAna hokara tAtkAlika sI. TI. skaina Adi jA~ca karavA lenI cAhie, yaha breIna TyUmara yA mastiSka kI koI ora gaMbhIra bImArI ho sakatI hai / siradarda ke ciMtAjanaka kAraNoM meM meninjAiTisa, breIna hemareja, brena TyUmara, blaDaprezara, ArTarAITisa, mastiSka kI sUjana, blaDa paribhramaNa meM kSati Adi ho sakate haiM, hAlAMki siradarda ke bahuta kama keso meM aisI gaMbhIra bImArI dekhane ko milatI hai jinameM uparokta lakSaNa siradarda ke sAtha dikhAI dete haiM / siradarda ke sAdhAraNa aura ciMtAjanaka nahIM aise

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84 mastiSka aura jJAnataMtu kI bImAriyA~ kAraNoM meM AdhAzIzI pramukha bImArI hai, jise sAmAnyataH mAigrena ke nAma se jAnA jAtA hai / isake alAvA anya sAdhAraNa kAraNoM meM Tenzana, davAI kA duSprabhAva, klasTara heDeka Adi hai / isa prakAra ke darda meM mastiSka kI jA~ca saMpUrNataH normala hotI hai aura marIja ko kisI prakAra kI vikalAMgatA yA perelisisa kA bhaya nahIM rahatA / isake uparAMta Diprezana, zarAba kA vyasana, gardana ke maNake kI bImArI, zaradIsAInusAiTIsa, A~kho kI kamajorI yA jhAmara kI bImArI athavA nyUrAljiyA Adi se bhI siradarda ho sakatA hai / 1. AdhAzIzI (mAIgrena) mAIgrena - AghAzIzI bahuta hI prakhyAta roga hai / isake eTeka (hamalA) ke daurAna marIja bahuta hI niHsahAya, parezAna aura lAcAra ho jAtA hai / bIsa pratizata vayasko ko yaha bImArI kama yA adhika pramANa meM ho sakatI hai / isa bImArI meM mahIne meM ausatana 1 se 6 bAra (kabhI-kabhI hararoz2a) siradarda ho sakatA hai, jo kI sira ke eka yA donoM tarapha (dAe~ aura bAyeM) hotA hai / isakA darda tIvra aura layabaddha hotA hai, jo kAma karane se bar3hatA hai, kaI bAra DakAra, ulaTI AnA, A~khoM ke sAmane aMdherA chAnA aura prakAza ke sAmane adhika na dekha sakanA, AvAz2a sahana na kara sakanA, jaisI paristhiti hotI hai| yaha darda 4 se 72 ghaMTe taka calatA hai / aise pAMca jitane eTeka Aye to marIja ko mAigrena hai, aisA nidAna ho sakatA hai / sAmAnyataH ulTI hone ke bAda aura ArAma se darda baMdha ho jAtA hai / AdhAzIzI (mAIgrena) ke prakAra : (1) komana mAIgrena (2) klAsika mAIgrena (jisameM A~kha-draSTi se saMbaMdhita cihna / hone jarUrI hai| ) (3) mAIgrena ke sAtha kSaNika pakSAghAta honA (4) klasTara heDeka (5) komplikeTeDa mAIgrena

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7 - AdhAzIzI aura anya siradarda evam varTigo (Migraine other headaches & vertigo) AhAra tathA jIvanazailI meM badalAva hone ke kAraNa bhI AdhAzIzI ho sakatA hai / isalie AhAra-vihAra meM niyamitatA, mana kI zAMti, pUrNa ArAma kI jarUrata hotI hai / kabja na ho yaha dekhanA cAhiye, aura dhUpa meM ghumanA nahIM cAhie, agara dhUpa meM jAnA ho to gogalsa pahanane caahie| caoNkaleTa, cIjha, kaoNphI, cAinIsa phuDa, khaTTe phala, reDa vAina Adi aneka prakAra ke AhAra se AdhAzIzI ho sakatA hai / kaI bAra bhUkhe rahane se yA zarIra meM pAnI kI mAtrA kama ho jAne se, adhika jAgaraNa se yA mAnasika tanAva se bhI mAIgrena kA hamalA ho sakatA hai / kadAcita jAtIya samAgama se yA kabhI vAtAvaraNa meM pherabadala se, AvAz2a - zoragula se aura mahilAoM ko garbhanirodhaka goliyA~ lene se yA menopoz2a ke daurAna mAIgrena bar3ha sakatA hai / mAIgrena ke sabhI marIjoM ko vyavasthita zArIrika jA~ca karavAnI Avazyaka hai / kaI mAmale meM sI. TI. skena yA ema. Ara. AI. dvArA bhI ilAja - upacAra kA nirNaya liyA jAtA hai / yogya davAI tathA nirdezita AhAra-vihAra ke niyamoM kA anusaraNa karane para yaha bImArI para niyaMtraNa lAyA jA sakatA hai / AdhAzIzI kI mukhya auSadhiyA~ : (1) hamale ke daurAna lI jAnevAlI auSadhiyA~ : 85 hamalA ho usa samaya turata lI jAne vAlI davAI meM perAsiTemola, ulTI kI golI, pIr3AnAzaka davAI jaise kI ibuprophena yA kaI kesa meM aragaTomAIna nAmaka davA mu~ha se, injekazana dvArA yA gudA meM sapojhiTarI dvArA diye jAne se saMpUrNa rAhata hotI hai yA hamale kI mAtrA kama kI jA sakatI hai| naI davAI meM sumATripTAna (TebleTa yA injekzana), rIjhATripTAna, nArATripTAna Adi lAbhadAyaka sAbita huI haiM / klasTara heDeka meM sumATripTAna ke sAtha 100% oNksijana kA bhI prayoga kiyA jAtA hai /

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86 mastiSka aura jJAnataMtu kI bImAriyA~ (2) hamale ko rokane hetu auSadhiyA~ : anya prakAra kI auSadhiyA~ jisameM bITAblokara yA phlunArijhina davAI athavA emiTriplIna davAI lambe samaya taka lI jAe to AdhAzIzI ke hamale kama ho jAe~ge / Aja kala, TopIrAmeTa (TOPAMAC), vAlaproyeTa ityAdi davAI jyAdA pracalita hai / kabhI kabhI boTokSa injekzana bhI sirameM jahAM darda hotA hai, vahA~ lagAne se bhI phAyadA hotA hai / klasTara heDeka ke kesoM meM verApAmila, lithiyama aura preDnisolona kA prayoga kiyA jAtA hai / isake sAtha sAtha uparokta jAnakArI ke anusAra AhAravihAra kA dhyAna rakhanA Avazyaka hai / 2. spAsTika heDeka (Tension Headache) yaha darda AdhAzIzI jitanA hI yA usase bhI adhika pracalita hai| nAma anusAra snAyuoM ke khiMcAva aura Tenzana se yaha darda hotA hai / yaha darda "sira para mAna lo koI paTTA ba~dhA ho" aisA tathA lagAtAra aura halakA hotA hai, jo lagabhaga roja yA mahIne ke adhikatara dinoM meM rahatA hai / ina sabhI kAraNoM se yaha mAIgrena se bahuta alaga hai / zArIrika jA~ca aura eksa-re, sI.TI. skena isameM bhI normala hI AtA hai| isakA upacAra bhI mAIgrena se alaga hotA hai / sabase pahale to marIja ko kina bAtoM kA tanAva hai yaha khojakara use dUra karane kA prayAsa karanA cAhie / sAmAnyataH kauTuMbika, sAmAjika, Arthika yA zArIrika bImArI ke kAraNa yaha darda meM mukhya bhUmikA nibhAte hai, jisakI marIja aura unake snehI saMbaMdhI ke sAtha mukta mana se carcA kara aura use dUra karane kA upAya karanA yahI mukhya bAta hai| vizeSataH Age 'tanAva' ke cepTara meM likhe anusAra mAnasika zAMti ke tamAma prayoga karane se adhika lAbha hotA hai| vyAyAma, dhyAna, Asana aura yoga isake upacAra meM mukhya bhUmikA nibhAte haiN| Avazyaka lage to hipnosisa, oTosajezana, bAyophiDabeka kiyA jA sakatA hai|

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7 - AdhAzIzI aura anya siradarda evam varTigo (Migraine, other headaches & vertigo) 87 nyUrolaoNjisTa, phijiziyana aura jarUrata par3e to sAikiyATrisTa DaoNkTaroM kI sahAyatA lekara isa roga meM yogya davAI, upacAra tathA sAikotherApI karavAne se lAbha hotA hai / udAsIpana tathA atyAdhika ciMtA ko dUra karane vAlI davAI ke sAtha vyakti kA mUDa sudhare, paristhiti kA sAmanA karane kI zakti bar3he aisI davAI kA upayoga kiyA jAtA hai / sAtha hI snAyuoM ko zAMta karane kI tathA tanAva kama karane kI davAI kA upayoga kiyA jAtA hai / AhAravihAra meM yogya badalAva Avazyaka hai / isameM darda kI davAI kama lene kA Agraha kiyA jAtA hai / darda kI davAI kA aniyaMtrita upayoga isa prakAra ke darda ko bar3hAtA hai aura phira darda kI davAI kA asara nahIM hotA, duSprabhAva yakRta tathA mUtrapiMDa para hotA hai / rakta koSikAoM para ina davAoM kA duSprabhAva hai| koI koI marIz2a davAI ke Adi ho jAte hai (Headache of drug abuse) / DaoNkTaroM ko aise marIz2a ke upacAra meM bahuta dhyAnapUrvaka aura dhairya se kAma lenA cAhie aura darda kI davAI ke alAvA uparokta anya cikitsA paddhatiyoM para bhI dhyAna denA caahie| 3. siradarda ke anya kAraNa Age dI gaI jAnakArI ke anusAra mastiSka ke darda ke anya kAraNoM meM mastiSka kA saMkramaNa aura meninjAiTisa ke mAmale meM tAtkAlika upacAra karane se marIz2a kA jIvana baca sakatA hai / breIna TyUmara kA nidAna sI. TI. skaina athavA ema.Ara.AI. dvArA ho sakatA hai / usake pazcAta yogya upacAra, sarjarI dvArA marIja acchA ho sakatA hai| isI prakAra hemareja kI yogya saghana sAravAra se adhikAMza keso meM jIvana bacAyA jA sakatA hai| darda se mukti pAne ke lie adhika davAI ke sevana se yA usakI Adata par3a jAne se siradarda bar3ha jAtA hai / kaI bAra siradarda ke eka se adhika kAraNa hote hai / isake uparAMta sAInasa, A~kha kI takalIpha Adi siradarda saralatA se acche ho sake, aise prAthamika rogoM ke nivAraNa para dhyAna denA Avazyaka hai /

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88 mastiSka aura jJAnataMtu kI bImAriyA~ siradarda ke gaMbhIra kesa meM nimna cinha sAmAnyataH dikhate hai| isa prakaraNa kA mukhya saMdeza yahI hai ki tAtkAlika jA~ca aura upacAra se aise kesoM meM jIvana bacAyA jA sakatA hai / siradarda ke sAtha-sAtha nimna likhita cihna ho to marIja kI saMpUrNa jA~ca jarUrI banatI hai jaise kI... : .. mirgI AnA, cakkara AnA, aMdherA chA jAnA, calate hue laDakhar3AnA yA pakSAghAta kA asara honA athavA yAdadAsta yA AvAja calI jAnA yA behoza ho jAnA / bukhAra AnA / nIMda se uThane ke bAda siradarda honA, chIMka yA khAMsI Ate samaya darda honA yA bar3ha jAnA / acAnaka hI kucha samaya ke liye asahanIya darda honA / baccoM meM hotA siradarda / 50 varSa upara ke vyakti ko bar3hatA jAtA siradarda / davAI lene ke bAvajUda darda niyaMtraNa meM na AnA / siradarda ke sAtha sAtha uparokta sabhI cihna ho to sAvadhAna ho jAnA cAhie / jisakA mukhya kAraNa mastiSka meM sUjana, gAMTha yA saMkramaNa ho sakatA hai / 50 se upara vayavAlI vyakti ko bar3hatA huA siradarda ho aura sira kI rakta kI nalI sujhana se moTI hotI ho yA darda karatI ho aura sAtha sAtha zarIra meM thakAvaTa, halkA bukhAra, kamajorI ho to Temporala ArTarAITisa ho sakatA hai / isameM ESR aura CRP nAmaka blaDaTesTa kiye jAte hai / bAyopsI se isakA nidAna hotA hai aura sTIroIDa davAI se yaha bImArI acchI ho sakatI hai| 4. TrAijeminala nyUrAljiyA : nyUrAljiyA zabda kA sarala artha hai naso meM darda / jisa nasa kI (narva-jJAnataMtu kI) saMvedanA kA jitanA hissA zarIra meM hotA hai arthAt vaha nasa zarIra meM jahA~ se saMvedanA grahaNa kara mastiSka taka pahu~cAtI

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7 - AdhAzIzI aura anya siradarda evam varTigo (Migraine, other headaches & vertigo) 89 hai, utane hisse meM nasa darda pIDA utpanna kareM use nyUrAljiyA kahate haiM / sAmAnyataH kucha nasoM meM yaha aksara dekhA jAtA hai jaise ki mastiSka kI pA~ca nambara kI, nava nambara kI nasa... Adi / aise nyUrAljika darda chAtI meM, peTa meM, tvacA para, hAtha aura pairo kI cetAoM meM bhI ho sakatA hai / yaha bAta mukhyataH jAnanI cAhie kI tvacA para hone vAle hIsa-jhosTara-vAIrasa kI bImArI nasa para sUjana utpanna karatI hai aura usase atyaMta pIr3Ajanaka nyUrAljiyA kA udbhava hotA mastiSka kI pA~ca nambara kI nasa ko TrAijeminala cetA (narva) kahA jAtA hai aura usameM hone vAle isa prakAra ke darda ko TrAijeminala nyUrAljiyA kahA jAtA hai / yaha darda bijalI ke karaMTa jaisA alpa samaya taka paraMtu atyaMta tIvra pIr3AdAyaka hotA hai aura bAra-bAra hotA hai / dina meM eka-do bAra se lekara 100 yA 200 yA usase bhI adhika karaMTa jaise darda se marIz2a lAcAra ho jAtA hai / use kucha acchA nahIM lgtaa| ThaMDe pAnI kA sparza yA bhojana ke lie muMha khole yA ThaMDA pAnI-havA kA jhoMkA Ae to bhI darda zuru ho jAtA hai / TrAijeminala nasa tIna bhAga meM vibhAjita hotI hai / prathama bhAga meM takalIpha ho to bhAlapezAnI para darda hotA hai, dvitIya bhAga meM takalIpha ho to gAla para aura tRtiya bhAga meM takalIpha ho to jabar3e meM darda hotA hai| sAmAnyataH yaha roga pA~ca naMbara kI cetA para koI choTI-sI raktavAhinI ke dabAva ke kAraNa paidA hotA hai / sAmAnyataH yaha roga meM nyUrolojikala jA~ca meM kisI prakAra kI gar3abar3a nahIM dikhatI hai lekina agara sAtha sAtha jisa kisI bhAga meM saMvedanA kama ho gaI ho usake sAtha meM anya nasoM (udA. 6 yA 7 nambara kI naseM) para takalIpha dikheM athavA marIz2a kI umra 40 se kama ho to ema.Ara.AI. breIna (vitha konTrAsTa aura kabhI ema.Ara. enjiogrAphI) karA lenI cAhie, kyoMki isa prakAra ke kisI bhI kesa

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mastiSka aura jJAnataMtu kI bImAriyA~ meM pA~ca nambara kI nasa para athavA AsapAsa meM gAMTha ho athavA malTipala skle rosisa (yaha roga apane deza meM bahuta kama dekhane ko milatA hai) nAmaka vicitra roga ho sakatA hai / TrAijeminala nyUrAljiyA kI TrITamenTa pahale to meDikala arthAt davAI se karanI cAhiye / mukhya davAI hai kArbAmejepIna (TegreTola, kArbeTola, jhepTola ityAdi) / usakA asara 80 % marIjoM meM adhika acchA hotA hai, anya marIjoM meM phInAiToina, gAbApenTIna, klonAjhepAma aura beklophena Adi davAI kA upayoga kiyA jA sakatA hai| ___ darda ko zAMta karane ke liye darda nivAraka davAI kA prayoga bhI kiyA jA sakatA hai / Alkohala ke lokala injekzana se usa nasa meM tInacAra mahIne taka rAhata milatI hai / TrAijeminala nyUrAljiyA meM RFTC arthAt reDiyo phrikvansI tharmokoegyulezana se nasa ko zAMta kiyA jAtA hai / yaha paddhati aksIra hai aura atyAdhika darda kA ilAja o.pI.DI. prosIjara se kiyA jAtA hai, jisase 90 se 95 pratizata saphala pariNAma Ate hai / jisa marIjoM meM davAI asara na karatI ho aise kesa meM sarjarI kI madada se (rAiz2oTomI, nyUrekTomI) nasa kATa di jAtI hai| hAlAMki sabase zreSTha upAya to mAIkrovAskyUlara Dikamprezana sarjarI hai, jisameM upara batAI gaI raktavAhinI ko pA~ca naMbara kI cetA se alaga karake bIca meM jelaphaoNma rakhA jAtA hai / yaha sabhI TrITamenTa gujarAta, muMbaI tathA sabhI bar3e senTaroM meM nyUrosarjana ke pAsa upalabdha hai / 5. varTigo (cakkara AnA) eka sarvekSaNa anusAra o.pI.DI. meM AnevAle marIjoM meM cakkaraasaMtulitatA, chAtI kA darda aura zArIrika thakAvaTa-kamajorI ke bAda kA tIsarA sabase pracalita lakSaNa hai| prauDha vyaktioM meM ausatana 50 pratizata ko yaha takalIpha hotI hai / jaba vyakti ko apane AsapAsa kI cIje ghumatI huI lage athavA vyakti svayaM ko bhI ghumatA huA

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91 7- AdhAzIzI aura anya siradarda evam varTigo (Migraine other headaches & vertigo) mahasUsa kareM khuda ko saMtulita na kara sake, aisI sthiti meM use "varTigo cakkara AyA- - hai " aisA kahA jAtA hai / sAmAnya rUpa se kSaNika aMdherA chAnA, kamajorI mahasUsa honA, kSaNika asaMtulana jaisA laganA, becainI mahasUsa honA ina sabhI ko sahI artha meM varTigo nahIM kahA jAtA, isakA khAsa dhyAna rakhanA cAhie / varTigo ke mukhya kAraNa hai : (1) zArIrika mudrA meM badalAva se AnevAle cakkara (Benign Positional Vertigo) (2) kAna ke aMdara aMta:karNa ke saMtulana saMbaMdhita nAjuka avayava meM takalIpha (Vestibular disturbance) (3) choTe mastiSka kI bImArI (4) mInIarsa Disiz2a (5) mastiSka meM rakta kA kama paribhramaNa (6) gira jAne kA Dara (7) anya kAraNoM kucha logoM ko acAnaka Ane vAle cakkara kucha samaya taka hI rahate hai / kucha logoM ko cakkara laMbe samaya taka rahate hai aura kucha ko miniTo ke lie bAra-bAra cakkara AtA hai / ina sabhI meM aMta:karNa meM hone vAlI takalIpha se AnevAle cakkara mukhya hai / vaha kabhI vesTibyulara nyUronAiTisa se hote hai / jisameM vAirasa ke kAraNa aMta:karNa meM sUjana honA athavA lebirinthAiTisa se hotA hai, isameM cakkara ke sAtha baherApana aura kAna meM vicitra prakAra kI AvAz2e sunAI detI haiM / donoM hI prakAra meM ulTI bhI ho sakatI hai / I

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92 mastiSka aura jJAnataMtu kI bImAriyA~ cakkara ke sAtha baherApana ho to hIsa, lebirinthAiTisa, choTe mastiSka meM rakta kA kama paribhramaNa yA gAMTha honA jaise kAraNoM kI jA~ca honI cAhie / gAMTha sAmAnyataH ekosTika nyUromA nAmaka hotI hai / jisameM cakkara, baherApana, asaMtulana, choTe mastiSka se saMbaMdhita cihna ityAdi hote hai, sAtha meM siradarda aura ulTI bhI hotI hai / minIarsa Disiz2a meM aMtaHkarNa meM sUjana ke sAtha pAnI bhara jAtA hai, jisase kAna meM cakkara ke sAtha sITI jaisI AvAz2a Ae, kAna bhArI lage, baherApana ho aura ulTI bhI ho sakatI hai / yaha sabhI kucha ghaMTo se lekara kucha dinoM taka calatA haiM aura phira marIz2a ThIka ho jAtA hai| aisA bAra-bAra hamalA ho to phira baharApana aura kAna meM sITI kI AvAja hamezA AtI rahatI hai / aise marIjoM ko namaka, kaoNphI, caoNkaleTa kA sevana baMda kara denA cAhie / vayaska vyaktioM meM cakkara kA mukhya kAraNa Benign Paroxysmal Positional Vertigo hai / jisameM khar3e hone para, baiThane para yA sote samaya karavaTa badalane se kucha kSaNoM ke lie cakkara Ate hai| isameM sAmAnyataH mastiSka meM koI gaMbhIra takalIpha nahIM hotI / prauDha vyaktioM meM khar3e hone para blaDaprezara kama ho jAne ke kAraNa cakkara yA asaMtulana AtA hai, jise Orthostatic Hypotension kahate hai| cakkara ke marIjoM kI uparokta kAraNoM meM se sahI kAraNa jAnakara sAravAra karanI caahie| cakkara ke lie enTihisTAminika, enTiekjhAyaTI, enTikolinarjIka, phInothAyAjina davAI se lekara DAIyureTika aura naI davAI jaise ki onDenaseTrona kA upayoga kiyA jAtA hai / sAtha hI yogya keso meM AhAra kI sUcanA dI jAe, udA. namaka kA kama sevana / vizeSa meM cakkara se saMbaMdhita kucha vyAyAma bhI kucha keso meM sIkhAyA jAtA hai|

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7 - AdhAzIzI aura anya siradarda evam varTigo (Migraine, other headaches & vertigo) 93 yaha saba karane ke uparAMta kabhI-kabhI viziSTa prakAra kI sarjarI bhI lambe samaya taka calanevAle cakkara meM sahAyaka hotI hai / gAMThavAle kesa meM to gAMTha nikAlanI hI paDatI hai / mastiSka meM rakta paribhramaNa kI kamI ho to, usakA bhI yogya upacAra karanA par3atA hai| ina sabhI upacAra paddhatiyoMse cakkara ke cakkara se chUTA jA sakatA hai - rAhata mila sakatI hai| (sukhiyA~ kaI vyaktioM ko hara thoDe dino meM yA hapto meM eka tarapha kA saradarda hotA hai, jo ki AdhAzIzI ho sakatA hai / yaha kAma karane se bar3hatA hai / / * kaI bAra DakAra-ulaTI AnA, AMkho ke sAmane aMdherA chAnA, prakAza sahana nahi kara pAnA jaise lakSaNa bhI sAthameM hote hai| AhAra aura jIvanazailI meM badalAva ke kAraNa bhI AdhAzIzI kA roga ho sakatA hai| nasa zarIra ke jitane hisse meM saMvedanA pahu~cAtI hai, utane hisse meM nasa amuka prakAra kA darda utpanna kareM ise nyurAljiyA kahate hai| mastiSka kI pAMca naMbara kI nasa jise TrAijeminala kahA jAtA hai, usameM honevAle isa prakAra ke darda ko TrAijeminala nyurAljiyA kahA jAtA hai / * yaha darda bijalI ke karaMTa jaisA alpa samaya taka hotA hai, lekina atyaMta pIDAdAyaka hotA hai /

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94 mastiSka aura jJAnataMtu kI bImAriyA~ * mAigrena - AdhAzIzI aura TrAijeminala nyurAljiyA kI atyaMta asara kAraka davAIyA~ upalabdha hai / jaba vyakti ko apane AsapAsa kI cIjeM ghumatI huI lage, athavA vyakti svayaM ko bhI ghumatA mahesusa kare, khuda ko saMtulita na kara pAeM, use varTigo kahate hai / * zArIrika mudrA meM badalAva, kAna ke aMdara ke saMtulana meM gaDabaDa, choTe mastiSka kI bImArI, miniarsa DisIja, mastiSka meM rakta kA kama paribhramaNa... yaha saba kAraNoM se varTigo ho sakatA hai / AhAra meM Avazyaka badalAva aura yogya davAI lene se yaha bImArI niyaMtraNa meM A sakatI hai /

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mUvamenTa DiorDarsa aura DisToniyA .: (Movement disorders & dystonia) manuSya ke zarIra kA halanacalana aura gatividhiyA~ jo ki adhikAMza icchAvartI hotI hai, ve mukhyataH tIna prakAra ke jJAnataMtuoM ke samUha para AdhArita hai / jise taMtra yA System kaha sakate hai / (1) pIrAmiDala sisTama (2) perApIrAmiDala sisTama (3) eksTrApIrAmiDala sisTama isameM pahalA nambara mukhya hai / isakI kAryavAhI meM avarogha ho to hama use pakSAghAta kahate hai arthAt jahA~ nasoM kI kAryavAhI bigar3a jAtI hai, utanA aMga kAma karanA baMda kara detA hai aura usameM dhIre dhIre kar3akapana (spAsTisiTI) paidA hotA hai| (1) yaha pirAmiDala sisTama mastiSka ke phanTala loba ke pichale hisse meM aura kucha aMza meM perAITala loba ke agale hisse meM Ane vAle koSoM - Upara ke yAne apara nyUrona koSa ke samUha se paidA ho kara, koronA reDieTA banAne ke pazcAt bejhala gengalIA ke bIca AnevAlI inTarnala kepsyUla ke pichale bhAga se phailakara seribrala pIDakala meM se nIce utarakara paurAmiDala TrekTsa banAtI hai / bAda meM donoM tarapha ke mastiSka kI TrekTa krosa karake apanI sAmane kI tarapha meDyulA meM utara kara koTirko spAinala TrekTa nAma se karor3arajju meM nIce utaratI hai aura karor3arajju meM Ae hue spAnaila koSoM ko milatI hai / yaha spAinala koSoM ko loara-nIce ke moTaranyUrona kahate hai / yaha koSa mastiSka se nIce AtI AjJA-sUcanAoM ko spAinala cetAoM dvArA snAyuoM ko pahuMcAtI hai aura pariNAma svarUpa halanacalana kA udbhava hotA hai / eka sekanDa ke kSaNika aMza jItane samaya meM ye samagra prakriyA saMpanna hotI hai| mastiSka kA phanTala loba yaha sisTama kA mukhya bhAga hai / sAtha

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96 mastiSka aura jJAnataMtu kI bImAriyA~ sAtha mastiSka kA dUsarA bhAga jise saplimenTarI moTara korTeksa kahate hai, vaha halanacalana ke pUrva kucha saMdeza pedA karate hai / usakA bhI mahatvapUrNa yogadAna hai / pirAmiDala sisTama meM kSati paidA ho to pakSAghAta hotA hai| (2) perApIrAmiDala sisTama meM mukhyataH rubrospAinala, TekTospAinala, reTIkyulospAinala, vesTIbyUlospAinala Adi cetAsamUha TrekTsa Ae hue haiN| isakA kAma pirAmiDala sisTama para apanA prabhAva DAlanA hai, jisase icchAvartI kArya kucha nizcita rUpa se nizcita kramabaddha tarIke se hI hotA hai / isameM reDa nyUklIyasa, TekTama aura choTe mastiSka jaise mastiSka ke aneka avayava jur3e hue hai / isameM kSati ho to asaMtulana aura ka~pana Adi cihna Ate hai / (3) isa prakaraNa meM jina rogoM ke viSaya meM bAta karanI hai, unheM mUvamenTa DisaorDarsa (halana-calana kI khAmiyAM) kahate hai| una ghaTakoM meM mukhyataH bejhala gengalIA nAmaka mastiSka ke madhya bhAga meM Ane vAle koSa samUha mukhya bhUmikA nibhAte hai aura isa sisTama ko eksTrA pIrAmiDala sisTama kahate hai / Basal Ganglia kor3eTa nyukliasa iMTarnala kepsyula globasa pelIDasa thelemasa puTAmena

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8 - mUvamenTa Diso rDarsa aura DisToniyA (Movement disorders & dystonia) 97 AkRti meM kIe gae nirdeza anusAra yaha phaMTala loba, globasa pelIDasa, puTAmena, koDeTa nyUklIyasa, klosTrama tathA emIgDelA nAmaka koSoM ke samUha kA banA huA hai / yaha pIrAmiDala sisTama ko apane tarIke se kaMTrola karatA hai| phira bhI isa sisTama kI kAryavAhI meM rukAvaTa ho to pakSAghAta arthAt perelisisa nahIM hotA, paraMtu nIce batAI do prakAra kI takalIpha ho sakatI hai jise hama lakSaNa-cihnasamUha yA siMDroma nAma se pahacAneMge : (ka) ekAineTika rIjIDa sinDroma jaise ki kaMpana (pArkinsonijhama - jisake viSaya meM hama agale prakaraNa meM dekheMge), jisameM hAtha-paira kaDaka ho jAte hai, marIz2a kI sabhI kriyA maMda-kamadhImI ho jAtI hai, aura hAtha-paira meM kaMpana hotI hai| DopAmIna nAmaka kemikala kI mAtrA mastiSka meM kama ho jAne se aisA hotA hai| (ba) hAIparakAineTika DisorDarsa : saMkSipta rUpa meM yaha kahA jA sakatA hai ki isameM mastiSka meM DopAmIna tatva kI mAtrA bar3ha jAtI hai / svAbhAvikataH usase svaicchika niyaMtraNa bAhara kI adhika kriyAeM anaAvazyaka hotI hai, jaise ki DisToniyA, korIA, DiskAInejIyA, hemIbelIsmasa / (A) fstelfaren (Dystonia ) : jaba koI mudrA lambe samaya taka eka hI sthiti (poscara) meM rahe to ise DisToniyA kahate haiM / gardana eka tarapha khiMcI huI avasthA meM jhukI rahe to use sarvAikala DisToniyA (TorTIkolisa) kahate haiM / A~kha aura mu~ha ke snAyu bAra-bAra eka hI tarapha khice rahe to use hemIphesiyala spAz2ama kahate haiN| A~khe anaicchika tarIke se baMda rahe, mukhyataH sAmane khar3e vyakti se A~kha milAkara bAta karane meM bhI muzkila ho to use blepherospAjhama kahate hai / mu~ha ke yA jihvA ke snAyu vicitra prakAra se lekina kucha kramabaddha tarIke se hile to use phesIyala DisToniyA athavA mIgsa sinDroma kahate hai|

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98 mastiSka aura jJAnataMtu kI bImAriyA~ bahuta pracalita aisA roga hai jise rAiTarsa kempa kahate hai, jisameM marIz2a ko likhane kI prakriyA meM takalIpha hotI hai| sabase pahale akSara bigar3ate hai, zIghratA se nahIM likhA jA sakatA / aMta meM svahastAkSara karane meM bhI marIz2a ko muzkila hotI hai| zikSaka, klArka Adi jaise likhane vAlI naukarI-vyavasAya karate ho use kitanI muzkila hotI hai yaha samajhA jA sakatA hai| udAharaNa, koI ekjikyUTiva, jise hastAkSara karane meM muzkila hotI hai taba unake ceka vApasa Ate hai / konTrAkTa meM hastAkSara alaga par3ane se bhI gaMbhIra muzkileM hotI hai / dekhanevAlI bAta yaha hai ki ina marIjoM ko kevala likhane meM hI parezAnI hotI hai| inheM khAne meM, choTI moTI cIja pakar3ane meM kisI prakAra kI kamajorI-dikkata nahIM hotI hai yA pakSAghAta ke koI lakSaNa nahIM hote / vokala korDa DisToniyA meM gale se AvAja atyAdhika patalI nIkalatI hai yA to baMdha ho jAtI hai| eka mata anusAra isa prakAra ke kama se kama 100 se adhika DisToniyA hai / vAyolIna bajAne vAlI uMgaliyoM meM DisToniyA ho to becAre saMgItakAra ko usakA nAma-kAma aura AjIvikA khonI par3atI hai / tabalA bajAne vAle kI uMgaliyoM meM DisToniyA ho jAe to tabale kA tAla hI badala jAtA hai / aisI aneka parezAniyA~ marIz2a ko bImArI ke prakAra anusAra hotI hai / bejhala gengalIA kI kAryakSamatA meM gar3abar3a hone ke kAraNa yaha DisToniyA hotA hai| DopAmIna tatva bar3ha jAtA hai, jisake pariNAmasvarupa marIz2a kI kriyAeM bar3ha jAtI haiM athavA kucha nizcita snAyu niraMtara khiMcAva meM rahane se layabaddha kriyA meM rukAvaTa hotI hai / __ Upara batAe gae adhikatara DisToniyA prAImarI hote hai aura mukhyataH yuvA avasthA meM hote hai / vaha jAnA nahIM gayA hai ki yaha kisa kAraNa se hote hai / mAnasika tanAva se lekara, eka hI kAma vizeSataH karane se (jaise ki likhanA) DisToniyA ho sakatA hai| paraMtu yaha bImArI asaMkhya logoM meM se kucha logoM ko hI kyUM hotI hai ? sambhavataH

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8- mUvamenTa DisorDarsa aura DisToniyA (Movement disorders & dystonia) AnuvaMzika (jineTika) yA vaMzAnugata kAraNoM se yA paryAvaraNa ke kAraNa, marIz2a kI jIvanazailI, AhAra aura mAnasika kAraNa ityAdi ke saMyojana se yaha roga saMbhavita hai / 99 kucha bhI ho, isakI cikitsA bhI itanI hI muzkila hai / usakI davAI aMdAja karake hI dI jAtI hai, kyoMki usake kAraNa kA bhI patA nahIM hai / udA. TrAihekSI phenIDIla, heloperIDola, benjoDAijepIna (jaise ki klonAjepAma ), TeTrAbenjhina ityAdi aneka davAI akele yA saMyojana ke rUpa meM dI jA sakatI hai| marIz2a kI prakRti anusAra Doz2a bhI badalatA hai / lekina ye sabhI davAI kevala 30% se 40% kesa meM hI asarakAraka hotI hai| davAI kA asara ho tabataka marIz2a ThIka rahatA hai / samaya bItane ke sAtha davAI kA asara bhI kama hotA jAtA hai / paraMtu yuvA marIz2oM ke lie ina davAI kA duSprabhAva ciMtAjanaka haiM / isa kAraNa DokTaroM ko ina davAI kA adhika upayoga na karake marIz2a kI takalIpha anusAra kucha hada taka hI saMyamita upayoga karanA cAhie / usake badale naI prakAra kI TrITamenTa jise boTulInama iMjekazana (boToksa / DIsporTa) kahate hai, ise snAyu meM yogya mAtrA meM upayoga karane se ina sabhI prakAra ke DisToniyA meM acchA pariNAma lAyA jA sakatA hai / pariNAmasvarUpa uparokta samajhAe hue sarvAikala DisTonIA (Tokolisa) se lekara blepherospAjhama hemIpheziyala DisTonIA, rAiTarsa krempa ityAdi meM yaha auSadhi camatkArika aura lAbhadAyaka siddha huI hai / isa prakAra ke iMjekzana dene ke lie yogya TreniMga prApta kie hue nyUrolojisTa DaoNkTara bhArata deza meM muMbaI, ahamadAbAda, kolakAtA aura dillI aura anya zaharoM meM upalabdha hai / isa iMjekazana ko kisa snAyu meM, kitanI mAtrA meM denA vaha DokTara taya karate haiM, jisase isakA duSprabhAva na ho / udA. jisa snAyu meM adhika khiMcAva ho vahA~ isa iMjekazana ko dene se snAyuoM meM saMtulana A jAtA hai, snAyu kriyA ThIkaThAka ho jAtI hai aura khiMcAva se darda ho to vaha bhI calA jAtA hai / kasmeTika tarIke se bhI marIz2a ThIka rahatA hai aura vaha vyavasAya, naukarI dubArA yathAvat kara sakatA hai /

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100 mastiSka aura jJAnataMtu kI bImAriyA~ yaha iMjekazana maha~gA hotA hai, jisakI sAravAra kA kharca hemIphesiyala spAjhama meM ausatana ru. 4 se 5 hajAra hotA hai / blepherospAjhama meM ausatana ru. 6 hajAra kA kharca hotA hai / 4 se 6 mahIne ke bAda usakA asara sAmAnyataH khatma hone se yaha iMjekazana dubArA denA par3atA hai / kabhIkabhI kisa snAyu meM denA hai yaha sahI tarIke se jAnanA muzkila ho jAtA hai / taba i.ema.jI. nAmaka snAyuoM ke TesTa kI madada se yaha snAyu DhU~DhanA paDatA hai aura agara Doz2a adhika ho jAe to usase snAyu kI kAryakSamatA kucha dinoM taka kamajora ho jAtI hai| jaise ki A~kho kI palakoM kA baMda ho jAnA / isa kAraNa yaha iMjekzana kevala niSNAta nyUrolojisTa athavA isa prakAra kI yogya TreniMga prApta phijiziyana dvArA hI lenA cAhie / yaha boTulinama iMjekzana jo boToksa, DisporTa ityAdi nAma se milatA hai, vaha do cetAtaMtu jahA~ milatI hai, vahAM sAyanepsa ke prIsAyanepTika kolinajika Tarminala para isa prakAra kA baMdha (bonDa) banAtA hai ki jisase cetAtaMtu se kaMTrola hue snAyupeziyoM kA phaMkzanala Dinarvezana ho jAtA hai / jisase snAyu kI peziyoM ko vaha kamajora banAtA hai / yaha kamajorI dhIre dhIre khatma ho jAtI hai / isa boToksa iMjekzana dvArA upacAra kA vyApa atyaMta zIghratA se bar3ha rahA hai, jisase DisTonIA ke alAvA jo bhI snAyu meM khicAva mahasUsa ho athavA snAyu meM darda uThatA ho, vahA~ upayoga meM AtA hai / pakSAghAta ke bAda snAyuoM meM AnevAlA kaDakapana (spasticity) aura usake sAtha aMgoM meM honevAlI vicitra sthiti (posture) meM boToksa iMjekzana se adhika lAbha hotA hai, paraMtu 4 se 6 mahIne bAda isakA asara phira se kama ho jAtA hai / serebrala pAlsI se kaDaka hue hAtha-paira ke upacAra se lekara snAyuoM ke darda aura umra ko chupAne ke lie jharariyoM kI TrITamenTa taka ina sabhI meM boTulInama iMjekzana upayogI hai yaha siddha huA hai / usakA Doz2a choTe snAyu meM 2 yuniTa se lekara kula 150-200 yuniTa taka ho sakatA hai|

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8 - mUvamenTa Diso rDarsa aura DisToniyA (Movement disorders & dystonia) 101 davAI aura mukhyataH boTulinama TokSina ke upacAra se adhikatara bhAga meM isa prakAra kA DisToniyA niyaMtraNa meM rahatA hai / lekina kabhI jarUrata par3ane para sarjarI bhI karavA sakate hai / sarjarI meM rAIjhoTomI, Dinarvezana prosijara ityAdi se TrITamenTa kiyA jAtA hai| kabhI kabhI spAinala korDa sTimyulezana kiyA jAtA hai / DisToniyA ke kaI kesa meM rogagrasta snAyuoM para kI tvacA para lagAyA paTTA (splinTa) upayoga kiyA jA sakatA hai / DisToniyA ke kaI kesoM ko sekanDarI DisToniyA kahate hai / usameM mastiSka meM kisI na kisI prakAra kI kSati-kamI-vikRti hotI hai jaise ki koSoM ke cayApacaya kI vaMzAnutAgata bImArI, vilsana Disija, AnuvAMzika DisToniyA (DisToniyA maskyulophormansa), mastiSka kI gAMTha, rakta kI kSati, kaI davAI ke duSprabhAva ityAdi / isameM se kaI kAraNoM ko dUra karane se DisTonIA meM rAhata hotI hai| kaI kAraNoM ko sahI DhaMga se kaMTrola kiyA nahIM jA sakatA / DisToniyA ke uparAMta anya kaI muvamenTa DisorDarsa bhI mahatvapUrNa hai| (B) korIA (Chorea) bejhala gengalIA meM sthita koDeTa nyuklIasa kI kAryapraNAlI meM samasyA hone se, hAtha-paira, gardana, cahere kA vicitra, ardhahetuka halanacalanaki jo adhikatara kramabaddha tarIke se punarAvartita hotA hai| (1) rAmeTika phIvara nAma se prakhyAta joDoM ke darda kA korIA (2) haMTigTana korIA (vaMzAnugata) / (3) senAila korIA (buDhApe meM hotaa)| (4) DiptheriyA, vhupiMga kapha, (kAlI khAMsI) rUbelA ityAdi rogoM meM hotA huA koriiaa| (5) thAIroiDa bar3hane se hotA huA korIA / (6) nyUro ekenthosisa korIA /

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102 mastiSka aura jJAnataMtu kI bImAriyA~ (7) davAoM ke duSprabhAva se hotA huA korIA - mukhyataH mAnasika bImAriyoM kI davAIyA~, garbhanirodhaka goliyA~, lithiyama, ulTI kI davAIyA~, pArada jahara - ina sabhI kAraNoM se korIA ho sakatA hai| korIA meM Age batAe gae anusAra DopAmIna tatva bar3ha jAtA hai, isalie DopAmIna kI rokathAma ke lie heloperIDola, klora promejIna, TeTrAbenjhina aura sIna ityAdi davAI upayoga meM lI jAtI hai| (c) Tremara (Tremor) (kaMpana) hAtha-paira kI uMgaliyoM kI yA gardana-hoTha jivhA kI kramabaddha, parivartita aura eka jaisI kaMpakaMpI (kaMpana) ko Tremara kahate haiM / yaha sabase adhika pAyA jAtA mUvamenTa DisorDara hai / kaI bAra svastha manuSyoM ko bhI thakAvaTa, davAI kI asara, kophI kA sevana, preganansI jaisI paristhiti meM bhI kaMpakaMpI hotI hai / davAI meM sTiroiDa, dama kI sAlabyuTAmola, thIophAIlIna; lithiyama, TrAisAyaklika tathA enTisAyakoTika jaisI mAnasika rogoM kI davAI aura mirgI ke rogoM meM upayoga meM Ane vAlI vAlproyeTa davAI mukhya hai / thAiroIDa kI mAtrA bar3hane se bhI Tremara ho sakatA hai / kaI mAmaloM meM Tremara vaMzaparaMparAgata hotA hai / jise phemilIyala esenzIyala Tremara kahate haiM / kucha logoM ko umra kI vajaha se Tremara AtA hai, aura pArkinsonijama ke mukhya lakSaNoM meM bhI Tremara sammilita hai| __ isa prakAra bhinnabhinna kAraNoM se honevAle Tremara meM alaga-alaga davAI kA upayoga hotA hai, jaise kI bITA blokara (proprenolola), DAyAjepAma, klonAjepAma, gAbApenTIna, prImIDona, pArkinsoniz2ama hetu DopAmInarjika davAI / kaI kesoM meM sarjarI se bhI lAbha mila sakatA hai|

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8 - mUvamenTa DisorDarsa aura DisToniyA (Movement disorders & dystonia) 103 (D) Tiksa ( Tics ) zIghra, parivartita Adata jaisI laganevAlI halanacalana jaise ki palakoM ko bArI bArI samaya samaya para paTapaTAnA kI prakriyA ko Tiksa kahate hai | pAMca pratizata baccoM meM isa prakAra kI Adata hotI hai, jo taruNAvasthA meM samApta ho jAtI hai / kisI davA ke duSprabhAva yA vAIrasa ke roga se bhI aisA hotA hai| lekina jo kharAba prakAra ke Tika hai, Gilles de la Tourettee Syndrome meM dekhe jAte hai jisameM dardI ke vyavahAra meM parivartana (ADHD, OCD) tathA asabhya bhASA kA prayoga bhI lakSaNa hai / isakI ucita TrITamenTa karavAnI cAhie / vaha anta meM kucha elopethika davAI ke duSprabhAva se hone vAle mUvamenTa DisarDarsa ko dhyAna meM leMge : (1) DiskAInejIyA phInothAyejhInsa, lIvoDopA, ityAdi davAI se hotA huA korIA, DisTonIA / (2) DisToniyA : nyUrolepTika grUpa kI davAI se hotI hAtha-paira kI vicitra khiMcAva kI avasthA / : (3) ekIthIsIA : enTisAyakoTika davAI se hotI huI eka prakAra kI viSama paristhiti / (4) pArkinsonijhama : udA. heloperIDola, mAnasika rogoM kI davAI se hotA kaMpana | (5) korIA : udA. garbhanirodhaka davAI / (6) nyUrolepTika melignanTa sinDroma : enTIsAyakoTika davAI ke duSprabhAva se hotA roga ( bukhAra aura jakar3ana ) (7) TArDiva DiskAInejIyA : nyUrolepTika davAI ko laMbe samaya lene para hotA huA korIA, DisTonIA ityAdi /

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104 mastiSka aura jJAnataMtu kI bImAriyA~ sakhiyA~ / mastiSka kI eksTrA pIrAmiDala sisTama kI bejhala gengaliyA kI kAryavAhI meM rukAvaTa hone para kaMpana, DisToniyA, korIA jaise muvamenTa DisaoNrDarsa hote hai / jo DopAmIna nAmaka tatva ke asaMtulana se hote hai| sarvAikala DisToniyA, hemiphesIyala spAjhama, blepherospAjhama, rAiTarsa kempasa vagairaha DisToniyA ke prakAra hai| muvamenTa DisaorDara kI sAravAra kI davAI kA duSprabhAva jyAdA hotA hai, isalie eka nae prakAra kI TrITamenTa jise boTulInama injekzana kahate hai, vo Ajakala jyAdA pracalita hai yaha injekzana kA koI khAsa duSprabhAva nahi hotA hai| bejhala gengaliyA meM sthita koDeTa nyuklIyasa kI kAryapraNAlI meM samasyA hone para hAtha-paira, gardana, mukha kA vicitra ardha hetuka halana-calana krama baddha tarIke se punarAvartana hone ko korIA kahate hai| hAtha paira kI uMgaliyoM kI yA gardana, hoTha kI krama baddha parivartita aura eka jaisI kaMpakaMpI ko Tremara kahate hai| * zIghra parivartita, Adata jaisI lagane vAlI halana-calana prakriyA ko Tiksa kahate hai / * kucha elopethI davAI ke duSprabhAva se bhI muvamenTa DIsaorDarsa ho sakate hai|

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Parkinsonism) san 1817 meM DaoN. jemsa pArkinsana ne sabase pahale mastiSka ke isa roga ke lakSaNoM kI vistRta jAnakArI dI thI, isalie yaha roga unhIM ke nAma se jAnA jAtA hai / vayaska logoM meM yaha parezAna karatA huA pracalita roga hai, jisameM mastiSka kA 'sabasTensiyA nAyagrA' nAmaka koSa-samUha kisI kAraNavaza kSatigrasta hokara naSTa ho jAtA hai, taba 'DopAmIna' nAmaka breIna ke mukhya jaivika rasAyana kI utpatti kama ho jAtI haiM / isI kAraNa halanacalana kama aura maMda ho jAnA, kaMpana, snAyuoM kA kar3akapana ityAdi lakSaNa dikhate hai / usakI zuruAta adhikatara zarIra kI eka tarapha arthAt dAe~ yA bAyeM aMga se hotI hai| kucha marIjoM meM Age calakara kucha varSoM meM yaha donoM tarapha ke aMgo meM phaila jAtA hai| lakSaNa : (1) ArAma ke samaya meM yA baiThe baiThe bhI hAtha-paira kI uMgaliyA~ meM viziSTa prakAra se (pIlaroliMga kI taraha athavA rUpaye kI noTa ginate ho isa prakAra se hAtha kI uMgaliyA~ kA layabaddha) kNpn| (Tremors) (2) thoDA jhukakara choTe aura zIghra kadama se calanA, aura calate samaya hAtha kA halanacalana kama ho jAnA / (3) sabhI kriyA kama honA aura maMda honA / (Bradykinesia) (4) hAtha-paira aura cahere ke snAyu kar3aka honA / (Rigidity) (5) akSara choTe ho jAnA /

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106 mastiSka aura jJAnataMtu kI bImAriyA~ (6) kadama dhIre par3a jAnA, calatecalate khaDe raha jAnA / (Postural instability) (7) yAdadAsta meM kamI AnA, Diprezana honA, adhikatara pasInA honA, zarIra meM darda honA, AvAja dhIrI aura nIrasa ( Monotonous) ho jAnA, cahere ke hAvabhAva kamaadRzya honA, mu~ha se rAla TapakanA aura AMkhoM kI palake khola-baMdha hone kI prakriyA maMda honA / aise lakSaNa dikheM to DaoNkTara ko milakara roga kA ilAja karavAnA jarUrI ho jAtA hai / cikitsA kI dRSTi se isa roga ko pAMca alagaalaga avasthA (stages) meM bA~TA gayA hai / yaha roga umra ke kAraNa hone se mastiSka ke ghisAva (wear & tear) ke sAtha jur3A huA hotA hai, lekina usake nizcita kAraNoM ko abhI saMpUrNata: jAnA nahIM gayA hai| kaI bAra davAIyoM ke duSprabhAva se, sira meM jakhma ke kAraNa, jaharIlI gaisa yA jaivika rasAyanoM se hotA nukazAna yA vAyarasa se, asAmAnya saMyoga meM vaMzAnugata kAraNoM se bhI yaha roga hotA hai| adhikAMza kesa meM koI samaja nahIM sake aise ajJAta kAraNoM se hI (iDiyopethika) yaha roga hotA hai / kaI bAra yaha roga anya kisI bar3e roga ke lakSaNoM ke rUpa meM bhI dekhane ko milatA hai| jaise ki malTIsisTama eTrophI athavA progresiva suprAnyukliyara paalsii| usame Age batAye gaye kaMpana ke sAtha sAtha kaI aura lakSaNa dikhate hai| ___ausatana hara pA~casau meM se eka vyakti ko pArkinsonijhama ho sakatA hai / 60 varSa se adhika umra meM ausatana 1.5 % loga isa roga se pIDita haiM / kaI bAra yuvAvasthA meM bhI yaha roga hote hue dekhA gayA hai / jaba 'DopAmIna' nAmaka mastiSka kA rasAyana utpanna karane vAle

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9- kaMpavAta (Parkinsonism) 80 pratizata jitane koSa naSTa ho jAte haiM taba pArkinsonijhama ke lakSaNa dikhAI dete haiM / 107 vaise to pArkinsonIjhama roga ke nidAna ke lie koI viziSTa jA~ca kI AvazyakatA nahIM hai; phira bhI jaba kabhI nidAna meM zaMkA ho yA pArkinsana plasa sinDroma kI zakyatA ho (jisake bAre meM hama bAdameM dekheMge) to ema. Ara. AI. yA spekTa yA phaMkzanala ema. Ara. AI karavAnA cAhie / ina koSoM ko naSTa hone se bacAne ke lie koI cikitsA yA davAI nahIM hai / isa kAraNa isa roga ko jar3a se nahIM nikAlA jA sakatA hai / lekina niyamita davAI, upacAra karane se isake adhikAMza lakSaNoM para niyaMtraNa avazya hI kiyA jA sakatA hai / Adhunika cikitsA paddhati tathA vyAyAma aura yoga dvArA isa roga meM rAhata mila sakatI hai / upacAra : cikitsAkiya upacAra hetu kI davAI meM mukhyataH livoDopA, DopAmIna egonisTa (ropInIrola) aura enTikolInajika davAeM (pesiTena) ityAdi davAI prayoga meM lI jAtI hai| isameM se livoDopA mukhya davAI hai jo breIna meM DopAmIna nAmaka tattva sIdhA hI praveza karavA detI hai / jisakI kamI se yaha roga hotA hai / jitane pramANa meM lakSaNa hote haiM, usake anusAra davAI kI mAtrA DaoNkTara taya karake yaha davA dete hai / AvazyakatA anusAra niSNAta DaoNkTara kA mArgadarzana jarUrI hotA hai, kyoMki isa davAI kA duSprabhAva bhI adhika hotA hai / yaha davA alaga alaga pramANa meM, bhinnabhinna saMyojana meM, aura TebleTa, pravAhI va pampa kI sahAya se bhI marIja ko dI jA sakatI hai / adhikatara niSNAta cikitsaka isa davAI kI jagaha para roga kI prAraMbhika avasthA meM pesiTena, emenTiDIna, bromokripTina, premIpekSola

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108 mastiSka aura jJAnataMtu kI bImAriyA~ aura TrAIvAsTAla ityAdi davA se kAma calAte haiM aura agara roga dUsarI yA tIsarI avasthA meM (zarIra meM donoM tarapha asara kare) ho to livoDopA dete hai| jisase marIja duSprabhAva ke binA lambA jIvana jI sakate hai| nae saMzodhana ke mutAbika DopAmIna egonIsTa nAmaka davAI agara prAraMbhika avasthA meM dI jAe to roga kI Age baDhatI huI gati avazya thoDI maMda par3a sakatI hai / cikitsAkIya dRSTi se yaha roga pAMca avasthA (stages) meM vibhAjita hai| udA. prathama avasthA meM zarIra ke eka hI tarapha kaMpana yA kaDakapana hotA hai jabaki aMtima avasthA meM marIja bistaravaza ho jAtA hai / kisa avasthA meM marIja ko kauna sI davAI denI cAhie vaha nyUrophijiziyana taya karate hai / yahA~ yaha spaSTatA Avazyaka hai ki kisI bhI do marIja kA upacAra hetu eka hI prakAra kI davAI kA prayoga hoM aisA nizcita rUpa se nahIM hai| pichale kaI varSoM meM isa roga ke nirmUlana ke lie atyaMta mahattvapUrNa saMzodhana ke kAraNa cikitsako tathA marIjo meM AzA kI naI kiraNa prakaTa huI hai / premiprekSola, ropinirola, Tolakepona, enTAkepona jaisI davAI atyaMta asarakAraka aura kama duSprabhAvavAlI hai, kI jisase marIja ko bahuta hI ArAma milatA hai| vartamAna meM ropinirola (Ropark) premIpekSola (Premirole, Remipax) aura enTAkepona (Entacom, Adcapone) bAjAra meM upalabdha hai / videzoM meM rAsAjilina (aijhilakTa) aura roTigoTina ke skIna peca bhI asarakAraka mAlUma hue hai| viTAmIna 'I' tathA anya kaI dravyoM ke sevana se bhI isa roga kI mAtrA kama hotI hai aisA kaI loga mAnate haiM, paraMtu isa bAta ko abhI sarvasvIkRti nahIM milI hai|

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109 9 - kaMpavAta (Parkinsonism) sarjarI khAsa camatkArika bAta to naI sarjarI kI hai / cAlIsa se bhI adhika varSa pahale pArkinsonijhama sarjarI kI khoja huI thI / lekina livoDopA davAI ke AviSkAra se isa bImArI meM camatkArika lAbha hone ke kAraNa sarjarI kA yogya vikAsa nahIM ho skaa| livoDopA davAI ke laMbe samaya ke prayoga bAda satata duSprabhAva ke viSaya meM cikitsako ko patA calane se phirase pArkinsonijhama saMbaMdhita sarjarI kA vikAsa pichale dasa varSoM meM huA, aura aba usameM dina-pratidina anubhava bar3hane ke kAraNa sarjarI salAmata aura svIkArya hotI jA rahI hai| sarjarI kisa kesa meM kaba kareM, kisa prakAra kI kareM yaha bAta bhI Ajakala meDikala pariSada kA mahattvapUrNa muddA bana rahI hai jo prasannatA kI bAta hai / pArkinsonijhama ke kesa meM tIna prakAra kI sarjarI ho sakatI hai / (1) eblezana sarjarI : isameM pArkinsonijhama hone ke kAraNa mastiSka ke koSoM kI sarakiTa meM yogya sthAna para chidra yA ghAva (Ablation) kiyA jAtA hai / chidra karane hetu sTirIoTeksI paddhati kA upayoga kiyA jAtA hai / aisA chidra thelemasa, pelIDama yA sabathelemika nyukliyasa meM kiyA jAtA haiM / usa anusAra use thelemoTomi, peliDoTomi ityAdi nAma diye jAte hai / marIja yuvAna ho aura jinameM kaMpakaMpI jaise lakSaNa ho to unameM thelomoTomI kiyA jAtA hai / livoDopA davAI ke duSprabhAva, jaise ki DiskAInejiyA ityAdi se chuTakArA pAne ke lie bhI pelIDoTomI ho sakatI hai| isa sarjarI se apekSita pariNAma milatA hai lekina ekabAra chidra kiyA gayA bhAga hamezA chedagrasta raha jAegA, vizeSa meM kabhI oparezana ke daurAna rakta jamA honA (Hematoma), saMkramaNa ho jAnA ityAdi vikriyA bhI ho sakatI hai / lekina isakA pramANa bahuta kama honA jarUrI hai / isakA kharca 30 se

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110 mastiSka aura jJAnataMtu kI bImAriyA~ 60 hajAra rUpaye jitanA ho sakatA hai / yaha sarjarI donoM tarapha karanA khataranAka ho sakatA hai / isalie sAmAnyataH eka tarapha kiyA jAtA hai| (2) sTimyulezana takanika : kisI bhI bhAga ko hamezAM ke lie chedagrasta na karanA ho aura ilekTrika paddhati se Avazyaka pramANa meM niyaMtraNa karanA ho to usa bhAga ko atyAdhika (sTimyuleTa) uttejita karane se isa bhAga kI kAryazakti kuMThita ho jAtI hai / isa vaijJAnika satya ke AdhAra para yaha paddhati vikasita huI hai / mastiSka kI elbezana sarjarI meM batAe hue bhAgoM ko yahAM Hyperexcite-atiuttejita kiyA jAtA hai| usake lie sTimyuleTara ilekTroDa aura sarkiTa rakhA jAtA hai / / (isa prakAra thelemika sTimyulezana, pelIDala sTimyulezana aura sabathelemika sTimyulezana-isa prakAra tIna paddhati vikasita huI hai| lekina vartamAna samaya meM sabathelemika sTimyulezana takanika ke pariNAma sabase acche dikhAI die hai / ) isa paddhati kA eka lAbha yaha hai ki mastiSka ke bhAgoM kA kAyamI nukasAna nahIM hotA / uttejanA kama-jyAdA karane se pariNAma badala sakate hai / isakA duSprabhAva bhI kama hotA hai paraMtu yaha atyaMta kharcIlA hotA hai / sarjarI kA sTimyuleTara sahita eka tarapha kA kharca rU. 4 se 5 lAkha AtA hai / yaha mazIna donoM tarapha bhI rakhA jA sakatA hai / kaI keso meM kharca kama karane ke lie aura anya kAraNoM se eka tarapha sTimyuleTara aura dUsarI tarapha eblezana sarjarI kI jAtI hai / aisA karane se zarIra ke donoM tarapha roga phailA ho to usameM adhika rAhata mila sakatI hai|

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111 (3) 9 - kaMpavAta (Parkinsonism) yaha saba sarjarI hamAre saubhAgya se hamAre deza meM bhI kucha kendroM meM upalabdha hai aura usakA vyApa bar3hatA jA rahA hai / videzoM meM bImA kI (meDikala insyoransa kI) pracalitatA ke kAraNa sarjarI atyAdhika zIghratA se phailatI jA rahI hai|| sela TrAnsaplAnTezana sarjarI : aisA kahA jA sakatA hai ki yaha sarjarI abhI prAyogika avasthA meM hai| isameM eDrinala graMthi ke koSoM ko marIja ke mastiSka meM prasthApita kiye jAte hai / kucha samaya pahale ardhavikasita garbha ke koSoM kA TrAnsaplAnTa bhI bahuta pracalita huA thA / paraMtu isameM kaI meDikolIgala aura naitika prazna uThate haiM / ina sabhI kAraNoM se yaha TrAnsaplAnTa sarjarI apekSAnusAra pracalita nahIM ho sakegI aisA merA mAnanA hai / meDikala tathA sarjikala prakAra ke isa upacAra ke uparAMta niyamita vyAyAma, prasannacitt, logoM se milanA aura yogopacAra ityAdi bhI sahI upacAra ke upayogI paribala hai, jo nizcitarUpa se marIja ke upacAra meM bhUmikA nibhAte hai| saMkSipta meM, pArkinsana roga se aba Darane kI bilakula jarUrata nahIM hai| saMbhava ho utanA jalda nidAna, sahI upacAra, niSNAta phijiziyana athavA nyUraoNphijiziyana kA mArgadarzana, grUpa therApI(samUha cikitsA), vyAyAma-yoga aura AvazyakatA anusAra sarjarI Adi dvArA isa roga ko mahad rUpa se niyaMtrita kiyA jA sakatA hai| ahamadAbAda, muMbaI jaise zaharo meM pArkinsonijhama se pIDita marIjoM kA esosiezana (saMgaThana-maMDala) hai, jahAM Ina marIjoM ko upayogI jAnakArI dete haiM, grUpa meM yoga-dhyAna, vyAyAma sIkhAte hai aura acchI sevAeM pradAna karate haiN|

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112 1. so mastiSka aura jJAnataMtu kI bImAriyA~ pArkinsana plasa sInDromsa : __pArkinsana jaise hI lakSaNoM vAle nimnalikhita rogo meM samayasara nidAna karanA atyaMta jarUrI hai| kyoMki ina rogo meM pArkinsana kI davA jyAdA upayogI nahIM sAbita huI hai aura agara jaldI nidAna karake ucita sAravAra na kI jAe to ye roga jaldI se Age bar3hate hai aura marIja pathArIvaza ho jAte haiM / (1) malTI sisTama eTrophI (MSA) : yaha roga meM pArkinsana ke kucha lakSaNa to hote hI hai / sAthameM asaMtulana - gira jAnA - bolane meM takalIpha - hAtha kI kriyAoM kI takalIpha bhI AtI hai / ye hone kA kAraNa choTe dimAga (Cerebellum) kA kArya bigaDanA hai / anukaMpI - parAnukaMpI taMtra (autonomic system) ke bigaDane se ekadama khaDe hone para blaDa prezara kama ho jAtA hai / yurIna (pizAba) meM aTakAva AtA hai yA yurIna kapaDe meM ho jAtA hai / isameM pArkinsana ke alAvA do aura taMtra meM musIbata hone ke kAraNa ise malTIsIsTama aTraphI kahA jAtA hai / (2) DiphyUjha levI baoNr3I DisIjha (DLB) : isameM roga ke zurUAta meM hI yAdadAsta kamajora honA, bhramaNA honA, samAnatA meM kAphI caDhAva-utAra AnA vagairaha dekhane ko milatA hai, aura pArkinsana ke lakSaNa bAda meM Ate hai / cittabhramakI davAIyoM kA isameM jyAdAtara bahuta ulTA asara hokara zarIra jakaDa jAtA hai / /

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9.kaMpavAta (Parkinsonism) 113 (3) progresiva suprAnyukliara pAlasI (PSP) : pArkinsana jaise zurUAta meM laganevAle ye roga meM kaDakapana mukhyataH chAtI aura pIThameM AtA hai (Axial Rigidity) - jo ki pArkinsansa DisIja meM hAtha-paira ke snAyu meM AtA haiM / A~kho ke snAyu kI halanacalana kama hotI hai (Supranuclear palsy) / vizeSa to ye marIja roga kI zurUAta se calate calate bArabAra giratA hai aura usakI AvAja meM pharka paDa jAtA hai / (4) korTikobejhala DIjanarezana (CBD) : isameM kaMpavAta ke sAtha eka bAju ke hAtha kI vicitra halanacalana hotI hai (alien limb movements) aura usameM saMvedanA bhI alaga ho jAtI hai / hAtha meM tAkata hone ke bAvajUda vo hAtha se kArya nahIM hotA hai (Apraxia) / -(sukhiyA * mastiSka meM sthita sabasTenziyA nAyagrA nAmaka koSa kisI kAraNa vaza kSatigrasta hokara naSTa ho jAtA hai taba DopAmIna nAmaka beIna ke mukhya jaivika rAsAyaNa kI utpatti kama ho jAtI hai, jisake kAraNa kaMpavAta kI bimArI hotI hai| jyAdAtara marIjo meM Tremara pahalA lakSaNa hotA hai / anya lakSaNoM meM snAyuoM kA kaDaka honA, kArya kI gati kama honA, yAdadAsta meM kamI honA, DIprezana AnA, cehare ke hAvabhAva adrazya honA, muMha se rAla TapakanA Adi hote hai| Age jAte marIz2a eka pUtale jaisA bana jAtA hai, kintu sabhAnatA AkharI dama taka banI rahatI hai|

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114 mastiSka aura jJAnataMtu kI bImAriyA~ * livoDopA, DopAmIna egonisTa aura pesiTena ityAdi davAI se roga ke lakSaNa ThIka hote haiM / isa roga ke upacAra ke lie aba acchI naI davAIyA~ upalabdha hai aura sarjarI jaise ki eblezana, sTImyulezana aura sela TrAnsaplAnTezana vagairaha bhI upayogI hai| matalaba, ye roga ke marIja davAI yA oparezanase kAphI ThIka ho sakate haiM / kintuM, davAI kAyama lenI paDatI hai / pArkinsonIjhama jaise lakSaNa vAle anya cAra roga MSA, DLB, PSP aura CBD hai, jisameM pArkinsonIjhama kI davAI itanI upayogI nahIM hai aura ye cAroM roga meM dardI bahuta jaldI parAvalaMbita ho jAtA hai /

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smRtibhraMza-matibhraMza; aura yAdadAsta bar3hAne ke upAya (Dementia & tips to improve memory) DimenziyA : ise hama sAmAnya zabdo meM smRtibhraMza ke rUpa meM jAnate haiM lekina matibhraMza nAma kucha jyAdA yogya lagatA hai / (mati = buddhi) jisameM vyakti kI yAdadAsta socazakti, bhASA ( samajhane aura samajhAne kI zakti) tathA vyavahAra meM kamI AtI hai / marIja kI vANI, vartana, vyaktitva aura vyavahAra meM ullekhanIya badalAva ke sAtha unakI cetanA kama hotI calI jAtI hai / isa prakAra buddhimattA kI kamI ke kAraNa vyavahArika jIvana meM kaI prazna uThate hai| DimenziyA ke kAraNa : DimenziyA hone ke sAmAnyata: bahuta se kAraNa ho sakate hai / ausatana 80 pratizata marIjoM meM isakA kAraNa Alz2Aimarsa roga yA vAskyulara DimenziyA hotA hai / isake uparAMta phanToTemporala DimenziyA, levI bor3Ija, normala prezara hAIDrosiphelasa, jekaba kruTz2aphelDa Disija, korTiko bejhala Disijha, hanTiMgTana Disija, sabakorTikala lyUkoensephelopathI, e. ela. esa. jaise rogo meM bhI DimenziyA dekhane ko milatA hai | viTAmina B12 kI kamI, thAIroiDa, perAthAIroiDa aura DAyabiTIsa jaisI bImAriyA~ aura kaI jaharIleM dravya tathA bhArI dhAtuoM kI asara... aise aneka kAraNoM se DimenziyA ho sakatA hai / ( 1 ) Alz2Aimarsa DimenziyA ke lakSaNa cihna : isa roga kI zurUAta meM nIce diye gaye lakSaNa dekhane ko milate haiM / bhASA kI takalIpha ( samajhane aura arthapUrNa bolane meM ) hotI hai

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116 mastiSka aura jJAnataMtu kI bImAriyA~ yAdadAsta (turaMta yA to bhUtakAla kI bAteM yAda rakhane kI zakti) meM kamI / adhika samaya taka purAnI yAdadAsta acchI rahatI hai| sthala-samaya kA jJAna kama honA / nirNayazakti kama honA / nIrasatA baDhanA, Diprezana AnA, atizaya krodha AnA / roga Age bar3hane se ina marIjoM ko apanA dainika kArya nibhAne meM tathA rojamarrAha ke kAmakAja meM bhI takalIpha hone lagatI hai| marIja pratidina kI ghaTanAyeM aura paricita vyaktiyoM ke nAma bhUlane lagatA hai| sage-saMbaMdhI, mitroM aura jAnIpahecAnI vastuoM ko pahacAnane meM takalIpha; aura marIja cIjeM idhara-udhara rakha detA hai / sAphasaphAI, rasoI yA kharIdI jaisI bAto meM parAdhIna ho jAtA hai| snAnAdi aura vastraparidhAna ke lie bhI use madada kI jarUrata paDatI hai| bAtacIta karane meM aura ghumane-phirane meM bhI muzkila hotI alaga alaga taraha ke bhrama utpanna hote hai / / marIja ko khAne-pIne meM muzkila hotI hai / ve saMyogo aura paristhiti kA vizleSaNa karane meM asaphala hote haiN| ghumane phirane meM takalIpha paDatI hai / vyaktitva meM parivartana Ane se marIja apanoM se alaga ho jAtA hai| mala-mUtra kArya aniyaMtrita ho jAtA hai / sArvajanika taura para vicitra vartana karatA hai|

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10- smRtibhraMza - matibhraMza; aura yAdadAsta bar3hAne ke upAya 117 cikitsakIya dRSTi se tIna avasthA meM bAMTe gaye isa roga kI aMtima avasthA meM marIja saMpUrNataH parAvalaMbI bana jAtA hai / kAraNa tathA upacAra : Alz2Aimarsa hone kA nizcita kAraNa nahIM jAnA gayA hai / lekina marIja kA vicAra, yAdadAsta aura bhASA para niyaMtraNa rakhanevAle mastiSka ke koSa naSTa ho jAte hai / aisA hone ke kAraNoM meM rakta kA paribhramaNa kama honA, saMkramaNa (inphekzana) yA bar3hatI umra nahIM hote / aise to kaI vizvavikhyAta vyaktiyoM meM yaha roga hai, yaha sarvavidita bAta hai / jaise kI amarikA ke bhUtapUrva pramukha ronAlDa rIgana, riTA hevartha, zugara re robinsana, I. bI. vhAiTa tathA anya... isa roga kI koI nizcita davAI kA abhI taka koI saphala saMzodhana nahIM huA / roga ke lakSaNoM kI tIvratA ghaTAnevAlI naI davAI kA saMzodhana jArI hai / aisA hone para isa roga kA ilAja karake ina marIjoM ke lie madada ho sakatI hai / rojiMdI jiMdagI meM AnevAlI apekSita Apatti ke nivAraNa ke bAre meM marIja tathA unake sage-saMbaMdhiyoM ke pAsa paddhatisara jAnakArI aura tAlIma honA Avazyaka hai / * nidAna : Age batAe gayeM lakSaNoM ke uparAMta marIja kA hoza, yAdadAsta, grahaNazakti aura bhASAkIya saMtulana ko jAMcate hue aneka parikSaNa (Cognitive Test) se marIja ko DimenziyA hone kI bAta kA samarthana mila sakatA hai / mini menTala sTeTasa ekjAminezana, varDa lisTa memarI TesTa, varDa rikaoNla TesTa jaise nyUrosAIkolojikala mApadaMDa dvArA roga aura usakI tIvratA nApI jA sakatI hai / rakta kA TesTa, blaDazugara kA pramANa, thAIroiDa TesTa, perAthAIroiDa TesTa, yakRta tathA kiDanI ke TesTa, viTAmina bI12 tathA pholika esiDa kI mAtrA Adi parikSaNa bhI ilAja meM sahAyaka hai, jo isa roga ke marIjoM meM normala hone cAhie /

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118 mastiSka aura jJAnataMtu kI bImAriyA~ I.I.jI. dvArA jekaba-kruTjaphelDTa DisIja tathA phanToTemporala DimenziyA jaise roga ke nidAna meM samarthana milatA hai / sI. TI. skena, ema.Ara.AI. uparAMta ema.Ara.enjio, spekTa (SPECT), peTa (PET) jaisI nyUroImejiMga paddhatiyoM kI bhI nidAna meM kabhI jarUrata par3atI hai| * nayeM saMzodhana : Aljhaimarsa ke kAraNoM aura upacAra ke liye saMzodhana ho rahe hai| . ausatana 5% se 10% keso meM yaha roga vaMzAnugata hotA hai| marIja ke 19 ve raMgasUtra para epolAipoproTIna I-4 janIna ho to marIja ke vArisa ko AljhaImarsa hone kI saMbhAvanA adhika rahatI hai / mastiSka ke nyUronsa meM (koSikAoM meM) nyUrophIbrilarI Tengalsa bananA, koSikAoM ke bAhara bITA emAyaloiDsa nAmaka proTIna ke pleksa ikaTThA hone se mastiSka kI nAjuka koSikAoM ko hAni honA aura sUjana honA isa roga kI eka petholojikala prakriyA hai| paraMtu yaha kisa kAraNa hotA hai ? abhI taka usakA uttara nahI milA hai / saMbhAvanA hai ki APOE nAmaka proTIna aura TAU nAmaka anya jaivika rasAyana ina sabhI prakriyA ke lie jimmedAra ho sakate hai / naye saMzodhana ina sabhI ko rokane kI davAI kI khoja para kendrita hue haiM / aljhaImarsa ke marIjo meM 'DAnepejhila (Donep, Alzil, Aricep) nAmaka davA asarakAraka hai| naI upayoga hone vAlI davAI meM rivAsTigmina (Rivamer) aura usase saMbaMdhita anya davAI kA pariNAma bahuta acchA hai| yuropa meM gelenTemAina (Galamer) adhika pracalita hai / bhArata meM memenTAina (Admenta, Mentra) nAmaka davAI upalabdha hai / pahale jyAdA mAtrA meM prayoga meM lI jAtI TekrIna (kognekSa) davAI apane duSprabhAva kI vajaha se prayoga meM kama ho gaI hai / sTeTIna grupa kI davAI (Atorvastatin ityAdi) kA upayoga sAmAnyataH rakta kI carabI ghaTAne ke liye hotA hai| paraMtu ye davAI AljhAimara DimenziyA meM bhI upayogI siddha huI hai|

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10 - smRtibhraMza-matibhraMza; aura yAdadAsta bar3hAne ke upAya 119 anya naI davAI-paddhati jisameM jineTika enjiniyariMga tathA kloniMga kA upayoga kiyA jAtA hai, vaha abhI prAyogika kakSA meM hai| AljAimarsa kA veksina bhI taiyAra kiyA gayA hai / hamAre deza meM ina sabhI maha~gI davAI ke sAtha pirAsiTAma ( normAbreIna, nUropIla) jinkago bilobA tathA aragaTa grupa kI davAI pracalita hai| (2) Frontotemporal Dementia : vismRti ke rogoM meM AljhAImara ke roga ke bAda yaha eka mahatvapUrNa roga hai / isameM phanTala laoNba aura Tembaporala laoNba ke koSoM kA kramazaH nAza hotA hai / jisake lakSaNoM ko do samUhoM meM vargIkRta kiyA jA sakatA hai| vyavahAra ke lakSaNa yA vyaktittva meM badalAva / aura Executive (netRtva) function ke saMbaMdhita samasyAoM ke lakSaNa / vyavahAra ke lakSaNoM meM sustI, anucita vartAva karanA yA udAsina rahanA, apane ApakI dekhabhAla na karanA vagairaha zAmila hai / dardI jaTila kauzala (Complex Executive Task) pradarzana karane meM asamartha hotA hai / yaha roga meM marIja kI bhASA bhI prabhAvita hotI hai / kaI marIjoM kI bhASA kA dhArApravAha sAmAnya hotA hai para vaha kisI cIja kA nAma aura zabda samajhane meM kaThinAI mahasUsa karate hai| jabaki kaI marIjoM kI bhASAmeM vAkyAtmaka truTi hotI hai / / aljhAImara ke roga jaise hI laganevAle yaha roga meM mukhyataH nimna pharka hai| AdamI kI netRtva zakti, nirNaya zakti aura vizeSa buddhimatA ko pahale asara hotI hai / usake vyaktitva aura vartana meM kAphI badalAva A jAtA hai / jaise ki pahale kA AdamI hI na ho / AljhAImara roga se aura eka alaga bAta yaha hai, ki isa roga meM yAdadAsta ke saMgraha (Memory Storage) aura rAste kI parakha kAphI dera taka ThIka rahatI hai / isa roga ke tIna prakAra hai /

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120 mastiSka aura jJAnataMtu kI bImAriyA~ (1) Frontal variant (2) Primary progressive aphasia (3) Semantic dementia yaha roga ke cihna samUha ke sAtha ema. Ara. AI. nAmakI jA~ca dvArA yaha roga kA nidAna ho sakatA hai / jisameM phanTala laoNba aura / yA Temporala laoNba kA saMkucana ( Atrophy) dekhA jAtA hai / yaha saMkucana kI mAtrA dardI ke roga kI gaMbhIratA anusAra hotI hai / paraMtu kaI marIjo meM roga ke zurU ke samaya para ema. Ara. AI. normala bhI laga sakatA hai / yaha roga meM janina kI khAmI bhI dekhI gaI hai, jisameM MAPT janina meM myUTezana yA progrenyUlina meM myuTezana 17 naMbara ke raMgasUtra meM dekhI gaI hai / yaha roga kA koI Thosa upacAra nahIM hai / (3) vAskyulara DimenziyA - malTi inphArkaTa DimenziyA (MID ) : mastiSka ke choTe choTe hisso meM rakta kA paribhramaNa ghaTane se ina bhAgoM kI koSikAaiM naSTa ho jAne para yaha sthiti utpanna hotI hai / rakta kA dabAva bar3hane se, choTI choTI raktavAhinIyoM ke TUTane se aura rakta ke choTe gaThThe dvArA choTI raktavAhinIyoM meM avarodha paidA hone se mastiSka ke kaI bhAgoM meM rakta kA paribhramaNa kama yA baMdha ho jAtA hai / aneka jagaha aisI kSati honese MID hotA hai / ucca raktacApa (High B. P . ) ke kAraNa dhamanI kSatigrasta ho ke moTI (Thick) hotI hai / usase khUna kA paribhramaNa kama hone se bhI ye roga ho sakatA hai (Deep white matter changes ) I yaha roga kI zuruAta acAnaka ho sakatI hai / yA usameM uttarottara (Stepwise) bar3hata ho sakatI hai / AraMbha meM adhikatara logoM kI yAdadAsta (mukhyataH najadIka ke bhUtakAla kI bAteM) kama ho jAtI hai I roga ke lakSaNoM meM aura marIja kI mAnasika sthiti meM caDhAva - utAra hotA rahatA hai / isa prakAra ke marIja meM sajAgatA, AljAimarsa DimenziyA ke marIjoM se adhika hotI hai / marIjoM kA asala vyaktitva bhI kama

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10 - smRtibhraMza-matibhraMza; aura yAdadAsta bar3hAne ke upAya 121 yA adhika mAtrA meM banA rahatA hai, paraMtu roga Age bar3hane se marIja kI hAlata adhika kharAba ho jAtI hai| sAtha meM pakSAghAta kA asara bhI ho sakatA hai, paraMtu kisa nalikA para asara hai usa para vaha AdhArita hai / marIja ke uparokta lakSaNoM ke uparAMta sI. TI. skaina, ema.Ara.AI., ema.Ara. enjiyo dvArA nidAna bahuta nizcita rUpa se ho sakatA hai / isa taraha AljAimarsa kI tulanA meM nidAna ati sahaja haiM / rakta meM carabI kA pramANa, gale kI nasoM kA keroTiDa Doplara, hRdaya kA dviparimANIya iko (TU-DI iko) ityAdi TesTa nidAna meM vizeSa sahAyaka hote haiM / rakta patalA karane kI davAI ke uparAMta isa roga ko hone se rokane ke lie blaDaprezara, DAyAbiTIsa kA niyaMtraNa tathA AhAra kA niyamana aura niyamita vyAyAma ityAdi anivArya ho jAtA hai| kabhI-kabhI AljAimarsa aura vAskyulara DImenzIA sAtha bhI ho sakatA hai / * smRtibhraMza ke marIjoM kI sAravAra : isa roga ke marIjoM ke liye sarala ho aura vaha jitanA bhI svAvalaMbI raha sake isa prakAra kI dinacaryA kA Ayojana karanA cAhie / sAtha hI marIja kI surakSA ke lie bhI Thosa kadama uThAne caahie| snAnAdi aura kapar3e pahanane, bhojana karane, jaise nityakramo meM marIja kI avasthA anusAra yogya madada karanI paDatI hai| yAdadAsta meM madada kara sake aisI bAtoM ko DhUMDhakara marIja ko samasyA meM se nikAla sakate hai, jaise kI likhane ke lie DAyarI denA / marIja ke sAtha bAtacIta kA vyavahAra rakhanA atyaMta jarUrI hai, jisase marIja kI saMvedanAyeM banI raheM /

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122 mastiSka aura jJAnataMtu kI bImAriyA~ ghumane-phirane aura ArAma ke lie marIja ko kisI prakAra kA baMdhana mahesUsa na ho, isa prakAra kA nityakrama Ayojita kara denA cAhie / isake uparAMta naI davAI jaise ki rivAsTigmina, gelenTAmAIna aura Donepez2ila upayoga meM lAI jA sakatI hai / usake uparAMta enTipleTaleTa prakAra kI davAI marIja ke roga ke kAraNa anusAra denI cAhie / vaMzAnugata tarIke meM honevAlA AljAimara yA anya DimenziyA meM unake najadIka ke sagesaMbaMdhI (putra, putrI, bhAI-bahana Adi), arthAt svastha vArisa kI pahale se hI isa roga ke saMdarbha meM jA~ca karanA kitanA ucita yA vyavahArika hai, yaha eka gUDha prazna hai / __paraMtu kaI dezo meM aisI suvidhAe~ upalabdha hai ki janIna kI jA~ca (vaMzAnugata lakSaNoM kI jA~ca) dvArA yaha roga isa vyakti ko bhaviSya meM vaMzAnugata hogA yA nahIM vaha pramANa meM nizcita hI jAnA jA sakatA hai| adhikatara DimenziyA jaise lakSaNa mAnasika tanAva kI sthiti meM bhI hote hai, jisameM mukhyataH Diprezana yA sTresa hI kAraNa banate hai use syUDoDimenziyA kahate haiM / yogya nyUrolojikala jA~ca se hI vaha jAnA jA sakatA hai / usakI cikitsA pramANa meM sarala haiM / yaha roga niyaMtrita kiyA jA sakatA hai, aura usakI asara la~be samaya taka rahatI nahIM hai aura bar3hatI bhI nahIM hai| kaI meDikala rogo meM bhI kama yA adhika mAtrA meM yAdadAsta, vyavahAra, vyaktitva ityAdi para asara ho sakatA hai, taba kaI bAra bhUla se AljAImara kA nidAna hote hue dekhA gayA hai / jaise ki, thAIroiDa kA kArya kama honA (hAIpothAIroiDa), viTAmina B12 kI kamI, kucha kolejana Disija jaise ki, esa.ela.I. ityAdi /

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123 10 - smRtibhraMza-matibhraMza; aura yAdadAsta bar3hAne ke upAya davAI marIja ke roga ke anusAra yogya davAI dI jA sakatI hai, jaise ki(1) enTipleTaleTa : vAskyulara DimenziyA meM (2) naI viziSTa davAI jaise ki rivAsTigmina, Donapejila, gelAmara, memenTIna ityAdi AljaImara DimenziyA meM dI jA sakatI hai| (3) aragoTa samUha kI davAI jaise ki samiana, hAiDarajina, sereloiDa (4) pirAsiTAma jaise ki normAbreina, nyUTropila, seresiTAma athavA ensephebola dvaaii| smRtibhraMza kI rokathAma aura mastiSka kI kAryakSamatA : aisA mAnA jAtA hai ki prauDha manuSya kI mastiSka kI koSikAeM kSiNa-naSTa hotI jAtI hai aura yAdadAsta aura mastiSka zakti kama ho jAtI hai, lekina yaha saMpUrNataH satya nahIM hai / saMzodhana dvArA abhI aisA jAnA gayA hai ki agara yogya vAtAvaraNa diyA jAe to vRddha vyaktiyoM ke mastiSka meM bhI naye cetAkoSa aura kozikAe vikasita ho sakatI hai| yAdadAsta aMta samaya taka acchI rakhI jA sakatI hai| mastiSka ko kAryazIla karane ke lie rakta saMcAra jarUrI hai, isalie zurUAta subaha se hI karo, thoDA sA jogiMga karo, jisase zarIra meM rakta pravAha baDhatA hai / pariNAmasvarUpa mastiSka ko rakta aura oksijana kI ApUrti adhika milegI aura cetAtaMtra jAgrata hogA / vyAyAma ke pazcAt nAstA lene meM dhyAna rakho / carabIyukta padArthoM ke bajAya kArbohAIDreTayukta (glukoz2a AdhArita) padArtha adhika pasaMda karo / ophisa yA kAmakAja ke sthAna para eka se Der3ha ghaMTe kAma karane ke bAda kucha kSaNoM ke liye vizrAma karo, thor3A Tahelo / niraMtara eka hI prakAra kA kAma karate mastiSka ko dUsarA kAma do, jo mastiSka ko adhika saceta rakhatA hai|

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124 mastiSka aura jJAnataMtu kI bImAriyA~ dopahara ke bhojana meM bhI kArbohAIDreTa bharapUra leM, carbI aura proTInayukta AhAra pramANasara leM / AhAra lene ke bAda mastiSka ko rakta kama pahu~catA hai, jisase nIMda sAmAnyataH Ane lagatI hai, isa kAraNa jitanA Avazyaka ho utanA hI AhAra leM / samaya milate halakA vyAyAma kara leM / zarIra AlasI ho to sthUla ho jAtA hai / isa prakAra mastiSka meM bhI aisA hai / kelakyuleTara aura kaoNmpyuTara ke yuga meM mastiSka ko bahuta adhika mahenata nahIM karanI par3atI hai| isalie memarI gema yA zabdavyUha racanA jaise mastiSka ki kasauTI kareM aise (nyUrobiksa) khela khelane kI Adata ddaalo| yAdadAsta kA upayoga na ho to vaha kama hotI jAtI hai, isaliye yAdadAsta kA niyamita upayoga kreN| udA. kharIdadArI karate samaya lisTa banAnA chor3a do, TelIphona naMbara yAda rakho aura mitroM-saMbaMdhiyoM kI janmatArIkha yAda rakhane kI Adata DAlo / yaha hakIkata hai ki yAdadAsta bar3hAne ke lie koI aksIra ilAja nahIM hai| mastiSka aura zarIra ke vyAyAma karane se mastiSka kI zakti bar3hatI hai| zAma ke khAne meM bhI carbIyukta padArtha kama lenA cAhie / zarIra ko kelziyama yogya mAtrA meM mile aisA Ayojana karo / dUdha-kelA aura DrAyaphUTsa mukhyataH leM / mastiSka ko vyAyAma kI jitanI jarUrata hai utanA hI ArAma bhI jarUrI hai| pUrNataH nIMda milanA atyaMta Avazyaka hai| nIMda ke daurAna bhI mastiSka sakriya hotA hai| pUre dina ke anubhavoM meM se guDanAiTa - zubharAtrI ke lie kAraNa khoja ke, pojiTiva (sakArAtmaka) vicAra ke sAtha caina se so jAnA cAhie / aisA karanA kaThina nahIM hai| isake uparAMta yoga aura dhyAna se mastiSka kI kAryakSamatA bar3hatI hai| yaha eka vaijJAnika satya hai| mastiSka kI kAryadakSatA bar3hAne ke lie itanA avazya kareM __ tanAva ko niyaMtrita kareM, tanAva se cetAkoSoM meM hAnikAraka rasAyana paidA hote hai / isa kAraNa mastiSka ke prati nAjUka vyavahAra rakheM /

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10- smRtibhraMza - matibhraMza; aura yAdadAsta bar3hAne ke upAya dhyAna aura yoga se mastiSka kI kAryadakSatA avazya bar3hatI hai / isaliye yaha Avazyaka hai / ucita samaya nIMda leM, kama nidrA se mastiSka kI kAryazakti aura yAdadAsta kama hotI hai / tambAku, zarAba aura davAI kI Adata mata DAlo, mastiSka ke lie hAnikAraka hai / 125 mitra banAeM, sAmAjika saMbaMdha rakheM / hakArAtmaka abhigama ( pojiTiva thiMkiMga ) rakheM / niyamita zArIrika aura mAnasika vyAyAma kareM / viTAmina aura khanijatatvoM se bharapUra samatola AhAra leM / adhika carbIyukta AhAra kama kareM / vidyArthiyoM ke lie yAdadAsta meM vRddhi lAne kI sarala paddhati : abhyAsa karate samaya apanI jarUrI pAThyapustaka, pena, noTa, anya sAhitya sAtha hI rakheM, jisase bAra-bAra uThanA na par3e / saMbhava ho to par3hane kA sthAna eka hI jagaha rakhanA cAhie / par3hane kA kamarA zuddha havAyukta aura zAMtipUrNa ho yaha jarUrI hai / yaha dhyAna denA cAhie ki vahA~ TI.vI. aura TeparekorDara ityAdi sAmagrI na ho / abhyAsa ke daurAna ekAgratA toDanevAle TelIphona ityAdi se bhI ho sake utanA dUra rahanA cAhie / nazA kabhI bhI sote sote yA ayogya aMgamudrA meM par3hanA nahIM cAhie / palathI mAra ke baiThe yA Tebala kursI kA upayoga kareM / 1

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126 mastiSka aura jJAnataMtu kI bImAriyA~ niyamita abhyAsa ke lie samayatAlikA banAnI cAhie, jise Tebala yA dIvAra para rakheM / abhyAsa samaya meM Apako koI bAdhA na pahu~cAe isa kAraNa mAtApitA aura mitroM ko isakI jAnakArI deN| abhyAsa zurU karane se pahale aura abhyAsa karane ke bAda eka miniTa A~khe baMda rakhakara dhIre dhIre gaharI zvAsa leM / mukhyataH kaThina viSaya ke abhyAsa ke bAda pAMca minaTa ke lie gaharI zvAsa leM / isase mana kI ekAgratA bddh'egii| dilase, utsAhapUrvaka paDhAI kareM, rIbojomala memarI ke siddhAMta anusAra nimna sUcanoM se lAbha hotA hai : dhyAnapUrvaka pratyeka peregrApha par3heM aura usameM likhe hue muddoM ko ThIka taraha yAda rakheM / usI prakAra dUsarA peregrApha par3heM / aura thoDI dera par3hane ke bAda pAThyapustaka eka tarapha rakhakara par3heM hue pATha ko yAda kareM / mukhya muddoM ko yAda karake use likheM tathA anya logoM ke sAtha par3he hue muddoM kI carcA kareM aura usake pazcAt par3he hue muddoM kI yAda kie hue muddoM ke sAtha tulanA kreN| pratyeka naye prakaraNa-pATha ko par3hane se pahale 2 se 5 minaTa pIche par3he hue prakaraNa ko sarasarI nigAha se yAda kara leM / 24 ghaMToM ke bAda, 7, 15 aura 30 dinoM ke bAda par3he hue viSayoM ke 2 se 15 minaTa ke lie kevala mukhya mudde yAda kareM to kisI bhI kamajora vidyArthI ko bhI yaha sahI DhaMga se laMbe samaya taka yAda rahatA hai - isameM koI AzaMkA nahIM hai|

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10 smRtibhraMza matibhraMza; aura yAdadAsta bar3hAne ke upAya 127 jahA~ saMbhAvanA ho aura AvazyakatA ho (udA. kisI eka prazna ke aneka kAraNoM yA mucheM yAda rakhane ho) to nemoniksa yA saMkSiptIkaraNa kA prayoga kiyA jA sakatA hai e.g. ABCD | kaI loga citra se (grAphika memarI) yA saMgItamaya tarIke (melor3I se) se bhI yAda rakhate haiM / yaha aura aise prayoga lambe lisTa kI jagaha svayaM hI apanAne cAhie / pAThyapustaka meM mahatva ke vidhAnoM ko rekhAMkita kareM, jisase binajarUrI par3hane meM yAda rakhane meM samaya vyartha nahIM hotA aura Avazyaka jAnakArI yAda raha jAtI hai / - kucha samaya taka par3hane ke bAda A~kho ko paTapaTAe~, isase AMkho kI thakAvaTa utara jAtI hai| AMkho ko baMda kara ke hAtha kI hathelI se halke se dabAo, hathelI kI uSmA aura zakti AMkha ko tAjagI pradAna karatI hai / thaka jAne taka eka hI sthiti meM raha kara na pddh'e| saMbhAvanA ho to kamare meM eka-do bAra ghUmakara, gahare zvAsa lekara, prANAyAma karake Avazyaka sphUrti mila sakatI hai / parIkSAkhaMDa meM kaThina prazna ho taba AMkhe baMda rakhakara par3hI huI jAnakArI yAda kareM, isase zIghra hI smaraNazakti jAgrata hogI / Age samajhAyA gayA hai ki yAdadAsta bar3hAne ke lie koI nizcita aksIra ilAja nahIM hai, lekina uparokta upAyoM ke anusAra paThana yA abhyAsa kiyA jAe to sirpha chAtroM ko hI nahIM, lekina pratyeka vyakti ko nizcita hI lAbha hogA /

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128 mastiSka aura jJAnataMtu kI bImAriyA~ sukhiyA~ * smRtibhraMza roga meM vyakti kI yAdadAsta, soca-zakti aura bhASA tathA vyavahAra meM kamI AtI hai| * smRtibhraMza ke kAraNa aneka hai, kintu AljAimarsa aura vAskyulara DimensiyA jyAdAtara (80%) marIjo meM pAyA jAtA hai| * AljAimarsa DimenziyA meM bhASA takalIpha, yAdadAsta kI kamI, Diprezana, pratidina ke vyavahAra karane meM asamarthatA se bar3hakara aMta meM marIz2a saMpUrNataH parAvalaMbI bana jAtA hai| * isa roga kI nizcita davAIyoM kA saMzodhana nahi huA hai, kintu roga ke lakSaNoM kI tIvratA ghaTAnevAlI davAIyA~ upalabdha hai| mastiSka kI kAryakSamatA baDhAne ke lie tanAva ko niyaMtrita karanA, dhyAna aura yoga karanA, pUrI nIMda lenA, nazIle padArthoM kA sevana baMda karanA, zArIrika aura mAnasika vyAyAma karanA, samatola AhAra lenA aura pojhiTiva thiMkiMga karanA atyaMta jarUrI hai /

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nidrA-vikAra aura upacAra (Sleep Disorders) nidrA yAne caina kI niMda pratyeka prANI ke lie khAna-pAna, prajotpatti jaisI hI eka mUlataH prAkRtika aura prAthamika AvazyakatA hai / hama apane jIvana kA ausatana eka tihAI bhAga nIMda meM gujAra dete hai / nidrA se, thake hue hamAre zarIra ko ArAma milatA hai, zakti aura utsAha kA saMcAra hotA hai, tana-mana phira se tarotAjA aura sphUrtile ho jAte hai / zarIra ke jo koSa ko ghisAva ho usakI marammata hotI hai, smRti draDha hotI hai, aura hamArI zArIrika svasthatA banI rahatI hai / isa prakAra nidrA hamAre lie kudarata kI ora se milI huI amUlya bakSisa bhI kahI jA sakatI hai| (svapna, nidrA kI eka gUDha sthiti hai jise adhikRta tarIke se pahacAnA nahi jAne ke kAraNa abhI taka pUrNataH samajhA nahIM gayA hai|) vaise to nidrA, sabhAnatA aura bebhAna avasthA donoM se hI alaga hai / lekina prayogoM, leboreTarI TesTa aura nidrA saMdarbha ke abhyAsoM se yaha jAnA gayA hai ki nidrA sabhAnAvasthA kA hI anya rUpa hai| hamAre jIvana meM nidrA kA sthAna atyaMta mahattvapUrNa hai, phira bhI usakI adhikAMza upekSA huI hai| nidrA ke vikAra-rogoM kA yogya nidAna na hone se aise marIja kA saMpUrNa upacAra bhI jyAdAtara yogya tarIke se nahIM hotA hai / isase janasamudAya kI kAryakSamatA tathA svasthatA meM ullekhanIya kamI huI hai| acchI nIMda hameM rogo se dUra rakhatI hai, nAdurasta tabiyata ke samaya ArAma pradAna karatI hai, tanAva ke samaya meM bhAvanAzIla rAhata detI hai / nidrA vikAra ke kAraNa, dina ke daurAna taMdrAvasthA rahane se adhikatara sar3aka durghaTanA bhI hotI hai, yaha saba jAnate hai / yadi marIja kI nidrA saMbaMdhita takalIphoM ke varNana ko adhika dhyAna se samajA jAye to usake adhikAMza vikAroM ko samajhA jA sakatA hai aura usakA yogya upacAra bhI kiyA jA sakatA hai| jaba marIja ko nidrA

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130 mastiSka aura jJAnataMtu kI bImAriyA~ daurAna, zvAsa meM avarodha hotA ho yA nIMda meM mirgI AtI ho taba hI leboreTarI meM adhika ekAgratApUrvaka jA~ca kI jarUrata par3atI hai| isa prakaraNa meM nidrA aura saMlagna vikAroM kI saMkSipta jAnakArI dene kA prayatna kiyA hai| nidrA kI saMracanA aura avasthA (Organisation and Stages of Sleep :) nidrA manuSya kI 24 ghaMTe kI jaivika ghar3I (Circadian) kI mUlabhUta prakriyA hai / eka dina meM navajAta zizu ko 16 se 20 ghaMTe, bAlaka ko 10 se 12 ghaMTe, dasa varSa ke bAlaka ko 9 se 10 ghaMTe, vayaska vyakti ko 7 se 7.5 ghaMTe aura prauDha vyakti ko 6.5 ghaMTe kI nIMda Avazyaka hotI hai / NREM Sleep aura REM Sleep nidrA kI do mukhya avasthA hai / sAmAnyataH vyakti jaba nidrAdhIna hotA hai taba 3710 of rafa fa-(Rapid Eye Movement - REM) 3701 FETT meM jAne se pahale, AMkha ke tvarita nahIM aisI (Non-Rapid Eye Movement-NREM) nidrA kI kama se kama eka avasthA se pasAra hotA hai / NREM Sleep kI 4 avasthA hotI hai / REM tathA NREM avasthA kA cakra samagra nidrA ke samaya meM 4 se 6 bAra ghuma ghuma kara utane hI samaya ke lie hotA hai / NREM avasthA meM AMkhe paTapaTAtI hai| AMkha kI palakeM AdhI girI huI hotI hai aura usakI putalI choTI ho jAtI hai / usake viruddha REM avasthA meM AMkha ke snAyuoM ke alAvA zarIra ke snAyu zithila ho jAte hai / paraMtu AMkha kI goTI zIghratApUrvaka gatizIla rahatI hai / zvAsa aniyamita hotA hai / nidrA kA jaivika-rAsAyanika pRthakkaraNa : kucha prayogoM meM jAnA gayA hai ki nidrA lAne meM sIroTInIna nAmaka tattva kAma karatA hai, jaba ki keTekolAmAIna nAmaka tattva jAgrata avasthA ke lie nimitta hai| REM avasthA kI nidrA ke lie kolInarjIka nyUroTrAnsamizana mahattvapUrNa hai, isI avasthA meM smRti draDha hotI hai| isake uparAMta prosTAglenDIna-DI-2, melATonIna Adi nidrAprada uddIpaka mAne jAte hai / ina uddIpakoM kI asara sAmAnyataH nidrA kI NREM

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11 - nidrA-vikAra aura upacAra (Sleep Disorders) 131 avasthA taka maryAdita rahatI hai / kucha nidrAprada-uddIpaka rogapratikAraka bhI hote hai| unake rogapratikAraka kArya aura nidrA-jAgrata avasthA ke bIca saMbaMdha pAyA gayA hai| rAta ko pInIyala graMthi meM se melATonIna nAmaka tatva kA srAva hotA hai / melATonIna ke srAva kA AdhAra nidrA ke sAtha nahIM hotA kyoM ki rAta ko jAgrata vyakti meM bhI usakA srAva hotA hai / prakAza meM reTinA kI uttejanA ke daurAna vaha kama hotA hai| (melATonIna kI vRddhi nidrA bar3hAtI hai / ) hAyapokreTIna tattva jAgRka avasthA ke lie mahattvapUrNa hai| usakI kamI se nArkolepsI aura dina meM jyAdA nidrA kI bimArI hotI hai / Fra facare ( Sleep Disorders ) : (1) ayogya nidrA-(Dyssomnias): anidrA, atinidrA ityAdi (2) vikSipta nidrAvasthA yA vikRta nidrA kI paristhiti (Parasomnias) (3) daihika / mAnasika rogoM ke kAraNa hone vAle nidrA ke vikAra (4) anya vikAra (1) anidrA (Insomnia) : anidrA zabda hI pUrNa suvidhA hone para bhI gaharI nidrA na Ane kI sthiti nirdezita karatA hai| isa taraha kI anidrA meM nIMda na AnA, nIMda kI avadhi ke pahale jAga jAnA, bAra-bAra jAganA yA paryApta aura gaharI nIMda na Ae athavA to ina tInoM prakAra kI paristhiti kA samAveza hotA hai / 15-25 pratizata vayaska vyaktioM meM yaha takalIpha hotI hai / Azcarya aura duHkha kI bAta hai ki jyAdAtara loga isa ke upacAra ke lie sajAga nahIM hai| isa anidrA ko nIce batAye anusAra tIna bhAgoM meM vibhAjita kara sakate hai : (1) mUlataH anidrA honA, jisameM Diprezana, nyUrosisa, mAnasika kAraNoM yA koI bImArI na ho phira bhI adhika samaya taka nIMda na aanaa|

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132 mastiSka aura jJAnataMtu kI bImAriyA~ (2) khAdya padArtha kI elarjI, sthala kI u~cAI, vAtAvaraNa kI pherabadala yA nIMda kI zurUAta na honI jaise bAhya kAraNoM se anidrA honaa| (3) zIphTa meM kAma karanA, TAImajhona meM badalAva yA sone jAgane kI aniyamita paddhati ke kAraNa anidrA honA / anidrA ke duSprabhAva : agara anidrA kA upadrava laMbe samaya taka cale to naye saMzodhana ke mutAbika marIja ko zArIrika aura mAnasika bahuta nukasAna ho sakatA hai| jaise ki aticiMtA, nirasatA (Diprezana), DAyAbiTisa, sthUlatA, blaDa prezara, hRdaya roga honA, mirgI ke daure zurU honA yA bar3hanA, AtmahatyA kI icchA honA yA nazIlI davAI kI Adata par3a jAnA / isalie anidrA kA suAyojita upacAra bahuta jarUrI hai / anidrA kA upacAra : sAmAnyataH bImArI yA anya asAmAnya saMyogo meM alpa samaya ke liye mukhya davA ke sAtha upazAmaka yA nidrAprada davAI upacAra ke liye dI jAtI hai| jina marIjoM ko nidrA na AtI ho yA nidrA meM bAdhA pahu~catI ho, to unheM zIghratA se asara kare aisI nidrA kI davAI upayogI sAbita hotI hai (jholpIr3ema, phlUrAjepAma, TrAyoz2elAma) / jo marIja lambe samaya se anidrA kA zikAra ho unheM lambe samaya taka nidrAprada upazAmaka davAI nahIM denI caahie| paraMtu anidrA kA kAraNa DhUMDha lenA cAhie / isa prakAra ke marIjoM ko sone ke samaya ke sAtha dinacaryA kA bhI suAyojana karanA cAhie, dina meM zArIrika rUpa se sakriya rahanA aura sone se tIna ghaNToM pahale kucha halakA sA vyAyAma zrama karane ke liye protsAhita karanA caahie| tanAva se mukta rahanA cAhie /

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11 - nidrA-vikAra aura upacAra (Sleep Disorders) 133 anidrA ke upacAra ke lie nidrA ghaTAyeM aise kAraNoM meM badalAva lAnA cAhie, jaise ki : kephInayukta peya, sTIroiDa tathA mastiSka ko uttejita karane vAlI davAI kA upayoga nahIM karanA cAhie / tambAku aura bIr3I-sigareTa kA sevana bhI anidrA kA kAraNa bana sakatA hai| gaMbhIra zArIrika bImArI, jaise ki hRdaya roga, pakSAghAta, kensara Adi ho jAegA, aisI aprastuta ciMtA aura bhaya ko dUra karanA caahie| kabhIkabhI anidrA ke upacAra karane ke bAda jaba davAI baMda karate hai taba anidrA kI bImArI pahale se bhI adhika na bigaDe isa bAta kA dhyAna rakhanA caahie| (2) asthira paira aura paira kA bArabAra halanacalana (restless legs syndrome and periodic leg movement ) : asthira (Restless) paira ke lakSaNa jaise dikhane vAle vikAra hamezAM samayasara kI nidrA meM vikSepa karate hai / isa prakAra ke lakSaNoM meM ghuTanoM para calane se honevAlA darda jaisA hI darda paira ke pichale hisse aura piMDI meM hone kI zikAyata marIja karatA hai / ina lakSaNoM meM pairoM kI thor3I sI halacala thor3e samaya rAhata bhI detI hai / aise to yaha lakSaNa kudaratI hai paraMtu kabhIkabhI vaha perIpherala nyUropathI (nyUrAiTisa) kA saMketa karate hai| isake jaisA hI anya vikAra anidrA meM bArabAra paira kI asthira halacala se hotA hai, jisake lie dina kI adhika nIMda bhI kAraNabhUta hai / lohatattva kI kamI (enimiyA) se pIDita marIjoM meM yaha bImArI adhikatara dekhI jAtI hai|

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134 mastiSka aura jJAnataMtu kI bImAriyA~ upacAra : DopAminarjika davAIyA~, oksikoDona, gAbApenTina, lohatattva kI kamI kA upacAra (3) nidrA meM zvAsa ruka jAnA : (Sleep-Apnea Syndrome) usake mukhyataH do prakAra hai / (a) Obstructive sleep Apnea : nIMda meM jora se kharrATe bolanA, nIMda meM zvAsa ruka jAnA aura dina meM jyAdA niMda AnA Isake mukhya lakSaNa hai| jaisA ki Age batAyA gayA hai, nidrA kI REM avasthA meM zvAsa aniyamita rahatA hai / kabhIkabhI to zvAsa 10 sekanDa taka rUkA huA lagatA hai / nidrA kI prAraMbhika avasthA meM zvAsa kA, isa prakAra kA avarodha koI bImArI nahIM hai, paraMtu kitane hI vyaktiyoM meM yaha zvAsAvarodha bArabAra hotA hai aura vaha 10 seMkanDa se bhI adhika samaya taka calatA hai / zvAsocchvAsa meM rUkAvaTa, yA to zvAsocchvAsa baMda ho jAne ke kAraNa zvAsAvarodha hotA hai| uparI zvasana mArga (Pharyngeal airway) choTA yA dabA huA ho, to ye roga ho sakatA hai / sone ke bAda zvAsAvarodha hotA hai aura rakta meM prANavAyu kama ho jAtA hai tathA kArbanaDAyoksAIDa bar3ha jAtA hai / isa kAraNa nidrA se bhI acAnaka uTha jAnA paDatA hai aura phira zvAsocchvAsa sarala hone se phira nidrA AtI hai / aisA kaI bAra hone se gaharI nidrA meM vikSepa paDatA hai, isa kAraNa marIja dina meM adhika nidrAdhIna rahatA hai / anidrA adhika samaya taka rahe to mastiSka kI kArya kSamatA meM vikSepa pahU~catA hai, jisase buddhi, vyaktitva aura vyavahAra meM badalAva ho sakatA hai / kvacita hRdaya baMdha ho jAtA hai / samaja meM na Ae aisI mRtyu nidrA meM ho sakatI hai yA blaDaprezara bhI ho sakatA

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___ 11 - nidA-vikAra aura upacAra (Sleep Disorders) 135 hai| moTe zarIravAle vyaktiyoM meM yaha lakSaNa pIkavIkIana (Pickwickian syndrome) sinDroma ke nAma se jAnA jAtA hai| prauDha, puruSo meM yaha roga jyAdA hotA hai / sthUla zarIravAle vyaktiko niMda meM jora se kharrATe Ate ho to yaha roga ke bAre meM socanA cAhie / isa roga ke nidAna meM polIsomnogrAphI TesTa mukhya hai / upacAra : * zarAba jaise nazeyukta pravAhI se nazA karanA chor3a dene se zvasanamArga sarala banatA hai / vaz2ana kama karanA caahie| citta (supine) sone kI Adata choDa denI cAhie aura muMha meM jIbha aMdara na calI jAe Isaliye yogya sAdhana kA upayoga Adi se zvAsa lene meM saralatA rahatI hai aura nAka se zvAsa lene kI Adata DAlanI caahie| dAyeM yA bAyeM karavaTa badala ke sone se rAhata mila sakatI hai| kaI bAra sarjarI dvArA bhI zvAsAvarodha ghaTAyA jA sakatA hai| kaI bAra zvAsocchvAsa kI mazIna (CPAP) tathA zvAsanalI meM chidra kI bhI jarUrata par3atI hai / moDAphInIla jaisI davAI se dina kI jyAdA nIMda kama ho jAtI hai| (b) Central Sleep Apnea kAraNa : ajJAta kAraNoM se / mastiSka kI bImArI (Brain stem dysfunction) / STT TEATA 37f-12FFISTOIT (Cheyne-Stokes Breathing) / oksijana kI kamI (U~cAI para, phephar3e kI bImArI) / hRdaya aura phephar3e se saMbaMdhita bImArI /

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136 mastiSka aura jJAnataMtu kI bImAriyA~ upacAra : kAraNa anusAra upacAra hotA hai / davAIyA~; zvAsocchvAsa kI mazIna BiPAP yA CPAP kA upayoga bhI karanA cAhie / (4) atinidrA : dina kI nidrA sahita ati (jarurata se jyAdA) nidrA honA, jisake kAraNa nimnalikhita hai / (1) nidrAprada davAI, cakkara kI davAI, DIprezana kI davAI yA niyamita nazIle padArtho ke sevana se / (2) gaMbhIra bImArI / (3) oparezana ke bAda enesthesiyA kI asara / (4) DIprezana - hatAzA / (5) cayApacaya kI takalIpha, thAIroiDa, eDisana DisIja / (6) mastiSka kA saMkramita bukhAra, vAyarasa, kSAra tattva kI kmii| (7) taMdrAvasthA / (8) dina kI atinidrA (Narcolepsy) aniyaMtrita nidrA (Narcolepsy) : grIka zabda Narken arthAt jhapakI AnA, Leptos arthAt kabje meM lenA, isake uparase aniyaMtrita nidrA (Narcolepsy) nAma diyA gayA hai| jisake mukhya cAra lakSaNa - dinameM jyAdA sonA, keTApleksI, niMdameM kSaNika pakSAghAta honA aura vicitra svapna AnA hai / isake alAvA rAta kI nidrA kharAba honA aura anaicchika vyavahAra karanA bhI mahatvapUrNa lakSaNa hai| kAphI marIjoM meM yaha roga vaMzAnugata hotA hai aura jiMdagIbhara rahatA hai|

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137 11 - nidrA-vikAra aura upacAra (Sleep Disorders) (i) dinameM atinidrA : * 15 se 35 varSa kI umra meM atinidrA kA vikAra zurU hotA yaha roga mukhyataH hAyapokre Tina nAmaka tattva kI khAmI se hotA hai| nidrA kA samaya 15 miniTa se adhika nahi hotA aura AvAja dene se yA sparza karane se marIja jAga jAtA hai / * dina meM aisA kaI bAra hotA hai / (ii) keTApleksI (Cataplexy) : kucha seMkanDa ke lie bhAvukatA se yA bhArI zrama karane se yA kabhI binA kAraNa sabhAna avasthA hone ke bAvajUda snAyuoM kA zithila honaa| gira jAnA / kaI bAra aisI paristhiti ghaMTo taka rahatI hai| kaI bAra snAyu AMzika zithila ho jAte hai udA. jabar3e kA laTaka jaanaa| (iii) nidrA Ane yA jAga jAne para vicitra bhrama honA / (iv) kucha marIjoM ko nidrA meM alpajIvI pakSAghAta bhI ho sakatA hai| polIsomnogrAphI-malTIpala slIpa leTansI TesTa dvArA yogya nidAna ho sakatA hai| upacAra : (1) 15 se 20 miniTa ke lie dina meM 2 se 3 bAra niyata samaya para so jaae| (2) mastiSka ko uttejita karane vAlI davAI - mithAIla phenIDeTa, empheTemAIna, moDAphonIla jaisI davAI kA yogya prayoga (3) TrAisAyaklIka enTiDIpresanTa davAIyA~, esa.esa.Ara.AI. aura esa.ena.Ara.AI davAIyA~ /

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138 mastiSka aura jJAnataMtu kI bImAriyA~ (5) vikSipta nidrAvasthA ( Parasomnia) : ___ yahA~ aise kucha nidrA ke vikAra samAviSTa ho sakate hai, jisa meM sirpha nidrA meM hI asAmAnya vyavahAra yA asAmAnya tarIke se zarIra kI halacala dekhane ko milatI hai / yaha roga ke lakSaNa REM nidrAvasthA aura NREM nidrAvasthA meM alaga-alaga hote hai / (A) nidrA se uThate ( Arousal) samaya honevAle vikAra : - nidrA meM calanA / - nidrA meM Dara kA ehasAsa honA / (B) ardhanidrA daurAna ke vikAra : - nidrA meM jarka / jhaTake AnA / nidrA meM bAteM karanA, bar3abaDAnA / - hAtha paira kI zreNIbaddha halacala honA / (c) nidA kI REM avasthA se jur3I huI vikRti : - Dara lage aise svapna / -- nidrA daurAna alpajIvI pakSAghAta / (D) vikSipta nidrAvasthA ke anya vikAra : nidrA meM dAMta bhiDAnA / nidrA meM pizAba ho jAnA / kharrATe lenA / - nidrA meM bAlaka kI mRtyu honA / (SIDS) nidrA meM calanA (Sleepwalking - Somnambulism) : - baccoM meM adhikAMza dekhane ko milatA hai / marIja sote samaya baiTha jAtA hai yA palaMga ke kinAre baiTha jAtA hai yA ghara meM ghUmane lagatA hai /

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11- nidrA-vikAra aura upacAra (Sleep Disorders) 139 yaha vikAra bacapana meM paidA hotA hai aura umra bar3hane se ThIka ho jAtA hai / vayaska vyakti meM yaha vikAra asAmAnya hotA hai aura yaha koI mAnasika bimArI yA kisI davA kA duSprabhAva ho sakatA hai / kabhI nidrA meM calane ke daurAna girane se coTa laga jAne athavA mRtyu ho jAne jaisI durghaTanA bhI ho sakatI hai, athavA to marIja anajAne hI gunAhita pravRtti meM phaMsa sakatA hai / koI bhAvukatAzIla durghaTanA yA bhaya athavA hiMsaka vyavahAra ho sakatA hai / kabhI Dara lage aura hRdaya kI dhar3akana bhI bar3ha jAtI hai / upacAra meM 0.5 yA 1.00 mi.grA. klonAjhepAma dI jA sakatI hai I nidrA meM Dara laganA ( Sleep Terrors ) : bacapana meM hotA hai / nidrA kI tIsarI yA cauthI avasthA meM aisA hotA hai / baccA acAnaka cauMka kara jAga jAtA hai aura usake zvAsocchvAsa gahare aura teja ho jAte hai, sAtha meM bAlaka Dara jAtA hai / aise bacco meM nIMda meM calane ke lakSaNa bhI ho sakate hai / DAyAjhepAma tathA anya kucha davAI isa bImArI ko niyaMtrita rakhane meM sahAyaka hai / I nidrA meM jarka / jhaTake laganA ( Sleep Starts ) : nidrA AtI hai taba kaI calana biMdu uttejita ho jAte hai, jisase adhikatara jarDsa / jhaTake Ate haiM aura vyakti jAga jAtA hai /

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140 mastiSka aura jJAnataMtu kI bImAriyA~ duHsvapna/ DarAvane svapna AnA ( Nightmares) : nidrA meM REM avasthA meM hotA hai / mukhyataH jaba zarAba yA anya nidrAprada davAI baMda karane se, REM avasthA niyaMtrita kI gaI ho taba isa prakAra ke svapna Ate haiM aise svapna kisI ekAkI ghaTanA ke anurUpa bhI ho sakate hai / kAraNa : bukhAra AnA, cayApacAya ThIka taraha se na honA, DarAvanI bAteM sunanA athavA DarAvanI Telivijana siriyala yA sinemA dekhanA, bArabAra sira darda honA, ityAdi / * nidrA meM dA~ta bhiDAne ( Sleep Bruxism) : - rAta meM nidrA meM hI dAMta bhiDate haiM / - yaha apaneApa hI hotA hai / nidrA meM pezAba ho jAnA (Nocturnal Enuresis): - dina meM pezAba roka rakhane se aisA hotA hai aura vayaska avasthA meM bhI cAlU rahatA hai / baccoM meM aisA adhikatara hotA hai| saiddhAMtika draSTi se - mUtrAzaya kI zArIrika vikRti honA / sAmAnya vyakti kI tulanA meM inakI mUtrAzaya kI kAryazakti kama hotI hai| aise marIjoM meM mUtrAzaya meM hone vAlA dabAva sAmAnya se adhika hotA hai / upacAra-davAI : - rAta ko sote samaya imiprAmIna / mUtrAzaya saMbaMdhita vyAyAma karanA / gaMbhIra mAmale meM nAka meM DAlane kI davAI-DesmopresIna spre (Spray) /

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141 11 - nidrA-vikAra aura upacAra (Sleep Disorders) (6) mAnasika aura daihika paristhiti se saMbaMdhita nidrA ke vikAra : (A) mAnasika vikRti, manorogI, ciMtA, ucATa, zarAba se saMbaMdhita / (B) mastiSka kI vikRtiyA~, unmAda, pArkinsana bimArI, opilepsI, smRtibhraMza se sNbNdhit| (C) anya : anaicchika nidrA kI bImArI (Sleeping Sickness), phephar3e kI bImArI, asthamA, jaThara meM chAle par3anA, anna nalikAoM kI takalIpha ityAdi dvArA nidrA meM vikSepa honaa| (7) anya prakAra ke nidrA-vikAra : (A) kama sone vAle (B) lambe samaya taka sone vAle (C) ardhajAgrata/ taMdrAvasthA vAle (D) nidrA meM jhaTake AnA (E) nidrA meM atyaMta pasInA honA (F) mAsika samaya se saMbaMdhita vikAra (G) garbhAvasthA se saMbaMdhita (H) isake uparAMta nidrA meM honevAlI anya takalIphoM meM zvAsa rukanA, zvAsa bar3ha jAnA, AvAja AnA ityAdi / isa prakAra nidrA ke itane sAre vikAra hone ke bAvajUda nidrA ina rogoM kI jananI hai, aisA mAnane kI galatI nahi karanI cAhie / nidrA manuSya ko hakIkata meM hakArAtmaka svAsthya denevAlI, zarIra ko ArAma denevAlI aura zakti kA punaH saMcAra karane vAlI hai / paramAtmA ne hameM nidrA ke rUpa meM uttama bheTa dI hai, sirpha usakA yogya jatana karanA cAhie aura hamane Age dekhA ki adhikatara nidrA ke roga sAmAnya hai, gaMbhIra

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142 mastiSka aura jJAnataMtu kI bImAriyA~ nahIM hai aura miTa sakate hai / isakA samayasara ilAja ho sake isalie jAgRti ke lie yaha prakaraNa likhA gayA hai / AzA hai ki isase logoM kI nidrA pravRtti meM yogya sudhAra hogA aura isase saMbaMdhita rogoM kA yogya aura samayasara ilAja hogaa| (surkhiyA~ manuSya jIvana meM nidrA kA sthAna atyaMta mahatvapUrNa hai| navajAta zIzu ko 16-20 ghaMTA, bAlaka ko 10-12 ghaMTA, yuvAna ko 7-7.5 ghaMTA aura praur3ha vyakti ko 6.5 ghaMTo kI nIMda kI AvazyakatA hotI hai / anidrA, asthira paira, pragADha nidA meM zvAsAvarodha, atinidrA, keTApleksI, vikSipta nidA, nidAmeM calanA, nidrA meM Dara laganA, nidrA meM jhaTake AnA, duHsvapna AnA, nidrAmeM dAMta bhIDanA, nidrA meM pezAba ho jAnA, mAnasika vikRti, unmAda, smRtibhraMza, anaicchika nidA kI bimArI vagairaha nidrA se jur3e hue vikAra hai / adhikatara nidrA ke roga sAmAnya hai, gaMbhIra nahi hai aura samayasara ilAja karane para svasthatA A sakatI hai|

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) mastiSka kI saMkramita bImAriyA S Infections mastiSka zarIra ke hRdaya jaise anya aMga kI tulanA meM kaI bAra ati zIghratA se aura kaI bAra saMkramita bImArI kA bhoga banatA haiM / vizeSataH mastiSka kA TI. bI., mastiSka kA pAyojanika meninjAiTisa, mastiSka meM mavAda kI gAMTha (ebsesa), mastiSka kA ensephelAiTisa (vAyarasa saMbaMdhita), mastiSka kA jaharI maleriyA aura anya paropajIvI jaMtuo se honevAlA saMkramaNa, jaise ki sisTisarakosisa, mastiSka meM hotI phaphUMda, jAtIya roga saMbaMdhita saMkramita bImAriyA~ jaise ki eIDsa Adi / isa taraha aneka prakAra ke jaMtu se mastiSka saMkramaNa bImArI kA zikAra banatA hai| mukhyataH kAna yA nAka meM saDana ho yA mavAda nikalatA ho, galA saMkramita huA ho, mu~ha para saMkramita phaphole hue ho, zarIra ke anya bhAga jaise ki chAtI meM mavAda huA ho athavA sepTisImiyA huA ho to mastiSka meM saMkramaNa kI saMbhAvanA rahatI haiM / isake uparAMta heDa injarI yAne sira para coTa laganA aura vizeSataH kAna, nAka meM se rakta nikalA ho yA phekcara huA ho, taba mastiSka kA pAnI (CSF) nAka meM se bAhara AtA hai, jise sI.esa.epha. rAinoriA kahA jAtA hai athavA to mastiSka kA kisI kAraNavaza oNparezana huA ho (jaise ki mastiSka kI gAMTha kA) aura zarIra kI roga pratikAraka zakti kama huI ho taba mastiSka meM saMkramaNa kI saMbhAvanA bar3ha jAtI hai / isa kAraNa se siradarda, bukhAra, mirgI Ane jaise cihno se lekara pakSAghAta, behozI chAnA yA mRtyu honA jaise khataranAka pariNAma A sakate hai| ina sabhI bImAriyoM ke bAre meM likhanA saMbhava nahIM hai, lekina atyaMta mahatvapUrNa bImAriyoM ke bAre meM jaaneNge|

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144 mastiSka aura jJAnataMtu kI bImAriyA~ (1) mastiSka kA TI.bI. : sAmAnyataH mastiSka kA TI. bI. zarIra ke anya bhAga yA chAtI yA peTa ke TI.bI. meM se phailatA hai / aisA bhI hotA hai ki chAtI kA TI.bI. bahuta pahale huA ho aura aba zarIra ko takalIpha huI ho, aura zarIra kI rogapratikAraka zakti kama ho gaI ho, taba mastiSka kA TI.bI. hone kI saMbhAvanA rahatI hai| apane deza meM TI.bI. itanA jyAdA pracalita hai ki adhikAMzataH logoM meM TI.bI. ke jIvANu kabhI na kabhI havA aura dUdha Adi se zarIra meM praveza kara cUke hote hai, aura usake pratibhAva svarupa kI elarjI zarIra meM hI raha jAtI hai| isameM se jaba bhI kisI kAraNavaza mastiSka kA TI.bI. | zarIra kI roga pratikAraka zakti kama hotI hai yA zarIra kamajora par3atA hai, taba bImArI kA prAraMbha hotA hai / eIDsavAle marIjoM ko asaMkhya jaMtuo kA saMkramaNa laga sakatA hai, isameM bhI TI. bI. mukhya haiM / mastiSka ke AvaraNoM meM TI. bI. kA saMkramaNa ho taba use TI. bI. meninjAiTisa kahA jAtA hai| mastiSka meM TI. bI. kI gAMTha ho to use TyubarakyUlomA kahA jAtA hai / mastiSka meM korTeksa kA saMkramaNa ho to use ensephelAiTisa ( ensephelopathI) kahA jAtA hai / isa roga ke lakSaNa meM sira darda honA, halkA sA bukhAra AnA, ulTI honA, bhUkha na laganA, azakti yA baicainI AnA... yaha saba prAraMbhika lakSaNa hai| usake bAda mirgI AtI hai / eka yA adhika aMgo meM pakSAghAta kI asara hotI hai aura bImArI bar3ha jAe to mastiSka meM sUjana Ane se marIja behoza ho jAtA hai yA mRtyu hotI hai| isake uparAMta mastiSka meM bar3I yA choTI rakta nalikA baMda ho jAye to use TI. bI. enDaAraTarAITIsa kahA jAtA hai

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12 - mastiSka kI saMkramita bImAriyA~ (CNS Infections) 145 jisase pakSAghAta bhI ho sakatA hai| mastiSka pravAhI (sI.esa.epha.) kI thelIoM meM pravAhI kA mArga avaruddha ho to hAiDrosIphelasa hotA hai, jisase thelIyA~ phUla jAtI hai aura marIja hoza kho beThatA hai yA A~kha kI draSTi bhI kho baiThatA hai| karor3arajju aura rIr3ha kI haDDI meM TI. bI. kI asara ho to paira kA pakSAghAta ho sakatA hai / * nidAna : isa bImArI ke nidAna ke lie marIja kI vidhivata saMpUrNa jA~ca aura Avazyaka TesTa karavAye jAte hai / kamara ke pAnI kI jA~ca (lambara paMkcara) mastiSka kI saMkramita bImArI ke nizcita nidAna ke lie lagabhaga anivArya prakriyA hai / mastiSka ke TI. bI. meninjAITIsa meM kamara ke pAnI kI jA~ca meM proTIna jyAdA aura zarkarA (sugara) kama aura limphosAiTa nAmaka zveta kaNa adhika mAtrA meM Ate hai / isake uparAMta kucha muzkila kesa meM sI.esa.epha.-pI.sI.Ara., sI.esa.epha.sI.Ara.pI., sI.esa.epha.-e.DI.e. Adi TesTa ke tahata bhI nidAna meM nizcitatA lAI jA sakatI hai| aisI nizcitatA isalie Avazyaka hai ki eka bAra mastiSka ke TI.bI. kA nidAna ho jAe to marIja ko kama se kama Der3ha se do varSa taka upacAra kI jarUrata par3atI hai| kabhI kabhI sITI skaina aura ema.Ara.AI. kI jA~ca kI bhI jarurata par3atI hai / bImArI kI zaruAta meM kamara ke pAnI ke riporTa meM kabhIkabhI vAIrasa athavA mavAda ke jaMtu kAraNabhUta ho aisA lagatA hai aura tIno meM se kisI kA bhI yogya upacAra karane meM kamI raha jAe to bhayajanaka pariNAma A sakate haiM / isalie ina tamAma saMkramita bImArIoM kI vyavasthita jA~ca atyaMta Avazyaka hai / aMdAja lagAkara upacAra nahIM karanA cAhie, aisA sabhI niSNAta DaoNkTara mAnate hai / paraMtu mastiSka meM jyAdA sUjana ho, zvAsa adhika ho, marIja kI sAmAnya paristhiti acchI na ho aise saMjoga meM kamara kA pAnI nikAlanA khatarA sAbita ho sakatA hai / aise vakta meM skaina, ema.Ara.AI. tathA anya sahAyaka sabUtoM ke AdhAra para davAI zuru kara denI caahie|

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146 mastiSka aura jJAnataMtu kI bImAriyA~ * davAI : mastiSka ke TI. bI. kI davAI meM mukhyataH sTrepTomAisina (SM ) ke injekazana, AisonAyAjhAir3a (INH ), riphAmpIsIna (RF ), pAyarejhInAmAiDa (Pz ) tathA ithAmbyuTola ( EMB ) hai, jise prAyamarI (prathama caraNa kI) davAI kahate hai / kucha haThIle kesa meM spAraphlokasAsina yA siprophloksAsina; athavA kenAmAisina injekazana, ithionemAIDa yA sAikloserina nAmaka davAI bhI upayoga meM lI jAtI hai, jise sekanDarI (dvitiya caraNa kI) davAI kahate hai| lekina ina saba davAI kA koI na koI duSprabhAva saMbhavita hai, isalie marIja ke lakSaNa ke uparAMta leboreTarI jA~ca se bArabAra caukasAI kI jAtI hai / jaise ki INH, RF yA Pz se yakRta (lIvara) meM kabhIkabhI sUjana A sakatI hai aura pIlie kI asara bhI dikhAI detI hai| isalie DaoNkTara SGPT/ SGOT Adi blaDariporTa samayasamaya para karavAte rahate haiM, aura agara riporTa ThIka na Aye to, saMbaMdhita davAI kucha samaya baMda karanI par3atI hai| kabhI ulTI honA, bhUkha kama ho jAnA, RF liyA ho to pezAba kA raMga lAla jaisA honA - yaha sabhI lagabhaga sabhI marIjoM meM dikhate haiM, paraMtu isa vajaha se davA baMda nahIM karanI par3atI / 4 se 6 saptAha meM marIja kI tabiyata meM sudhAra hone lagatA hai| mastiSka meM sUjana ho yA CSF jA~ca meM proTIna vizeSa ho to mukhyataH sTIroIDa davAI 4 se 6 saptAha ke lie dI jAtI hai aura yadi mastiSka meM bar3I gAMTha ho to zAyada bar3A oNparezana karanA paDatA hai yA naI sTIrioTekTika bAyopsI ke choTe oNparezana dvArA bAyopsI ke sAtha choTI gAMTha ho to vaha bhI nikAlI jA sakatI hai / sAmAnyataH gAMThoM ke lie oNparezana kI zAyada hI jarUrata par3atI hai| davAI ke mAdhyama se hI gAMTha pighalane lagatI hai| jisake lie 2 se 3 mahine ke bAda sI.TI. skaina yA ema.Ara.AI. jA~ca karavA kara usameM ho rahe sudhAra para najara rakhanI cAhie / kamara ke pAnI kI jA~ca (CSF) zAyada hI bArabAra karanI paDatI hai| paraMtu haThIle dardo meM kabhIkabhI kamara ke pAnI dvArA davAI dI jAtI hai, jise indrAthikala sTa se davA dI gaI aisA kahA jAtA hai /

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12 - mastiSka kI saMkramita bImAriyA (CNS Infections) 147 jaba mastiSka kI theliyoM meM (Ventricles) meM pAnI kA rAstA avaruddha ho aura usameM jyAdA pAnI bharane lage to marIja hoza khone lagatA hai, calane-bolane, samajane meM takalIpha ho sakatI hai, A~kho kI draSTi kama ho jAtI hai yA sira darda aura ulaTiyA~ hone jaisI takalIpha bhI ho sakatI hai| ise hAiDrosIphelasa kahate hai| aura use si.TI. skaina dvArA nizcita kiyA jA sakatA hai / yadi aisA ho to choTI TyUba khopar3I meM se hokara mastiSka kI thelimeM prasArita kI jAtI hai / isake dvArA mastiSka ke pAnI ko peTa meM camar3I ke nIce Tanela dvArA TyUba se prasArita kiyA jAtA hai / ise zanTa DAlA bhI kahA jAtA hai / yaha eka sarala oNparezana hai aura usake pariNAma acche hote hai| paraMtu zanTa avaruddha ho to takalIpha ho sakatI hai| vizeSataH TI. bI. ke jaMtu davAI se kaMTrola meM na Ae aura bImArI bar3hatI jAe to use Draga rejisTansa kahA jAtA hai| usameM prAyamarI davAI asaphala rahe to sekanDarI davAI upayoga meM lAI jA sakatI hai / phira bhI kisI kesa meM marIja kI rogapratikAraka zakti saMpUrNataH khatma ho gaI ho, jaise ki eIDsa ke saMkramita jaMtu haThIle ho to aise marIja kI jyAdA madada nahIM ho sakatI hai / oreknoDAiTisa ke kucha haThIle kesoM meM theliDomAiDa nAmaka davAI acche pariNAma detI hai / (2) pAyojanika meninjAiTisa : TI. bI. ke alAvA yaha mahatvapUrNa aura jokhimayukta aisA dUsare prakAra kA meninjAiTisa saMkramita jaMtuo se hotA hai, jo mastiSka meM mavAda banAtA hai / yaha mavAda mastiSka kI sapATI ke AvaraNoM meM jaldI se banatA hai aura phailatA hai / isalie TI.bI. kI tulanA meM khUba jaldI arthAt thor3e hI dino yA ghaMTo meM marIja kI hAlata bigar3atI jAtI hai aura atyAdhika bukhAra AnA, asahya sira dukhanA, ulTI honA aura garadana ke pIche darda honA, prakAza sahana na honA-isa prakAra ke prAraMbhika lakSaNa ke bAda thor3e samaya meM behozI AtI hai, mirgI AtI hai yA yogya upacAra ke abhAva meM mRtyu bhI ho sakatI hai|

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148 mastiSka aura jJAnataMtu kI bImAriyA~ ina jaMtuo meM meningokokasa, sTephilokokasa, nyUmokokasa, sTrepTokokasa, lIsTiriA, eca. inphalyuenjhA, syuDomonAsa, proTIasa, i. kolAI aise vibhinna grAma-pojiTiva aura grAmanegeTiva svarUpa ke bekTeriyA hote hai, jo mastiSka ko zIghratA se vividha prakAra ke nukasAna karate hai; paraMtu yadi tatkAla upacAra ho to kisI bhI prakAra kI dUrogAmI vikalAMgatA kI asara ke binA marIja ekadama ThIka ho sakatA hai / isalie kisI bhI prakAra ke sira darda ke sAtha yadi bukhAra AtA hai to mastiSka ke saMkramaNa kI eka ullekhanIya AzaMkA rahatI hai| sAtha hI yadi marIja kA bolanA calanA aura hAvabhAva badala gayA ho, mirgI AtI ho yA hoza khone kI zuruAta huI ho to tAtkAlika AdhI rAta ko bhI sI. TI. skaina kara denA cAhie / use aspatAla meM dAkhila kara denA cAhie / jarUrata par3ane para kamara kA pAnI (CSF Examination) sAvadhAnIpUrvaka nikalavA kara, upacAra sunizcita karanA ati mahatvapUrNa banatA hai / yaha jA~ca zreSTha DaoNkTara ke pAsa aura zreSTha leboreTarI meM karavAnA ati Avazyaka hai| isase hI marIja ke bhAvi upacAra ke bAre meM jAnA jA sakatA hai / isameM kisI bhI prakAra kA samAdhAna nahIM karanA cAhie (No Compromise) / kamara ke pAnI (CSF) kI jA~ca meM aise meninjAiTisa meM sAmAnyataH saiMkaDo se lekara hajAroM kI saMkhyA meM nyUTrophilsa (zvetakaNoM kA eka prakAra) hote hai / proTIna thor3A bar3hatA hai aura pAnI meM sugara (glUkoja) atyaMta kama yA nahivat ho jAtI hai / TI. bI. meninjAiTIsa ke kamara ke pAnI ke riporTa se yaha riporTa alaga prakAra kA hotA hai / isake uparAMta grAma sTeIna dvArA mAIkroskopa meM adhikatara jaMtU bhI nizcitatApUrvaka jAne jAte hai / ina saba bAtoM ko dhyAna meM rakhakara tAtkAlika kauna sI davAI zuru karanI cAhie usakA nirNaya kiyA jAtA hai / pratyeka kesa meM CSF kalcara enDa sensiTivITI TesTa karavAnA cAhie, jisakA pariNAma 48 se 72 ghaMTe meM milatA hai aura usake anusAra pahale hI pasaMda kI gaI davAI meM badalAva karane kI jarUrata hai yA nahI vaha taya kiyA jAtA hai /

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149 12 . mastiSka kI saMkramita bImAriyA (CNS Infections) uparAMta AvazyakatA anusAra CSF Lactate, CSF CRP, Latex Particle Agglutination, sirolojikala TesTa phora siphilisa, vAIrasa Aisolezana TesTa, imyuno ese, phangasa ke TesTa aura TI.bI. ke PCR TesTa bhI sAtha hI kiye jAte hai / isa prakAra yaha pAyojanika meninjAiTisa hI hai yA nahIM, vaha nirNita kiyA jAtA hai aura kauna se jaMtU hai yaha bhI jAnakara davAI zuru kI jAtI hai / * davAI : ____ jarUrata par3ane para yaha davAI jaise ki siphelosporina, penisilIna, venkomAisina, lAInejholiDa, meropenama, imipenama, piperAsilinaTAjhobekTama, jenTAmAisina, klorAmphenikola aura meTroniDejhola kA upayoga kiyA jAtA hai / yaha saba uttama aura saphala pariNAmalakSI davAI hai aura tvarita rUpa se yogya mAtrA meM, yogya saMyojanavAlI davAI ke upayoga se 80 se 85 pratizata marIja ThIka ho jAte haiM / sAmAnyataH ina davAI ko 10 se 14 dina taka eka samAna DhaMga se upayoga meM lAyA jAtA hai aura kalcara ke riporTa anusAra jarUra par3ane para bIca meM badalAva karane paDate hai / antataH dUsarI bAra kamara ke pAnI (CSF) kI jA~ca karake sunizcita kiyA jAtA hai ki jaMtU nikala cUke hai, aura yaha pAnI aba mavAda sarjaka nahIM hai| usake bAda hI davAI baMda karanI cAhie / yadi mastiSka meM thor3A bhI saMkramaNa raha gayA ho aura davAI baMdha kara dI jAe to saMbhava hai ki bImArI thor3e hI samaya meM phira se ho sakatI haiM / usa samaya zAyada yaha davAI apekSita asara na bhI kare, jise Draga rejisTansa kahA jAtA hai| __ mastiSka meM sUjana adhika ho, eka tarapha mirgI yA pakSAghAta kA asara ho (phokala simpaTama-sthAnika nukasAnasUcaka lakSaNa) to avazya jaldI se sI. TI. skaina karavA lenA cAhie / zAyada mavAda kI gAMTha ho sakatI hai| ina keso meM adhikatara kamara kA pAnI nikAle binA bhI yogya davAI zuru kI jAtI hai / AvazyakatA ho to sakSama nyUrosarjana ke pAsa jAkara gAMTha meM se mavAda khIMca liyA jAtA hai yA oNparezana karavAyA jA sakatA hai / isa prakAra marIja ko naI jiMdagI milatI hai|

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150 mastiSka aura jJAnataMtu kI bImAriyA~ mastiSka kA sUjana bar3hanA (Raised Intracranial Tension), mirgI AnA, thelI kA rAstA avaruddha honA (hAIDrosiphelasa), sabaDyurala Iphyujana yA sabaDyurala empAyamA (mavAda kI gAMTha mastiSka ke AvaraNa ke bIca) yA breIna ebsesa (mastiSka ke aMdara mavAda kI gAMTha)... baharApana, mastiSka kI zirAoM kA avaruddha honA (vinasa thrombosisa) aura vAskayulAITisa-yaha saba kama mAtrA meM honevAlI, paraMtu meninjAiTisa se honevAlI nizcita pracalita samasyAe~ hai aura usakA bhI yogya nidAna karake tvarita upacAra karanA cAhie / isake uparAMta ye sabhI bhArI davAI bhI viparIta asara kara sakatI hai, isalie sAvadhAnI rakhanI cAhie / (3) phangala meninjAiTisa : __ mastiSka meM honevAlI phaphUMda (phaMgasa)kI bImArI ko phangala meninjAiTisa kahA jAtA hai / phaphUMda aneka prakAra kA hotA hai| jisameM krIpTokoksa, kokIDosIsa, kenDIDA, esparajIlasa, hisToplAjhamA, phAikomAyaseTisa Adi hai| kamara ke pAnI kA riporTa TI.bI. jaisA hotA hai| paraMtu adhika sAvadhAnIpUrvaka mAikroskopa meM dekhane se usameM phangasa milate hai (e.g. India Ink Preparation In Cryptococcus) / yaha bImArI bhI sAmAnya bukhAra, sira darda, azakti evaM becainI se zuru hotI hai| kaI bAra usakA nidAna prAraMbhika avasthA meM nahIM hotA hai| isa prakAra bImArI bar3ha jAne se behozI tathA mirgI Ane jaise lakSaNa dikhAI dete hai| sAmAnyataH jisa vyakti ke zarIra kI rogapratikAraka zakti ekadama kama ho gaI ho unheM phangasa kI bImArI hotI hai, jaise ki kensara, limphomA, eIDsa, nazAyukta davAI kI Adata, jyAdA zarAba, jyAdA enTibAyoTika yA sTIroIDa davAI kA sevana, harpisa, kensara kI kemotherepI aura adhika DAyAbiTIsa - ina sabhI saMjogo meM phangasa zarIra meM phailane lagatA hai| ___ kabhIkabhI marIja aspatAla meM anya bImArI ke upacAra ke lie gayA ho aura TI.bI., phangasa (phaphUMda) aura anya mavAda paidA karanevAlI

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12 - mastiSka kI saMkramita bImAriyA (CNS Infections) 151 bImArI sAtha lekara vApasa AyA ho aisA bhI kabhI ho sakatA hai / arvAcIna cikitsA upacAra paddhati kI yaha eka viparIta asara hai / phaphUMda ke lie mukhyataH emphoTeresIna, phlUsAyaTosIna, phlUkonAjhola vorIkonAjhola, kespophangina aura spAranoksa jaisI davAI upayoga meM lI jAtI hai / ina davAI kA kiDanI (mUtrapiMDa), lIvara aura kAna para jyAdA duSprabhAva paDatA hai / isa vajaha se unakA upayoga atyaMta sAvadhAnIpUrvaka karanA cAhie / ( 4 ) vAirala ensephelAiTisa : yaha ekadama tIvra gati se hone vAlI bImArI hai, jisameM marIja ko bukhAra AtA hai, vyavahAra meM acAnaka badalAva AtA hai yA Diprezana hotA hai, prakAza se Dara lagatA hai| yaha saba ke bAda mirgI kI zurUAta hotI hai, bAda meM pakSAghAta kA hamalA ho jAtA hai aura marIja behozI vAirala ensephelAiTisa meM saraka jAtA hai| mastiSka - ke korTeksa ko dImaka kI taraha jaldI se khatama kara denevAlI yaha bImArI koSoM kA bhI nAza karatI hai| kabhIkabhI usakA sthAyI asara zarIra meM chor3a jAtI hai, jaise ki yAdadAsta kama honA, mirgI ke daure par3ane aura vyaktitva meM badalAva aanaa| adhikAMzataH galasuA kA vAirasa (mampsa), harpisa simpleksa vAIrasa (HSV-1), Arbo vAIrasa aura kabhIkabhI veriselA, epsTina bAra, enTa vAIrasa - ye saba vAIrasa kisI kAraNasara mastiSka meM praveza kara le to vAIrasa ensephelAiTisa hotA hai| eIDsa kA vAIrasa bhI isa prakAra P-13ant

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152 mastiSka aura jJAnataMtu kI bImAriyA~ kA ensephelAiTisa paidA karatA hai / kabhI kucha vAIrasa sirpha mastiSka ke AvaraNoM ko asara karate haiM, jise vAyarala meninjAiTisa kahate hai| yaha bImArI pramANa meM halkI hai / vAyarasa kI bImArI atizaya khataranAka ho sakatI hai, jaise ki harpisa ensephelAiTisa bImArI meM yu.esa.e. meM bhI lagabhaga 10 se 40 pratizata marIja kI mauta ho jAtI hai / utane hI pramANa meM unheM bImArI ke Age batAye gaye duSprabhAva raha jAte hai / * nidAna : kamara ke pAnI (CSF) ke riporTa meM proTIna thor3e jyAdA hote hai, sugara lagabhaga normala hotI hai aura limphosAiTsa nAmaka zvetakaNa adhika hote hai / imyunolojikala TesTa dvArA adhikAMzataH vAyarasa kI upasthiti jAnI jAtI hai| jaise ki CSF-HSV TesTa / kabhIkabhI CSF-PCR TesTa dvArA yaha taya kiyA jAtA hai / yogya kesa meM ema.Ara.AI. yA sI.TI. skaina athavA I.I.jI. kiyA jAtA hai| yadi isa bImArI kA sahI nidAna ho jAe to tAtkAlika kucha davAI se jindagI bacAI jA sakatI hai aura vikalAMgatA se dUra rahA jA sakatA hai| udAharaNa ke taura para harpisa ensephelAiTisa meM esAiklovira (jhovirekSa, vIra, esIvIra) ke injekazana diye jAte hai / pratyeka davAI kI taraha isa davAI kA dainika Doz2a aura use kitanI bAra lenA vaha niSNAta DaoNkTara hI taya karate hai| hAlAMki isakI viparIta asara jyAdA nahIM hai, phira bhI satarka rahenA Avazyaka hai| isake alAvA sI.ema.vI. jaise aneka dUsare vAyarasa mastiSka ko eka yA dUsarI taraha se takalIpha pahu~cA sakate haiM / jisakA vivaraNa jagaha kI kamI ke kAraNa yahA~ karanA saMbhava nahIM hai / isI prakAra mastiSka ke anya vAyarasa jise slo-vAyarasa kahA jAtA hai, vaha kramazaH mahine aura varSoM meM mastiSka ke koSoM kA nAza karate hai| isameM esa.esa.pI.I.

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12 - mastiSka kI saMkramita bImAriyA~ (CNS Infections) 153 (sabaekyUTa sklerojiMga pAnaensephelAiTisa), jekoba-kruDjhaphelDTa Adi mukhya hai / durbhAgya vaza isameM se kisI bImArI kI davAI upalabdha nahIM hai / thor3I rAhata mile aisI davAI se kAma calAnA par3atA hai aura adhikAMzataH aise slo vAyarasa ke kesa meM marIja kI antataH mRtyu ho jAtI hai| (5) phAlsiperama maleriyA : maleriyA ke jaMtu sUkSma jIvasRSTi meM hai / paraMtu ve bekTeriyA yA vAyarasa se ekadama viparIta proTojoA samUha ke haiM / yaha jaMtu maleriyala peresAiTa (paropajIvI jaMtu) ke nAma se jAne jAte hai / ina jaMtuoM ke kula cAra upaprakAra hai| paraMtu usameM vAiveksa aura phAlsiperama mukhya hai| phAlsiperama ke bAre meM jAnane se pahale hama isa pracalita bImArI ke bAre meM savistara jAneMge / yaha maleriyala peresAITa kA jIvanacakra do avasthA meM hotA hai : (1) eka avasthA mAdA enophIlisa macchara meM hotI hai / yaha avasthA prajanana avasthA ke rUpa meM jAnI jAtI hai / (2) dUsarI avasthA manuSya ke lIvara-yakRta ke koSa aura rakta meM sthita raktakaNoM meM hotI hai / yaha avasthA vikAsa, vibhAjana aura vRddhi kI avasthA kahI jAtI hai / enophilisa mAdA macchara manuSya ko kATatA hai taba usake DaMsa ke sAtha maleriyala peresAiTa ke sporojoiTsa manuSya ke rakta meM milate hai aura thor3I dera meM lIvara ke koSo meM dAkhila ho jAte hai / vahA~ usakA vikAsa, vibhAjana aura vRddhi hotI hai / antataH lIvara ke koSa TUTate hai aura asaMkhya meroz2oiTsa rakta meM milate haiM / jo rakta meM tairate hue raktakaNoM meM praveza karate haiM / isa avasthA meM kucha meroz2oITsa gemeTosAiTsa (nara aura mAdA) meM rupAMtarita hote hai / gemeTosAiTsa prajanana kI avasthA hai| enophilisa mAdA macchara jaba maleriyA ke marIja ko kATatA hai aura rakta letA hai to usake sAtha hI gemeTosAiTsa bhI usake peTa meM

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mastiSka aura jJAnataMtu kI bImAriyA~ pahu~cate hai / usameM se antataH nae sporoz2oiTsa paidA hote haiM, jo macchara ke DaMsa dvArA dUsare manuSya ke rakta meM milate haiM / raktakaNoM meM praveza kie hue bAkI merojoiTsa vikAsa, vibhAjana aura vRddhi kA krama cAlU rakhate haiM / pariNAmataH yaha raktakaNa bhI tUTate hai aura asaMkhya merojoiTsa phirase rakta meM milate hai tathA bAda meM dUsare raktakaNa meM dAkhila hote hai / vAiveksa maleriyA meM yaha cakra laMbe samaya taka calatA rahatA hai / phAlsIperama prakAra meM mAnava zarIra meM eka hI cakra hotA hai / 154 vAstava meM asaMkhya raktakaNoM ke eka sAtha tUTane-phaTane se maleriyA kI bImArI meM ThaMDI lagatI hai aura bukhAra AtA hai / bArabAra maleriyA hone ke kAraNa jo enemiyA hotA hai, ( rakta meM phIkApana, kama lohatattva hImoglobina) usakA bhI yahI kAraNa hai / isa prakAra mAdA enophilisa macchara aura manuSya ke bIca apanA AnA-jAnA cAlU rakhakara maleriyala peresAiTsa apanA aura sAtha hI maleriyA kI bImArI kA astittva aura jIvanacakra banAe rakhate haiM / isa prakAra saMkramita macchara kATane ke bAda 8 se 14 dina ke bAda hI maleriyA kA bukhAra hotA hai / maleriyA ke lakSaNa : maleriyA ke hamale kI tIna avasthAe~ haiM : (1) prAraMbha meM marIz2a tharakana yA sakhta kaMpana kA ( cArapAI bhI hila jAe usa prakAra kA ) anubhava karatA hai / I (2) kaMpana zAMta hote hI bukhAra car3hatA hai aura garmI lagatI hai| (3) kucha samaya ke bAda bahuta pasInA hone ke bAda bukhAra utara jAtA hai / marIja ko kamajorI mahasUsa hotI hai / phira tIsare dina (vAivekasa prakAra me) aisA hI hamalA hotA hai / isake sAtha siradarda, zarIra meM darda, ulTI, DakAra ke sAtha halkI khAMsI bhI rahatI hai / kucha kesa meM hoTha para phaphole bhI hote haiM ( harpisa simpleksa lebiyAlisa) /

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12 - mastiSka kI saMkramita bImAriyA (CNS Infections) 155 vizeSataH phAlsiperama nAmaka maleriyA asAmAnya prakAra ke kaI cinhoM ke sAtha ho sakatA hai / bukhAra kI laya anirNita hotI hai, phAlsiperama maleriyA ko jaharIlA maleriyA bhI kahate hai / isa prakAra maleriyA ke jIvANu pratyeka avasthA ke raktakaNoM meM saMkramaNa paidA karate hai (vAiveksa sirpha nayeM (yuvAna) raktakaNoM ko hI saMkramita karate hai)| 1-2 pratizata raktakaNoM para asara hotA hai / isa prakAra isa maleriyA kA saMkramaNa rakhane vAle raktakaNoM kI saMkhyA bar3ha jAtI hai aura isake sAtha . sAtha enimiyA bhI adhika mAtrA meM hotA hai / saMkramita raktakaNa rakta kI choTI nalikAoM (capillaries) meM jamA hote hai aura nalikA baMda ho jAtI hai / pariNAmataH marIz2a behoza ho jAtA hai (serebrala maleriyA) yA kiDanI kharAba ho jAtI hai, adhika dasta hote hai / uparAMta pIliyA honA, zvAsocchavAsa meM takalIpha aura blaDaprezara kama ho jAnA jaisI jAnalevA bImAriyA~ bhI ho sakatI hai| . sAmAnyataH vAiveksa maleriyA meM klorokvIna kI goliyoM kA upayoga hotA hai / phAlsiperama maleriyA meM upacAra kI aksIra davA kvinAina hai / vaha 10 milIgrAma/kilo prati 8 ghaMTe para 10 dina taka dI jAtI hai / yaha davAI kA duSprabhAva mukhyataH hRdaya para hotA hai / yaha davAI hamezAM DaoNkTara kI salAha anusAra aura unakI dekharekha meM hI lenI cAhie / kesa gaMbhIra ho to prAthamika avasthA meM kvinAina nasa meM glUkoja ke sAtha diyA jAtA hai / marIja mu~ha se golI le sakatA ho taba goliyoM kA prayoga kiyA jAtA hai / phAlsiperama maleriyA meM isa davAI kA asara na ho aisA bhI pAyA gayA hai| aise vakta para ArTisyUneTa, ArTethara, mephlokvIna, jaisI davAI kA prayoga karanA par3atA hai / isake uparAMta pAyarImethemAina, TeTrAsAiklina aura DoksisAyaklina davAI bhI kama gaMbhIra keso meM upayoga kI jA sakatI hai|

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156 mastiSka aura jJAnataMtu kI bImAriyA~ * nidAna nizcita karane hetu rakta kI jA~ca : sAvadhAnIpUrvaka rakta kI jA~ca kI jAe to sAmAnyataH raktakaNoM meM maleriyala peresAiTsa (ema.pI.) dekhe jAte hai / phAlsiperama meM maleriyala peresAiTa kI saMkhyA adhika hone se vaha rakta kI jA~ca se saralatApUrvaka dekhe jA sakate hai| lekina vAIveksa prakAra meM ema.pI. kama hone se, vaha nahIM bhI dikhatA haiM / kyU.bI.sI. prakAra kI jA~ca se adhika saphalatA mila sakatI hai / isalie bukhAra ho taba rakta lenA jyAdA icchanIya hai| paraMtu vaha bAda meM bhI liyA jA sakatA hai / kabhIkabhI do-cAra klorokvina kI golI lekara Ae hue marIja kI rakta kI jA~ca meM kucha bhI nahIM milatA hai| aise kesa meM lakSaNoM ko jyAdA mahatva de kara upacAra pUrNa karanA par3atA hai| lakSaNoM se maleriyA kI saMbhAvanA jyAdA lage to usakA saMpUrNa upacAra karanA par3atA hai, phira bhI bukhAra na utare to usakA anya koI kAraNa DhU~Dhane kI jyAdA koziza karanI cAhie aura bAda meM vaha kAraNa anusAra ilAja karavAnA hitakAraka rahatA hai| (6) nyUrosisTisarakosisa : peresAiTika bImAriyoM meM eka atyaMta pracalita aura cikitsako ko bhI parezAna karane vAlI yaha aisI bImArI hai, jisameM mastiSka ke sI.TI. skaina meM TI.bI. jaisI gAMTha (ring enhancing lesions) dekhI jAtI hai / aisA mAnA jAtA hai ki apane deza meM yuvA vyaktio meM mirgI (phiTa) Ane kA nyUrosisTisarakosisa sabase mahattvapUrNa kAraNa

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12 - mastiSka kI saMkramita bImAriyA (CNS Infections) 157 sisTisarakasa nAmaka peresAiTa hai, jo mAMsa ko khAne se ho sakatA hai, yA salADa ko binA dhoe khAne se ho sakatA hai / isameM mirgI (phiTa) rokane kI davAI uparAMta roga nAbUda karane ke lie nyUrolojisTa AlbenDejola yA prejikvonTAla nAmaka davA jarUrI mAtrA meM dete haiM / mAMsa nahi khAnA cAhie aura salADa ghokara aura ho sake to kaccA nahi lekina use thor3I dhImI A~ca para garama karake khAnA cAhie, jisase yaha atipracalita bImArI phailane se rUkatI haiN| (7) TITenasa (dhanurvA) : yaha roga klosTrIDiyama TITenI nAmaka grAmapojiTiva jaMtu se paidA honevAle jaharIle dravya se hotA hai / yaha jaMtu zarIra ke ghAva meM se aMdara praveza karate hai| yaha jaharIlA dravya (eksoToksina) snAyu aura naso kI uttejanA paidA karatA hai aura usase TITenasa paidA hotA hai / usameM snAyu jakar3a jAte hai, jabar3e ThIkase khulate nahI (lock Jaw) hai / mu~ha, garadana aura pITha ke snAyu jakar3a jAte hai / prAraMbha meM sAmAnya takalIpha se lekara antataH samaya jAte dinaba-dina aisI paristhiti kA nirmANa hotA hai ki snAyu satata uttejita rahate haiM / jhaTake (spasm) Ate hai aura aMtataH zvAsa tathA gale ke snAyuoM para asara hotA hai / kabhIkabhI sirpha ghAva taka hI TiTenasa sImita rahatA hai| usameM marIja kI sthiti meM sudhAra hone kI jyAdA saMbhAvanA rahatI hai| paraMtu zarIra meM sabhI jagaha phaile hue TITenasa meM mRtyu kA pramANa TrITamenTa karAne ke bAda bhI lagabhaga 60 pratizata taka pahu~catA hai| upacAra : enTI TITenIka sIhala (3000 se 10,000 yuniTa) se TrITamenTa kI zuruAta kI jAtI hai / jakhma ko ThIka se sApha kara AsapAsa meM sarjikala DresiMga kiyA jAtA hai lekina ho sake to DresiMga khullA rakhanA

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I mastiSka aura jJAnataMtu kI bImAriyA~ cAhie / penisilIna isa bImArI kI akasIra enTibAyoTika hai / jo 10 se 14 dina taka dI jAtI hai / penisilIna kI elarjI ho to TeTrAsAyaklina diyA jA sakatA hai / 158 marIja ko aMdhakArayukta kamareM meM rakhakara, jhaTake ke daure ko rokane ke lie satata DAyAjhepama botala meM auSadhi ke rupa meM yogya mAtrA meM nasa meM yA snAyumeM injekzana ke rupa meM diyA jAtA hai / kabhIkabhI venTileTara para rakhakara nyUromaskayulara blokiMga bhI kiyA jAtA hai / anaicchika sisTama kI aniyamitatA ke kAraNa blaDaprezara meM caDhAva - utAra, bukhAra aura hRdaya kI samasyA bhI ho to, usakA sAvadhAnIpUrvaka upacAra karanA cAhie / TITenasa rokane ke lie TIkAkaraNa : yaha eka bahuta mahatvapUrNa aura Avazyaka prakriyA hai jisase aneka jiMdagiyAM baca sakatI hai / do mahine se adhika umra kI pratyeka vyakti ko aura jisane TiTenasa kA TIkAkaraNa barAbara nahi karavAyA ho tathA jo marIja TITenasa kI bImArI se tatkAla ThIka huA ho, usako TITenasa ToksoiDa (TT) dvArA paddhatisara saMpUrNa TIkAkaraNa karanA cAhie | TT kA pahalA injekazana lene ke bAda eka mahinA pUrA hote hI injekazana kA dUsarA Doja lenA caahie| usake pazcAt cha mahine ke bAda tIsarA Doja lenA cAhie / usake pazcAt pratyeka dasa varSa meM TT kA eka busTara Doja lenA hotA hai / garbhavatI strI ko eksTrA Doja diye jAte hai / isa prakAra TIke kA saMpUrNa korsa karane se TiTenasa ke sAmane pratikArazakti bar3hatI hai / jaba kabhI bhI jakhma ho to TT kA eka Doja phira se diyA jAtA hai / yadi jakhma kharAba ho to hyumana TITenasa imyunoglobyulina kA eka Doja (250 Units/I.M.) diyA jAtA hai / TiTenasa ke nivAraNa (Prevention) hetu yaha sAmAnya mArgadarzana hI hai, kyoMki pratyeka vyakti/ kesa meM vibhinna kAraNoM ko dhyAna meM lekara upacAra kA aMtima nirNaya to DaoNkTara ko hI lenA par3atA hai /

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12 - mastiSka kI saMkramita bImAriyA ( CNS Infections ) durbhAgyavaza apane deza meM abhI bhI yaha bImArI jyAdA pracalita hai, kyoMki ajJAnatA aura gaMdagI kI mAtrA jyAdA hai / sAtha hI gA~vo taka meDikala sisTama aura suvidhAeM paryApta mAtrA meM vikasita tathA upalabdha nahi hai / isa lie niyaMtrita ho sakatI aisI bImAriyoM meM bhI prati varSa seMkar3o nAgarika mRtyu ke zaraNa ho jAte haiM / (8) poliyomAyalAiTisa : 1 vAyarasa kA yaha saMkramaNa enTarovAyarasa se hotA hai aura karoDarajju ke enTiriara horna sela kA nAza kara dete haiM / kadAcita pariNAmataH zarIra ke avayava jaldI se zithila ho jAte hai / paraMtu saubhAgyavaza TIkAkaraNa ke abhiyAna se yaha bImArI aba vizvabhara meM se adrazya ho rahI hai I usakI TrITamenTa mukhyataH pUraka upacAra hI rahatI hai / koI khAsa davA nahIM hotI hai| choTe bacco meM bukhAra ke daurAna snAyu meM iMjekzana nahi dene se poliyo ke kisse kama hote hai I palsa polIyo kAryakrama : 159 hareka navajAta zizu ko polIyo kI rasIkA pUrA korsa karane ke phala svarupa deza meM se yaha roga saMpUrNataH dUra karane kI dizA meM hama kAphI mAtrA meM saphala hue he / svAsthya vibhAga aura tabIbI vijJAna kI yaha mahatvapUrNa upalabdhi kahI jA sakatI hai / phira bhI, deza ke dUra dUra ke gAMvo meM kabhI bhI polIyo kI khabara dainika patro meM AtI rahatI hai / svAsthya vibhAga ne isa roga ko mUlataH aura haMmeza ke lie deza meM se haTAne ke uddezya ko paripUrNa karane ke lie palsa polIyo abhiyAna AraMbha kIyA hai aura usake pariNAmata: deza meM se yaha bimArI ko saMpUrNata: vidAya karane kI dizA meM hama maMjila kI tarapha pahUMcane se kucha kadama hI dUra hai aisA jarura kaha sakate hai /

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160 mastiSka aura jJAnataMtu kI bImAriyA~ (9) rebIsa ( haDakavA) : kuttA, baMdara, laumaDI aura garama raktavAle anya prANI tathA camagAdar3a Adi ke kATane se honevAlI aura acUka mRtyu lAnevAlI yaha bhayAvaha bImArI vAyarasa se hotI hai / prANI ke kATane se 30 se 60 dina meM aura kabhIkabhI cha mahine meM yaha bImArI pragaTa ho jAtI hai| prAraMbha meM vyavahAra meM pharka dikhatA hai, marIja uttejita ho jAtA hai aura bAda meM pakSAghAta Adi ho sakate hai / mukhyataH pAnI dekhakara vaha ghabarA jAtA hai aura thor3e samaya meM zvAsa baMda hone se athavA hRdaya kI gati bigar3ane se mRtyu hotI hai / zreSTha dekharekha yA davAI ke bAda bhI zAyada hI koI marIja bacatA hai / isalie usakI rokathAma pahale se hI karanI atyaMta jarUrI hai| prANI ke kATane se pratyeka kesa meM rebIsa kA TIkA aura enTIsIrama kA upayoga hitakAraka hai| hAlAMki purAne TIkoM kI kucha viparIta asara bhI hai| isalie aba naye saMzodhita riphAInDa TIke (jo thor3e mahaMge hai), aura jo HDCV nAma se jAne jAte hai, vaha denA hitakAraka hai / isa saMdarbha meM DaoNkTara kI salAha turaMta lenI cAhie / upasaMhAra : mastiSka kI ina tamAma saMkramita bImAriyoM kI carcA se jAnA jAtA hai ki mastiSka tathA zarIra kI aisI vibhinna saMkramita bImAriyA~ maMda rogapratikAraka zakti kI vajaha se hotI hai / isalie rogapratikAraka zakti bar3hAne ke prayAsa karane caahie| yogya pauSTika AhAra lenA, vyAyAma karanA, svacchatA banAe rakhanA, gaMdagIvAlI vastu-jagaha se dUra rahanA aura pAnI ubAlakara pInA, pUrI nIMda lenA Adi rogapratikAraka zakti banAe rakhane ke lie atyaMta Avazyaka haiN| isake uparAMta ghara meM yA kAma karane kI jagaha para kucha saMkramita bImArIvAle marIjoM se sAvadhAnI rakhanI cAhie / marIja ke parivArajanoM ko sAvadhAnI ke lie DaoNkTara kabhIkabhI enTibAyoTika athavA anya davAI dete haiN| isase anya vyakti kI rogapratikAraka zakti bar3hatI hai, isalie isa prakAra kI davAI lene meM hicakicAhaTa nahIM karanA cAhie | adhika mAnasika zrama

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161 12 - mastiSka kI saMkramita bImAriyA (CNS Infections) nahIM karanA cAhie aura jyAdA mAnasika thakAna na Ae usakA bhI dhyAna rakhanA cAhie / eIDsa ko rokane ke upAyo ke bAre meM isake bAda ke prakaraNa meM paDheMge / usameM batAe~ anusAra sAvadhAnI rakhanI cAhie / bAhara ke asvaccha aura kharAba guNavattAvAle AhAra aura pravAhI se dUra rahanA cAhie / aMta me, aMgrejI kahAvata "Prevention is better than cure" (roga ko roka lenA roga ke upacAra se jyAdA acchA hai), yAda rakhanI cAhie / (sakhiyA~ * mastiSka zarIra ke anya aMgo kI tulanA meM kaI bAra ati zighratA se saMkramita bimArI kA bhoga ho sakatA hai / vizeSata: mastiSka kA TI.bI., pAyojanika meninjAiTisa, mavAda kI gAMTha, ensephelAiTIsa, jaharI meleriyA, sisTisarakosisa, vagairaha roga saMkramaNa se hote hai / * mastiSka ke AvaraNoM meM TI.bI. kA saMkramaNa ho taba use TI.bI. meninjAiTisa kahA jAtA hai / mastiSka ke korTeksa meM saMkramaNa ho to use ensephelAiTisa kahA jAtA hai / * sTrepTomAisIna, AisonAyAsAiDa, rIphAmapIsIna, pAirejhInAmAiDa, ithAmbyuTola, lIvophloksAsIna, vagairaha davAIyAM TI.bI. meM aksIra hotI hai| * pAyojanika meninjAiTIsameM saMkramita jaMtu mastiSka meM mavAda banA kara jaldI se phailate hai, isalIe yaha jokhima yukta roga * kripTokokasa, kokiDosisa, kenDIDA, esparajilasa vagairaha phaphUMda se mastiSka meM honevAlI bimArI ko phaMgala meninjAiTisa kahate hai|

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162 mastiSka aura jJAnataMtu kI bImAriyA~ vAyarasa ensephelAiTisa-vAyarasa jaise ki, harpisa simpaleksa mampsa kA vAIrasa, veriselA, epsTinabAra, enTerovAirasa, eIDsa ke vAirasa vagairaha se hotA hai| vAirasa ensephelAiTisa meM samaya para sahI nidAna hone para jiMdagI bacAI jA sakatI hai / * phAlsIperama meleriyA meM enophilIsa mAdA macchara manuSya ko kATa kara daMza ke sAtha phAlsIperama nAmaka paropajIvI jaMtu ko rakta meM chor3a dete hai| sahI samaya para nidAna huA to kvinAina ke istemAla se jAna baca sakatI hai| salADa binA dhoe khAne se yA mAMsa khAne se sisTisarakasa nAma ke peresAiTa mastiSka meM jA kara apanA sthAna jamAte * TiTenasa meM klosTriDiyama TITenI nAmaka jaMtu zarIra ke ghAva se aMdara praveza karate hai aura atyaMta jaharIle padArtha choDate hai / isameM TrITamenTa karAne ke bAvajUda mRtyu pramANa 60% taka hotA hai| cetAtaMtra meM enTerovAirasa ke saMkramaNa se poliyomAilAiTisa hotA hai, kintu TIkAkaraNa abhiyAna se yaha bimArI vizvabhara se adrazya ho rahI hai| rebIsa-kuttA, baMdara, laumaDI aura garama rakta vAle anya prANI tathA camagAdaDa Adi ke kATane se hotI hai| yaha bimArI hone para zAyada hI koi marIz2a baca sakatA hai, isalie prANI ke kATane para turaMta TIkA lagavAnA cAhie /

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eIDsa (cetAtaMtra para usakI asara) (AIDS - its effects on Nervous System) ___eIDsa arthAt ekvAyarDa imyunoDephiziyansI sinDroma / yaha roga eca.AI.vI. arthAt hyumana imyunoDephiziyansI vAirasa se hotA hai| isa vAyarasa ke kAraNa zarIra kI rogapratirodhaka kSamatA meM kamI hone se yaha (AIDS) bimArI hotI hai / eIDsa eka hI roga nahIM paraMtu eka se adhika bImAriyoM ke samUha ko nirdezita karatA hai| sAmAnyataH hamAre zarIra meM vibhinna bImAriyoM kA mukAbalA karane ke lie do prakAra kI roga pratikAraka zakti hotI hai : (1) sela miDieTeDa-koSaprerita arthAt zvetakaNo-limphosAiTa se upalabdha roga pratikAraka zakti (2) hyUmarala imyUniTI arthAt enTiboDI se upalabdha kSamatA / eca.AI.vI. viSANu rakta meM rahane vAle TI-limphosAiTa prakAra ke zvetakaNoM ko saMkramita kara ke unakI saMkhyA aura kSamatA ghaTAte hai| zarIra kI rogapratirodhaka kSamatA kA mukhya AdhAra zvetakaNa hai / vaha kama hone se zarIra kI rogapratirodhaka zakti kramazaH ghaTatI jAtI hai / usake kAraNa jo sUkSma jIvoM se anya taMdurasta manuSya ko saMkramaNa nahIM hotA, unhIM sUkSma jIvoM se eIDsa bImArIyukta vyakti AsAnI se saMkramita ho sakatA hai / eIDsa kisa prakAra prasaratA hai : (1) sajAtIya yA vijAtIya saMbhoga se / (2) eca.AI.vI. saMkramita vyakti kA rakta anya marIja ko dene se| eca.AI.vI. saMkramita mAtA se garbhAvasthA daurAna usake bacce ko, prasUti ke samaya aura prasUti ke bAda stanapAna dvArA yaha saMkramaNa hone kI 30 se 40 % saMbhAvanA rahatI hai| (3) /

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164 mastiSka aura jJAnataMtu kI bImAriyA~ (4) iMjekzana kI suI, siriMja tathA anya oNparezana ke upakaraNoM se| (5) nasa dvArA nazIle dravyoM kA sevana karanevAle vyaktioM ke jUtha meM agara eka bhI vyakti rogiSTa ho to eka hI suI kA sAmUhika prayoga yaha roga ko janma detA hai| __ eIDsa ke saMkramaNa ke viSaya meM Aja bhI kaI galataphahamIyAM haiM, jaise ki marIja ke sAtha rahane se, unase hAtha milAne se, khelane se aura khAne se isa roga kA saMkramaNa hotA hai / yaha mAnyatA galata hai| itanA hI nahIM yaha roga AhAra, pAnI, jaMtu, mala yA havA se nahIM phailatA hai / isa kAraNa eIDsa ke marIja ke sAmAjika saMparka se DaranA nahIM cAhie, balki unheM adhika pyAra aura sAmAjika svIkRti mile usa prakAra kA vyavahAra karanA cAhie / * eIDsa prasarane se rokane ke liye itanA dhyAna rakheM : 1. iMjekzana lene ke lie bAjAra meM milanevAlI Dispojebala siriMja-sUI kA upayoga kareM tathA sAmAnya bImArI meM iMjekazana lene se baceM / aparicita vyakti ke sAtha zArIrika saMbaMdha na banAe~ yA to kaoNnDoma kA upayoga kareM / 3. agara rakta lene kI paristhiti ho to eca.AI.vI. kI leboreTarI-jA~ca karavA kara hI rakta ko upayoga meM le / saMbhavata: snehIoM kA rakta mila sake to adhika acchA hai| vyAvasAyika raktadAtAoM se rakta na leM / dAr3hI karane svayaM kA rez2ara tathA bleDa alaga rakheM, dUsaroM kA rez2ara-bleDa upayoga na kareM / eca.AI.vI. grasta mahilA dvArA usake bacce ko bImArI hone kI saMbhAvanA ko nimna samajhAe gayeM upAyoM se bacA jA sakatA hai: (ka) eca.AI.vI. kI davAiyA~ (enTirITrovAyarala) deN| yaha davA DaoNkTara kI salAha anusAra hI deM / 4.

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165 13 - eIDsa (cetAtaMtra para usakI asara) (kha) prasUti ke daurAna dhyAna rakheM / (ga) bacce ko stanapAna na karAe~ / (gha) bacce ko 45 dinoM taka jhIDovuDIna (Zidovudine) sapramANa Doja meM deM / ina upAyo se baccoM meM saMkramaNa hone kI saMbhAvanA 5 pratizata se bhI kama ho jAtI haiM / * eIDsa ke lakSaNa : (1) prathama bImArI 6 se 8 haphte meM hotI hai / isameM marIja ko bukhAra AnA, hAtha-paira ke snAyuoM meM darda honA, lasikAgraMthi para sUjana AnA, tvacA para lAla cAThe par3anA, gale meM sUjana AnA / yaha lakSaNa se marIz2a eka haphte meM binA davAI ThIka ho jAtA hai / yaha prathama bImArI ko ekyuTa siro kanvarjana ilanesa kahate haiM / yaha prathama bimArI ke bAda eca.AI.vI. kI jA~ca pojhiTiva hotI hai / zuruAta ke 6 se 8 mahine ke daurAna eca.AI.vI. kI leboreTarI-jA~ca meM nakArAtmaka pariNAma batAte haiM, lekina marIja apanA saMkramaNa yaha samaya daurAna anya vyakti ko phailA sakatA hai| yaha samaya ko vinDo pIriyaDa kahate haiM / yaha prathama bImArI ke bAda marIz2a binA cinha kI eca.AI.vI. vAhaka avasthA meM praveza karatA hai / yaha avasthA 5 se 10 varSa jitanI laMbI ho sakatI hai| yaha avasthA kA samaya marIja kI taMdurastI, AdateM ityAdi para AdhArita haiN| (3) yaha avasthA ke bAda marIja meM roga ke aneka cihana dikhate haiM, jisameM lasikAgraMthi kA phUlanA, bArabAra yA lagAtAra bukhAra rahanA, mu~ha aura gale meM chAle par3anA, AhAra kama honA, laMbe samaya taka khAMsI AnA, bArabAra dasta honA vajana kama honA ityAdi hai| yaha lakSaNa marIz2a meM bAra bAra yA lagAtAra rahe to usake rakta kI eca.AI.vI. jA~ca karavAne se nidAna ho sakatA haiM /

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166 mastiSka aura jJAnataMtu kI bImAriyA~ vizva Arogya saMsthA (WHO) dvArA eca.AI.vI. (Human Immunodeficiency Virus) hetu nizcita mukhya lakSaNoM anusAra : 1. eka mahIne se adhika samaya ke lie bukhAra. 2. eka mahIne se adhika samaya ke liye dasta aura vajana meM 10 % se adhika kamI honA / / uparAMta khAMsI AnA, zarIra meM khujalI honA, mu~ha, gale athavA gudA yA gupta bhAga meM chAle honA, do-tIna jagaha meM lasikAgraMthi kA phUla jAnA, yA bArabAra harpisa jhosTara ho to eca.AI.vI. parikSaNa karavAnA caahie| eIDsa ke roga meM nyUrolojikala sisTama arthAt mastiSka aura cetAtaMtra meM lakSaNa-cihna dikhate haiM / aisA kahA jAtA hai ki eIDsa ke 33 % marIjoM ko spaSTataH nyUrolojikala bImArI hotI hai aura pratyeka marIja ke mastiSka yA cetApezI meM thor3A bahuta nukasAna to hotA hI hai / leboreTarI parIkSaNa : marIja ke zarIra meM eca.Ai.vI. ke jaMtu kI upasthiti elIsA ELISA TesTa dvArA jAnI jA sakatI haiM / yaha TesTa skriniMga TesTa haiM / agara isa TesTa meM eca.Ai.vI. kI upasthiti (pojiTiva) dekhane ko mile to use 'vesTarna bloTa' (Western Blot) TesTa dvArA sunizcita karanA jarUrI haiM / saMkramaNa hone ke bAda adhikatara 6 haphte se 6 mahine meM isa TesTa dvArA marIja ke zarIra meM eca.Ai.vI. kI upasthiti ke bAre meM jAnA jA sakatA haiM / lekina zuruAta ke isa samaya daurAna (Window Period) yaha TesTa negeTiva yA inaDiTaramineTa (anizcita) pariNAma darzAtA haiM / marIja ke rakta meM vAIrasa kI mAtrA aura CD4 nAmaka koSoM kI saMkhyA (jisase zarIra kI roga-pratirodhaka kSamatA jAnI jA sakatI haiM) vibhinna parIkSaNa dvArA jAnI jA sakatI haiM, jo marIja ke upacAra meM upayogI haiN| agara yaha kAunTa 100 se kama ho to mRtyu najadIka hai aisA dekhA gayA hai / isake alAvA vAirasa loDa TesTa dvArA bImArI ko kitanA niyaMtrita kiyA gayA hai yaha jAna sakate haiM /

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167 13 - eIDsa (cetAtaMtra para usakI asara) mastiSka aura cetAtaMtra ke eIDsa saMbaMdhita rogoM ko mukhyataH pA~ca hisse meM bA~TA jA sakatA haiM : (1) mastiSka meM ensephelAiTisa, harpisa simpleksa, veriselA jhosTara inphekzana, eIDsa DimenziyA (yAdadAsta kI bImArI) kompleksa, mastiSka ke cayApacaya saMbaMdhita roga, mastiSka kA TI.bI., limphomA, ToksoplAjhamosisa, pI.ema.ela., mavAda kI gAMTha, mastiSka meM siphilisa, mastiSka meM phaphUMda ityAdi rogoM dvArA atyaMta eca.AI.vI. ensephelAiTisa _ hAni ho sakatI haiN| (2) spAinala korDa (karor3arajju) meM sUjana arthAt mAilAiTisa, mAilopathI ityAdi bImAriyA~ ho sakatI hai, jisase marIja kA halanacalana sthagita ho jAtA hai / (3) mastiSka ke AvaraNoM arthAt meninjisa meM saMkramaNa hone se meninjAiTisa ho jAtA haiM / usameM TI.bI., siphilisa yA phaphUMda ke jaMtu ho sakate haiM, jisake kAraNa marIja behoza ho sakatA haiM, mirgI A sakatI hai yA pakSAghAta ho sakatA haiN| ___ (4) cetAoM-jJAnataMtuo meM sUjana Ane se nyUrAiTisa ho sakatA hai jo saMkramita jaMtuoM, harpisa ityAdi kAraNoM se hotA haiM / isake kAraNa paira meM jalana, calane meM takalIpha aura darda ityAdi ho sakatA haiM / (5) polimAyosAITisa aura snAyuoM saMbaMdhita anya bImAriyA~, jisameM snAyu kamajora hote haiM / isa prakAra eIDsa dvArA zarIra meM lasikAgraMthi se lekara nyUrolojikala sisTama taka kaI roga ho sakate haiM / hRdaya saMbaMdhita bImArIyA~ eIDsa ke marIjoM meM bahuta kama dekhane ko milatI haiM /

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168 mastiSka aura jJAnataMtu kI bImAriyA~ upacAra : eIDsa ke marIjoM kA upacAra ho sakatA haiM lekina use saMpUrNa nAbUda kara sake aisA upacAra abhI saMzodhita nahIM huA haiM / vartamAna davAIyA~ tathA upacAra paddhati se isa roga ko Age bar3hane se kucha mAtrA meM rokA jA sakatA hai / rogapratirodhaka kSamatA (CD4 Count) sudhArI jA sakatI haiM / eIDsa kI bImArI ke vAirasa ke jaMtuo ko naSTa karane ke lie tIna davAI ke saMyojana meM lI jAtI haiM / yaha davAI marIja ke zarIra meM rahane vAle anya saMkramita roga jaise ki TI.bI., pIliyA ke vAirasa kI upasthiti tathA marIja ke lIvara, kIDanI, mastiSka ityAdi avayavoM kI kAryakSamatA ke AdhAra para niSNAta DaoNkTara taya karate haiM / davAI ke kama samaya ke aura laMbe samaya ke duSprabhAva hote haiM / marIja ko niyamita DakTara ko milakara duSprabhAva kama karane ke lie Avazyaka kadama uThAne cAhie / enTiTrovAyarala davAI (ART) niyamita lene se marIja laMbe samaya taka taMdurasta aura svastha jIvana vyatita kara sakatA haiM / davAI niyamita lI jAe to usakI asara laMbe samaya taka rahatI hai / agara marIja davAI lene meM aniyamita raheM to davAI asarakAraka nahIM rahatI hai / isalie aise kesa meM bImArI niyaMtrita karane kA kAma bahuta kaThina ho jAegA / ina davAI kA mAsika aMdAjita kharca eka hajAra se dasa hajAra rUpaye jitanA hotA hai / eca.AI.vI. saMkramaNa ke kAraNa prAthamika avasthA meM adhikatara marIja kI mRtyu nahIM hotI hai / yaha mukhyataH yAda rakhanA cAhie ki eIDsa ke marIjoM kI mRtyu adhikatara sUkSma jaMtu aura saMkramita jIvANuoM se hotI haiM / agara ina donoM jAti ke jaMtuoM kA yogya nidAna zIghratA se ho aura tvarita upacAra kiyA jAe to marIja ko jyAdA lAbha ho sakatA haiM /

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13 - eIDsa ( cetAtaMtra para usakI asara ) kucha mahatvapUrNa bAte : (1) eca.AI.vI. roga ke marIja niyamita parIkSaNa karavAaiM aura niyamita davAI leM to vaha bahuta Ayu taka svastha jIvana vyatita kara sakate hai / isa roga kI davAI sarakArI aspatAla meM muphta meM milatI hai / Aja kI tArIkha meM gujarAta ko milAke bahuta sAre rAjyoM ke mer3ikala kAlijoM meM ART Centre hai / isa roga kI prAthamika jA~ca ke lie vibhinna VCTC Centre bhI kAryarata hai / jahA~ marIja jA~ca karavA ke roga ke bAre meM jAnakArI bhI pA sakatA hai / 169 (2) eca.AI.vI. roga se pIr3ita garbhavatI mahilAoM ke lie MTCT programme bhI ART Centre para kAryarata hai, jahA~ unakI acchI dekharekha kI jAtI hai / jisameM navajAta zizu meM saMkramaNa kI dara kama kI jA sakatI hai / (3) eca.AI.vI. roga ke marIja meM CRF ho jAye to, usameM kir3anI TrAnsaplAnTa jaise bar3e oNparezana bhI acche pariNAma ke sAtha kiye jA sakate hai / (4) isa roga ke marIjoM kI sevA ke lie vibhinna sarakArI, prAIveTa tathA NGO kAryarata hai / (5) ART ke Agamana ke bAda isa roga ke marIja tIna dazaka taka svastha jIvana jI sakate hai / ina davAI ko mer3ikala dekharekha meM hI lenI cAhie kyoM ki ina davAI se vibhinna duSprabhAva ho sakate hai / (6) eca.AI.vI. grahita strI purUSa Apasa meM zAdI bhI kara sakate hai tathA acchI pArivArika jiMdagI vyatita kara sakate hai /

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170 mastiSka aura jJAnataMtu kI bImAriyA~ saMkSipta meM, tAtkAlika nidAna, yogya upacAra, dekharekha, saMkramita bImAriyoM se dUra rahane kI jIvana paddhati ityAdi dvArA marIja kI jIvanazailI aura Ayu sudhArI jA sakatI hai / marIja mAnasika rUpa se svastha raha sakatA hai / isa roga kI jAnakArI ke lie kucha sarakArI aspatAla meM muphta salAha kendra kI suvidhA haiM aura aba to inTaraneTa se bhI yaha jAnakArI upalabdha hai| sukhiyA~ * eca.Ai.vI. nAmaka vAyarasa se honevAlA yaha roga eka roga nahi paraMtu adhika bimAriyoM ke samUha kA nirdeza karatA hai, jo zarIra meM roga pratirodhaka kSamatA kI kamI ke kAraNa hotA hai| hara eca.AI.vI. pojhITIva vyaktiko eIDsa ho ye jarUrI nahIM haiN| eIDsa kaI prakAra se phailatA hai, usameM se mukhya hai - sajAtIya yA anaitika vijAtIya saMbhoga, rogI apanA rakta anya ko de taba, rogI mahilA garbhAvasthA meM ho to usake bacce ko yaha roga hone kI saMbhAvanA hai / injekzana kI sUI yA asurakSita sarjikala upakaraNa se / enTIrITrovAyarala davAI niyamita lene se marIz2a laMbe samaya taka taMdurasta aura svastha jIvana vyatita kara sakatA hai| isa roga kI jAnakArI ke lie kucha sarakArI aspatAlo meM muphta salAha kendra hai aura inTaraneTa para bhI yaha jAnakArI mila sakatI hai|

Page #190
staSka meM hone vAlI gAMTha (Brain Tumour) mastiSka meM honevAlI gAMTha (breIna TayUmara) eka gaMbhIra bImArI hai| usase sambandhita sahI jAnakArI atyanta mahatvapUrNa hai / mastiSka kI gAMTha aneka prakAra kI hotI hai / usakA kada, prakAra, sthAna, guNavattA aura hIsTolojI ke anusAra vaha aneka sAmAnya aura vizeSa cihna utpanna karatI hai / kucha gAMThe mastiSka ko dImaka kI taraha khA jAtI haiM / kucha mastiSka ko dabocatI haiM / mastiSka meM sUjana ke (Increased Intracranial Pressure) lakSaNa / cihna utpanna hone kA yaha eka mahatvapUrNa kAraNa hai| aba sarjikala paddhati meM tathA enesthesiyA meM sudhAra hone se Adhunika sTIrIoTeksisa takanIka aura mAIkro nyUrosarjikala takanika bar3hane se, reDimezana tathA kImotherepI meM ullekhanIya vikAsa hone se breIna-TayUmara ke marIjoM kA bhaviSya zIghratA se sudhara rahA hai| breIna TayUmara mastiSka kA pracalita roga hai aura yu.esa.e. jaise - deza meM prativarSa lagabhaga 1,00,000 logoM ko yaha roga hotA hai, yaha saMjoga meM apane deza kI paristhiti kI kalpanA kareM ! usameM se kucha kensara kI hotI haiM, jo mastiSka meM se hI udbhava hotI hai (prAImarI), jaise kI glAyomA athavA zarIra ke anya bhAga meM se mastiSka meM phailatI (sekanDarI) haiN| anya beIna TayUmara gAMTha pramANa meM nirdoSa

Page #191
mastiSka aura jJAnataMtu kI bImAriyA~ (Benign) hotI hai, jaise ki meninjiomA, pIcyuTarI TyUmara ityAdi / saMkramita roga se utpanna hone vAlI gAMThe jaise kI TyUbarakyUlomA, mavAda kI gAMTha, sisTasarakosisa, eIDsa kA bhI ullekha karanA cAhie / lekina usake lakSaNa, IlAja aura upacAra ke prakAra bhinna-bhinna hote haiM / 172 lakSaNa / cihna : mastiSka kI gAMTha ke lakSaNa kramazaH baDhate dikhAI dete haiM, jo alaga alaga taraha kI gAMTha kI guNavattA, sthAna, kada, prakAra, vikAsa aura sUjana para AdhArita hote hai / (1) mastiSka meM dabAva bar3hanA ( Increased Intracranial Pressure) : pratyeka gAMTha kA kada bar3hane se mastiSka meM dabAva bar3hatA hai, jisase donoM tarapha kA sira darda honA, ulTI honA, aMdherA laganA, becainI kA anubhava honA, cIjoM kA eka ke badale do dikhanA (Diplopia) jaise cihna Ate haiN| sira darda ke kesa ke sabhI marIjoM ko breIna TyUmara nahIM hotA / balki 1 pratizata kesa meM hI brena TyUmara hotA hai / koI bhI svastha vyakti ko kramazaH sira darda bar3hatA jAyeM to TayUmara ke viSaya meM niSNAta ke pAsa jA~ca karavA lenI cAhiye / (2) gAMTha mastiSka ke jisa hisse meM ho usa anusAra lakSaNa dikhAI dete haiM / jisase marIja ko kramazaH pakSAghAta kA asara bhI ho sakatA hai| bolane meM takalIpha honA, yAdazakti kama honA yA zarIra kA saMtulana bigar3anA, aisA ho sakatA hai / kucha marIjoM meM sirpha vyaktitva yA vyavahAra para asara par3atA hai / mala-mUtra tyAga aniyaMtrita ho jAtA hai / (3) mirgI AnA athavA behoza honA yaha bhI eka mahatvapUrNa lakSaNa hai / mirgI ke sAtha meM yadi siradarda athavA pakSAghAta kI asara bhI ho to tAtkAlika jA~ca karavA lenI cAhiye / (4) kabhI kabhI gAMTha meM hemareja hone se marIja kI paristhiti acAnaka hI bigar3a jAtI haiM /

Page #192
14- mastiSka meM hone vAlI gAMTha (Brain Tumour) 173 uparokta meM se eka se adhika lakSaNa / cihna ho to marIz2a ko gAMTha hone kI saMbhAvanA adhika hotI hai / nidAna : sahI nidAna ke liye adhikAMza keso meM (1) sI. TI. skaina breIna (konTrAsTa ke sAtha) eka pUrNa jA~ca hai / gAMTha choTI ho, mastiSka ke pIche ke bhAga meM ho athavA sI.TI. skaina dvArA usakA prakAra patA na cala sake to breIna kA ema. Ara. AI. karavAnA cAhie / (2) ema.Ara.AI. (megneTika rejonansa imejiMga) nAmaka TesTa karAne se nizcita nidAna kiyA jA sakatA hai aura kucha keso meM vaha Avazyaka bhI hotA hai / nizcita nidAna ke liye kabhIkabhI sAtha meM enjiyogrAphI yA ema. Ara. spekTroskopI bhI karavAnI par3atI haiN| zarIra meM pesamekara ho, meTala kA koI implAnTa ho to ema. Ara. AI. nahIM ho sakatI hai, aura aise saMjoga meM sI.TI. skaina hI eka upAya haiM 1 -- glAyomA : kensara kI gAMTha

Page #193
174 mastiSka aura jJAnataMtu kI bImAriyA~ meninjiomA : sAdI gAMTha kucha marIjoM ko ema.Ara.AI. kI kebina meM 20 se 30 miniTa sote rahanA atyaMta kaThina lagatA haiM, jise klosTrophobiA kahate haiM / aise saMjoga meM yA choTe baccoM ko kabhIkabhI nIMda kI davAI yA alpa mAtrA meM enesthesiyA dekara aisI chabI lI jA sakatI hai / (3) laMbara paMkcara dvArA kamara ke pAnI kI jA~ca kI jAtI hai, lekina agara mastiSka meM sUjana adhika ho to yaha jA~ca hAnikAraka ho sakatI hai / isalie breina TyUmara ke kesa meM isa prakAra kI jA~ca kI zakyatA bahuta kama hotI hai / mastiSka meM saMkramaNa kA ilAja jaise ki meninjAiTisa, ensephelAiTisa ityAdi meM yaha jA~ca atyaMta upayogI haiM / mastiSka kI gAMTha ke prakAra : jaise ki Age batAyA gayA hai, mastiSka kI gAMTha kensarayukta athavA binA kensara (nirdoSa) aise do prakAra kI hotI hai / jo gAMTha mastiSka ke upara ke bhAga meM hotI hai unheM suprATenToriyala kahateM hai,

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14- mastiSka meM hone vAlI gAMTha (Brain Tumour) 175 pIche yA nIce ke bhAga meM hone vAlI gAMTha ko inphATenToriyala kahate hai / isake alAvA karor3arajju meM bhI aisI donoM prakAra arthAt kensarayukta yA binA kensara (nirdoSa) kI gAMTha ho sakatI hai / kensara kI gAMTho meM kucha gAMTha bahuta hI zIghratA se bar3hatI huI gaMbhIra prakAra kI hotI haiM, jisameM marIja kI Ayu aghikAMzata: 6 mahIne se 3 varSa jitanI hI rahatI hai (jaise ki melignanTa glAyomA, enAplAsTika glAyomA, glAyoblAsTomA malTIphormI, ityAdi....) / kensara kI kucha gAMTha maMda gati se phailatI hai jaise ki esTrosAyaTomA (Astrocytoma), oligoDenDroglAyomA, ityAdi / isake alAvA mastiSka meM limphomA prakAra kI gAMThe bhI hotI hai, jo eIDsayukta marIz2a meM vizeSataH pAI jAtI haiM / binA kensara kI gAMTho meM mukhyataH meninjiomA zvAnomA aura piTyUiTarI graMthi kI gAMTha mukhya hai| zurUAta meM hI usakA nidAna huA ho aura yogya sarjana ke pAsa sahI tarIke se usakI sarjarI huI ho to marIja kI Ayu yathAvat rahatI hai, itanA hI nahIM balki kucha sAmAnya parezAniyA~ yA kamajorI choDakara mukhyataH normala jaisI hI jiMdagI rahatI hai / meTAsTeTika TyUmara

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176 mastiSka aura jJAnataMtu kI bImAriyA~ zAyada mirgI kI davAI AjIvana lenI par3atI hai| zarIra ke anya hisso meM se kensara mastiSka meM Ae to use meTAsTeTika TayUmara kahA jAtA hai| isa sthiti meM kaI bAra breina TayUmara ke cihna dvArA marIja ko anya kahIM kensara hai, aisI jAnakArI milatI hai taba atyaMta vilaMba ho cukA hotA hai| phira bhI prAImarI kensara DhUMDhakara usakI TrITamenTa karavAne se Ayu bar3hAI jA sakatI hai| upacAra : nidAna hone ke pazcAt breIna TayUmara ke upacAra meM nyUrolojisTa se adhika mahatvapUrNa bhUmikA nyUrosarjana kI rahatI hai / gAMTha kensara kI sAbita ho to onkolojisTa aura reDiyezana denevAle reDiyezana phijiziyana kI bhI adhika jarUrata rahatI hai / oNparezana aura anya upacAra ke bAda mastiSka ke zeSa lakSaNa jaise ki mirgI, sUjana aura pakSAghAta ityAdi meM nyUrolojisTa kI samaya samaya para salAha lI jA sakatI hai| breIna TayUmara ke oNparezana khUba acchI taraha vikasita hue hai, jisameM kucha prakAra kI gAMTha meM mastiSka ko binA khole gAmA reDizana se gAMTha ko Age bar3hatI rokakara use sUkhAI jAtI hai| yaha oNparezana asaphala rahe to mastiSka ko khola kara dubArA oparezana kiyA jA sakatA haiM / kucha choTI aura bAhara kI gAMTha kevala sTirioTeksisa takanIka dvArA viziSTa sUI se dUra ho sakatI hai to kucha kesa meM nizcita-viziSTa kiraNeM dvArA use jalAyA yA pighalAyA jA sakatA hai / zeSa keso meM oNparezana dvArA mastiSka yA karor3arajju kholakara saMbhava ho to gAMTha ke utane bhAga ko sarjana nikAla dete hai / kabhI mAIkroskopa kI madada se bArIkI se sUkSma sarjarI ho sakatI hai, jisase pariNAma acche mile aura normala hisse ko kisI prakAra kA nukazAna

Page #196
14 - mastiSka meM hone vAlI gAMTha (Brain Tumour) 177 na ho / isa kAraNa breIna ke kaI oNparezana 6 se 12 ghaMTo taka lambe calate hai / enesthesiyA ke vikAsa se oNparezana kA khatarA bhI pahale se bahuta kama huA hai / aise kuzala sarjana, acche sAdhana aura acche enesthesiolojisTa DaoNkTarsa pUre bhArata meM hara jagaha hai, vaha hamArA saubhAgya hai| oNparezana ke bAda phijiyotherepI kI jarurata par3atI hai| gAMTha ke upacAra daramyAna kisI prakAra kA duSprabhAva ho to usakA bhI upacAra kiyA jAtA hai| gAMTha kI bAyopsI meM agara kensara kA patA cale to kimotherepI, reDimezana ityAdi dvArA marIja ko jitanA jyAdA ThIka ho sake utanA ThIka karane kA prayAsa kiyA jAtA hai / isa prakAra breIna TayUmara nizcita hI takalIphajanaka roga hai / kintu, adhikatara aura mukhyataH binA kensaravAle marIjoM ko adhika acche pariNAma mila sakate hai| usake lie unake lakSaNoM/cihnoM ko jaldI pahacAnanA, usakA vizleSaNa karanA, tAtkAlika niSNAta DaoNkTaroM ke pAsa nidAna karavA kara zIghratA se upacAra karanA jarUrI hai, aise kesa meM saMpUrNa (yA to adhika mAtrA meM) saphalatA mila sakatI hai /

Page #197
178 mastiSka aura jJAnataMtu kI bImAriyA~ surkhiyA~ * mastiSka meM alaga alaga kAraNa se alaga alaga taraha kI gAMTha hotI hai / jo kada, AkAra, sthAna, guNavattA aura hisTolojI ke anusAra vizeSa cihna utpanna karatI hai / * saradarda, ulaTI, aMdherA chAnA, becenI laganA, pakSAghAta kA asara honA, yAdazakti bigaDanA, behoza honA, mirgI AnA vagairaha breIna Tyumara ke lakSaNa ho sakate haiM / Adhunika sTirioTeksisa takanIka aura mAikronyurosarjikala takanIka meM sudhAra Ane se tathA reDiezana tathA kimotherapI meM vikAsa hone se breIna Tyumara ke marIjoM kA vartamAna evam bhaviSya ujjavala hai /

Page #198
| seribala pAlsI (Cerebral Palsy) pratyeka haz2Ara meM 2 (do) baccoM ko honevAlA yaha lagabhaga janmagata prakAra kA mastiSka kA aisA roga hai jisameM donoM paira athavA hAtha-paira kA vikAsa atyaMta maMda ho jAtA hai| sAtha hI kucha mAtrA meM mAnasika vikalAMgatA aura mastiSka se udbhava hone vAlI mirgI hotI haiM / isa kAraNa isa roga ko seribrala pAlsI nAma diyA gayA hai / isa prakAra seribrala pAlsI (sI.pI.) kA sahI artha hai-vikasita hote hue mastika ko hAni pahu~canA / hamane Age ke prakaraNa meM dekhA ki mastiSka ke vibhinna hisse kucha nizcita manozArIrika kriyAoM kA prAraMbha aura niyaMtraNa karate hai / aba mastiSka ke jisa hisse ko hAni pahu~cI ho usa bhAga dvArA niyaMtrita kriyA hone meM parezAnI hotI hai| yaha saccAI ke kAraNa hI seribrala pAlsIgrasta baccoM meM eka yA adhika mAtrA meM takalIpha hotI haiM / isalie seribrala pAlsIgrasta do baccoM ko ekadama alaga prakAra kI takalIpha ho, vaha saMbhava hai| isa roga kI lAkSaNikatA yaha hai ki umra bar3hane se isameM dhIredhIre sudhAra hotA jAtA hai, bImArI bar3hatI yA bigar3atI nahI / isa prakAra jo bImArI dhIre dhIre bigar3atI jAtI hai, vaha seribrala pAlsI nahIM hotI / kAraNa : kucha keso meM yaha roga janmasamaya meM oNksijana kI kamI kI vajaha se hotA hai| zeSa adhikatara keso meM garbha ke vAtAvaraNa yA vikAsa meM kamI utpanna hone se aisA ho sakatA hai / vaMzAnutAgata kAraNa zAyada hI ho sakatA hai| hamane dekhA ki seribrala pAlsI mastiSka meM huI hAni ke kAraNa hai| ina kAraNoM ko hama mukhyataH tIna hisso meM vibhAjita kara sakate haiM :

Page #199
180 mastiSka aura jJAnataMtu kI bImAriyA~ (a) janma se pahale (garbhAvasthA daurAna) : (1) adhUre mahIne meM bacce kA janma honA / (2) garbhAvasthA ke zuruAta meM mAtA ko vAIrasa kA saMkramaNa honaa| (3) mA~-bApa ke rakta blaDagrupa-Rh (mAtA kA blaDagrupa-Rh negeTiva aura pitA ko pojhiTiva hone se) prakAra meM asamAnatA / (4) vaMzAnugata bImAriyA~ / (5) mAtA kI apanI hI bImArI aura garbha kA vAtAvaraNa tathA vikAsa meM kmii| (ba) janma samaya : (1) prasUti kI pIr3A bahuta laMbe samaya taka rahe aura bacce kI dhar3akana kama yA jyAdA ho / (2) aujAra se bacce kA janma karavAte samaya mastiSka ke Upara dabAva / (3) bacce ke gale ke cAroM ora garbhanAbha cipaTI ho to mastiSka ko apUrNa rakta-oNksijana milanA / (ka) janma pazcAta turaMta : (1) mirgI AnA (2) adhikatara mAtrA meM pIliyA ho jAnA (3) rakta meM zugara (cInI) kama honA (4) rakta meM saMkramaNa (5) rakta meM kelziyama kI kamI (6) mastiSka para sUjana (7) meninjAiTisa, ensephelAiTisa, ityAdi...

Page #200
181 15 - seribrala pAlsI (Cerebral Palsy) isI kAraNa yogya kesa meM navajAta bacce ko yogya nirIkSaNa tathA upacAra hetu inkyubeTara meM rakhA jAtA hai| lekina pratyeka bacce meM kAraNa mila jAe aisA nahIM hotA / uparyukta adhikatara kAraNoM ko rokA jA sakatA hai, lekina isake lie hama sabhI ko jAgrata rahanA jarUrI hai| isa kAraNa zizu kA janma (DIlIvarI) vividha suvidhAvAlI aspatAla meM niSNAta tabIba dvArA hI karavAnA caahie| * seribrala pAlsI ke prakAra : (1) spAsTika seribrala pAlsI : sI.pI. kA yaha sabase sAmAnya prakAra hai| isa prakAra meM snAyu khice hue aura kar3aka rahate hai, pariNAmataH isase asaragrasta hAtha-paira ko mor3ane yA sIdhA karane meM tAkata lagAnI par3atI hai| paira meM aMTasa yA caukar3I paDa jAtI hai| khar3e rahane yA calate samaya baccA sirpha paira ke paMje kA hI upayoga karatA hai aura eDI U~cI rakhatA hai| isakI asara zarIra ke kisa aMga meM huI hai, vaha AdhAra para usake upaprakAra nimnalikhita hai : hemIplejiyA : jaba AdhA aMga arthAt eka hAtha, eka paira aura vahI tarapha dhar3a ke snAyuo meM asara dikhatA haiM / DAiplejiyA : donoM paira ke snAyuoM para asara ho aura kabhI hAtha meM kucha asara dikheM / * kvADrIplejiyA : jaba donoM hAtha aura donoM paira tathA dhar3a ke snAyuoM para asara dikhatA hai| (2) DisakAIneTika (DisaTonika, ethiToIDa) seribrala pAlsI : zarIra ke aMgo meM anaicchika halana-calana hotA hai, jisase icchA anusAra kArya karane meM takalIpha hotI hai| zarIra dhanuSa kI taraha tirachA ho jAtA hai aura mastiSka ke niyaMtraNa meM nahIM rahatA hai /

Page #201
182 mastiSka aura jJAnataMtu kI bImAriyA~ (3) eTeksika seribrala pAlsI aura hAIpoTonika seribrala pAlsI : zarIra kA saMtulana nahIM rahatA hai aura zarIra ke snAyu bahuta DhIle rahate hai| zarIra jaise kI rabara kA banA huA ho aisA pratIta hotA hai| sI.pI. bacce meM uparyukta eka yA adhika pramANa ho sakate hai| isake uparAMta nimnalikhita kucha takalIpha sAmAnyataH dekhane ko milatI hai : (1) tirachI A~kha - 50 se 60% baccoM meM dekhane ko milatI hai| (2) draSTi meM kmii| (3) mirgI (epilepsI)-66 % / (4) sunane meM takalIpha / (5) maMda buddhi - 66 % / (6) svabhAva meM jiddIpana, ityAdi / sAmAnya jAnakArI : janma se hI seribrala pAlsI honA durbhAgyapUrNa to hai para usameM sudhAra na ho sake aisA bhI nahIM hai| kucha baccoM ko sAmAnya takalIpha ho to sudhAra zIdhra hI hotA hai| zeSa kesa meM bahuta vyAyAma (phijiyotherepI) se tathA yogya davAI ke saMyojana se laMbe samaya ke bAda kucha lAbha ho sakatA hai / isa prakAra kI bImArI meM karIba tIsa pratizata marIjoM ko tIvra roga hotA hai, jisameM acche hone kI saMbhAvanA kama hotI hai| janma pazcAta prathama mahIne taka normala dikhane vAlA baccA kramazaH usake vikAsa meM bahuta pIche raha gayA hai, aisA dikhatA hai yA to vaha baiThanA sIkha nahIM sktaa| isI prakAra calane kI kriyA jo sAmAnya saMyoga meM eka varSa kI umra meM honI cAhie, vaha adhika vilaMbita hotI hai aura calanA sIkha le to paira ke paMje para khar3e rahane kA prayatna karatA hai aura calane meM bahuta takalIpha hotI hai|

Page #202
15 - seribala pAlsI (Cerebral Palsy) 183 isI prakAra mastiSka vikAsa aura buddhizakti meM adhikatara bacce kamajora rahate hai, bolanA dera se sIkhate hai tathA uccAraNa spaSTa nahIM hote / kucha tIvra kesa meM cehare se hI bAlaka maMdabuddhi hone kA patA cala jAtA hai| isa meM se kucha bacce bahuta zarAratI aura jiddI bhI ho sakate hai aura kucha ko mirgI bhI AtI hai| paraMtu yAda rakhanA cAhie ki adhikatara baccoM ko yaha bImArI sAmAnya prakAra kI hone se kucha samaya ke bAda baccA lagabhaga sAmAnya ho sakatA hai| paraMtu jina baccoM ke hAtha-paira saMpUrNataH asarayukta ho, mastiSka meM adhika hAni ho aura maMdabuddhi kA ho usakA upacAra atyAdhika muzkila nidAna : janma pazcAt bAlaka kA umra ke sAtha vikAsa nahIM hotA, vaha mAtApitA ko sabase pahale dhyAna meM AtA haiM / bAlaka gardana kar3aka-TaTTAra rakhanA, najara ghumAnA, karavaTa badalanA, baiThanA, calanA ityAdi sIkha nahIM sakatA / bAlaka agara maMda buddhi kA ho to mAtA-pitA yA ghara ke sadasyoM ko pahacAnanA bhI nahIM sIkha sktaa| bacce ke janmasamaya kI jAnakArI, janma ke turaMta bAda bacce ke rone meM derI, zvAsocchvAsa meM takalIpha yA baccA paidA hokara nIlA par3a gayA ho, aisI koI jAnakArI mileM to nidAna sarala ho jAtA hai / kucha kesa meM hI ema.Ara.AI. yA anya jA~ca karavAnI par3atI hai / * upacAra : seribrala pAlsI kI koI jAdUI yA camatkArika davAI yA oNparezana nahIM hai, lekina isase hatAza hone kI jarUrata bhI nahIM hai / aise bacce ko zIdhra se zIdhra kucha khAsa prakAra kI tAlIma cAlU karavAnI par3atI hai / pA~ca varSa se kama kI umra ke baccoM ko denevAlI tAlIma ko arlI inTaravenzana

Page #203
mastiSka aura jJAnataMtu kI bImAriyA~ (Early Intervention) kahate hai / isa tAlIma meM bAlaka kI paristhiti ko dhyAna meM rakhakara nIce batAe hue logoM kA samanvaya aura yogadAna jarUrI hai : 184 4. oNkyupezanala therApisTa speziyala TIcara isake uparAMta jarUrata par3e to orthopiDika DaoNkTara, A~khoM ke DokTara aura nyUrolojisTa kA abhiprAya jarUrI hai / davAI meM kar3aka snAyuoM ko narma arthAt DhIlA karane ke lie davAI kA upayoga kiyA jA sakatA hai / yogya mAmale meM boTulinama Toksina ke iMjekazana yogya mAtrA meM snAyuoM meM dene se kaI bAra atyaMta acche pariNAma mila sakate haiM aura kucha marIja apanA kAma svayaM kara sakate hai, aura svayaM ghuma phira sakate hai / 5. 6. DevalapamenTala phijiyotherApisTa cAilDa sAIkolojisTa spIca therApisTa aura oNDiyolaoNjisTa 7. yogya kesa meM hAtha-paira kI choTI-bar3I sarjarI / upacAra aura tAlIma kA lakSya : pratidina ke kArya meM svAvalaMbana sAmAjika yogyatA - zaikSaNika yogyatA Arthika svAvalaMbana

Page #204
15- seribrala pAlsI (Cerebral Palsy) Apane dekhA ki yaha roga kI sAravAra maryAdita hai, isalie hamArA mukhya lakSya aTakAva (Prevention) honA caahie| garbha ke vikAsa daurAna gAyanekolojIkala niyamita parIkSaNa, aspatAla meM prasUti aura janma ke bAda zizu kI yogya dekhabhAla se roga ko 70 pratizata taka rokA jA sakatA hai| nyUroproTekTiva davAI, magneziyama salpheTa, InDomithAsina aura yogya samaya para sijheriyana oNparezana kA nirNaya isameM lAbhadAyI hai / upasaMhAra : I sI.pI. grasta 33 % baccoM kA buddhiAMka acchA hotA haiM / ye bacce skUla meM jA sakate haiN| zeSa baccoM ko speziyala skUla meM tAlIma dI jAtI hai / 185 dukhaH kI bAta hai ki aise baccoM kA janma, kudarata kA abhizApa mAnA jAtA hai / samAja aura kuTuMba ke lie ye bacce jimmedArI aura samasyA banakara raha jAte hai / cikitsAvijJAna kA itanA vikAsa hone ke bAvajUda hama aise kesa ko roka nahI sakate hai yA usakA yogya upacAra bhI nahIM kara sakate hai / isa kAraNa hama saba kI yaha sAmAjika, naitika aura mAnavIya pharja hai ki aise baccoM kA upacAra aura prazikSaNa pradAna karane vAlI saMsthAo athavA phijiyotherepI senTaroM ko yogya Arthika sahAyatA de kara yA aisI nayI saMsthAe~ sthApita karake, saMbhava ho to aisI saMsthAoM meM kucha ghaMTe bitAkara baccoM ke vikAsa meM madada kareM aura unheM yogya pyAra aura sahayoga deM / ina baccoM ko dayA kI nahi, sneha aura sahayoga kI jyAdA jarUrata hotI hai /

Page #205
186 mastiSka aura jJAnataMtu kI bImAriyA~ (surkhiyA~ * baccoM ko honevAle yaha roga meM donoM paira athavA hAtha-paira kA vikAsa atyaMta maMda ho jAtA hai / kabhI kabhI mirgI ke sAtha mAnasika vikalAMgatA bhI hotI hai| * isa roga kA pramANa 0.2% hai / isa roga ke kAraNa meM janma samaya oNksijana kI kamI, garbha ke vikAsa meM kamI, janma samaya para aujhAra ke istemAla se huI hAnI, janmabAda turaMta mirgI AnA yA pilIyA ho jAnA vagairaha hai| spAsTika seribrala pAlsI, DisakAIneTika seribrala pAlsI, eTeksika seribrala pAlsI aura hAIpoTonika seribrala pAlsI, yaha saba seribrala pAlsI ke prakAra hai / umra bar3hane se yaha roga meM sudhAra AtA hai / 33% bacce acche buddhiAMka vAle hote hai, jo Ama skUla jA sakate hai, bAkI ke baccoM ko spezyila skUla meM tAlIma dI jAtI

Page #206
aba taka hamane mastiSka saMbaMdhita rogoM ke viSaya meM dekhA, aba cetAjJAnataMtu aura snAyuoM ke roga ke viSaya meM jAnane se pahale saMkSipta meM karor3arajju ke rogoM ke saMdarbha meM jAnegeM / baDA mastiSka korpasa keloyama RAthelemasa hAIpothelemasa - choTA mastiSka MARARAMBRI sarvAikala korDa karoDarajju -Dorsala korDa 19023823301CUECOSISTERS -- lambara vibhAga -203RRIES ----konasa meDyUlArisa Spinal Cord mastiSka se pasAra honevAlI saMvedanAoM ko cetA aura snAyuoM taka pahu~cAne vAlA mukhya rile sTezana (prasAraNa kendra) hai karor3arajju (SPINAL CORD) / karoDa (merudaMDa) ke maNake ke bIca sahI taraha se surakSita karor3arajju ..

Page #207
188 mastiSka aura jJAnataMtu kI bImAriyA~ kA eka bahuta mahattvapUrNa aMga hai| karIbana 30 prakAra kI bImArIyA~ karor3arajju meM ho sakatI hai, jo usakI kArya paddhati aura racanA, saMvedanA-parivahana kArya, usakI laMbAI, usakA silinDara jaisA AkAra, bahuta kama caur3AI, usake AvaraNa, usakI rakta vAhiniyA~ aura karoDa (merudaMDa) ke maNake ke sAtha usakA saMbaMdha, ityAdi ke anusaMdhAna meM samajhAyA jA sakatA haiN| * karor3arajju saMbaMdhita bImArIoM ke cihna : - - donoM paira kamajora ho jAnA yA niSkriya ho jAnA / pUre paira meM jhunajhunI honA yA sunna par3a jAnA / hAtha-paira meM kamajorI AnA / mala/mUtra kA ruka jAnA yA usakA aniyaMtrita ho jAnA / hAtha-paira ke kisI bhAga meM niraMtara darda honA / paira meM se cappala nikala jAe to patA na cale athavA paira ke nIce gaddI jaisA laganA, jalana honA, hAtha-paira para cITiyoM calane jaisA anubhava honaa| - hAtha-paira ke snAyu sUkhanA / karor3arajju kI bImArI mukhyata: lakSaNoM-cihnasamUha (Syndrome) ke rUpa meM dikhAI detI hai aura vaha nizcita prakAra ke hone se usakA ilAja bhI adhikatara spaSTa hotA haiN| karor3arajju kI ina saba bImAriyoM ko mAyalopathIMyelopathy kahate haiN| gardana ke maNake ke bIca AnevAlI karor3arajju ko nukasAna ho to use Cervical Myelopathy (sarvAikala mAyalopathI) kahate haiM, jisameM paira uparAMta hAtha ke halanacalana kI kriyA tathA saMvedanAoM ko bhI asara pahu~catI pITha ke maNake ke bIca kI karor3arajju ko nukasAna huA ho to sirpha paira ke (eka yA donoM) halanacalana ko tathA saMvedanAoM ko asara pahu~catI hai, sAtha meM mala-mUtra kI kriyA para bhI asara ho sakatI haiM / ise Dorsal Myelopathy (Dojhala mAyalopathI) kahate haiM / mala-mUtra kI linacalana ko tathA saMvedanAkasAna huA ho

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189 16 - karor3arajju ke roga (Myelopathy) yaha samajhanA cAhie ki - 1. karor3arajju sAmanyataH kamara ke maNake meM hotI nahIM hai| arthAt Lumbar One (L1) maNake se karor3arajju samApta hotI hai / jise konasa meDyulArisa kahate haiM, vahA~ se vaha cetAoM meM parivartita hotI hai, jise Cauda Equina (ghor3e kI pUMcha jaisA jJAnataMtuoM kA jhuMDa) kahate haiM / kevala karor3arajju ke rogo meM mastiSka saMbaMdhita cihna nahIM hote, jaise ki bolanA, samajanA, A~kha, kAna, sugaMdha ityAdi jJAnendriya kriyA, mirgI, eka taraphA aMgo kA pakSAghAta, mu~ha kA pakSAghAta / yaha saba cihna hone se vaha karor3arajju ke alAvA koI anya bImArI ho sakatI haiN| Back Cross Section of the Spinal Cord Front karor3arajju kA Ar3a cheda karor3arajju ke rogoM ke lakSaNa : (1) karor3arajju kI tamAma saMvedanA eka nizcita stara ke bAda kaTa jAnA, sAtha hI donoM paira niSkriya ho jAnA, halana calana baMdha ho jAnA, mala-mUtra ruka jAnA, jaise ki sar3aka durghaTanA se huA maNake kA phekcr| kucha saMvedanAvAhaka nase kArya karanA baMda kara de, aura sAtha hI naso meM darda hokara usakA kArya kama ho jAe / (MyeloRadiculopathy), jaise ki sponDilosisa / (2)

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190 mastiSka aura jJAnataMtu kI bImAriyA~ (3) karor3arajju kI 50 pratizata kAryavAhI baMda honA (brAuna sikvrdd-siinddrom)| usase eka tarapha ke paira kI halacala baMdha hotI hai, aura dUsare tarapha ke paira kI saMvedanA baMda hotI hai| (4) karor3arajju ke agale bhAga kA kAma karanA baMda honA (jaise ki rakta nalI kA baMda ho jAnA) / (5) karor3arajju kA bilakula Upara ke bhAga meM daba jAnA (Foramen Magnum Compression) / (6) siriMgomAyeliyA : karor3arajju ke bIca kA bhAga rikta ho kara pravAhI bhara jAnA, jisase hAtha kI naseM sUkhe, pezAba ruke / (7) konasa meDayulArIsa sinDroma : karor3arajju ke aMtima bhAga meM dabAva yA gAMTha honaa| (8) koDA ikvAInA sinDroma : karor3a meM (merudaMDa) se nikalane vAlI aMtima jJAnataMtuo ke jhuMDa kI bImArI / isa prakAra anya tarIke se karor3arajju kI bImAriyoM ko do hisse meM vibhAjita kiyA jA sakatA haiM : (1) karor3arajju para dabAva kA asara honA (Compressive Myelopathy): udA. gAMTha, paru ityAdi se hone vAle dabAva / (2) karoDarajju para dabAva na ho, aisI bImAriyA~ (Noncompressive Myelopathy) : jisameM karoDa (merudaMDa) kA saMkramaNa, viTAmina kI kamI, sUjana, ghisAva (degeneration), rasAyanoM aura davAI se Ar3aasara ityAdi sammilita hotI haiN| yaha saba meM MRI, Myelography, Lumbar Puncture (kamara ke pAnI kI jAMca) Adi dvArA nizcita nidAna tathA ilAja ho sakatA haiN|

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. mamigame nedabana KED.. 16 - karor3arajju ke roga (Myelopathy) 191 (1) aba hama karor3arajju para dabAva ke saMdarbha meM dekheMge : PPIN SHASERAI (1) karor3arajju meM bIca meM gAMTha ho yA bIca meM pAnI bhara jAe use inTrAmeDayUlarI prakAra kA karor3arajju kA roga kahate haiM, jise meDikala nyUrolojI jA~ca meM turaMta hI pakar3a sakate hai aura ema.Ara.AI. dvArA sunizcita kara sakate haiM / (2) karor3arajju ke AvaraNoM kI gAMTha (meninjiomA) yA karor3arajju meM se nikalanevAlI cetA kI gAMTha (shvaanomaa)| (3) karor3arajju ke AvaraNoM para kensara yA limphomA kI gAMTha / (4) karor3arajju ke AvaraNoM kI bAhya gAMTha // : lAyapomA ityAdi / (5) karor3a (merudaMDa) ke maNake kA phekcara, usakI gAMTha ( bona TyUmara), sarvAikala sponDilosisa, maNake meM mavAda honA, jaise ki, TIbI, do maNake ke bIca kI gaddI khisaka jAnA, phlurosisa se maNake karor3arajju kA ema.Ara.AI. kA ghisaav| ina saba dvArA karor3arajju para dabAva hotA hai, jo upara ke citra meM darzAyA haiN| ina saba meM vAhana-durghaTanA se hone vAle karor3arajju ke ghAva sabase adhika dekhane ko milate hai aura isakA upacAra adhikatara kaThina hotA haiM / isake pazcAt sarvAikala sponDilosisa ke kAraNa karor3arajju aura naso meM hone vAle dabAva ke cihna bahuta pracalita hai / jisake lie oparezana kI AvazyakatA ho sakatI hai| yaha adhikatara vayaska logoM meM hotA hai|

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192 mastiSka aura jJAnataMtu kI bImAriyA~ sarvAikala sponDilosisa : bar3hatI umra ke sAtha karor3astaMbha meM gharSaNa paidA hotA hai aura eka prakAra kI sUjana hotI hai / gharSaNa kI pratikriyA ke sAmane kucha sthAnoM para asthi (haDDI) bar3hatI hai (osteophyte) aura do maNake ke bIca kI gaddI meM ghisAva AtA haiN| usakA jileTIna maTiriyala gaddI ghisane se bAhara nikalatA haiM / vaha samaya jAne para karor3arajju para dabAva DAlatA hai aura cihnasamUha paidA karatA hai| dabAva sIdhA karor3arajju para ho to use mAyalopathI kahate haiM / adhikatara keso meM gardana kI (sarvAikala) karor3arajju para dabAva hotA hai| CH-CE CA-CE; jise sarvAikala mAyalopathI kahate haiM / usI taraha Dorjala (pITha) mAyalopathI ho sakatI hai / ___dabAva cetA para ho arthAt sAIDa meM ho to use reDikyulopathI kahate haiM, jisameM saMbaMdhita cetA para jalana, jhunajhunI aura darda hotA hai; sAtha meM vahA~ saMvedana kama ho sakatA hai (sensarI reDikyulopathI) aura usase uttejita hone vAle snAyuoM kI kAryakSamatA kama hokara utane snAyu kamajora ho jAte haiM (moTara reDikyulopathI) / lambara (kamara) hisse meM karor3arajju nahIM hotI, isalie cetA para hI asara hotI hai| jaise ki reDikyulopathI yA koDAikvAinA sinDroma / anya kucha keso meM gardana yA karoDa meM anya jagaha kevala darda hI hotA hai| yaha darda bahuta pIr3AdAyaka hotA hai| yogya jA~ca se isakA nidAna aura ilAja hotA hai / mukhya TesTa ema.Ara.AI. hai| adhikatara saMpUrNa karor3a kI hI ema.Ara.AI. karanI par3atI hai, kyoMki sponDilosisa eka sAtha eka se adhika sthAna para hotI hai; jaise ki sarvAikala (gardana) tathA lambara (kamara) sponDilosisa /

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193 16 - karor3arajju ke roga (Myelopathy) yaha bImArI umra aura ghisAva se saMbaMdhita hone ke kAraNa ise rokanA kaThina hai, lekina gardana ko jhaTakA na lage, gardana para bahuta bojha na DAlA jAe aura AvazyakatA ho to kolara pahanakara gardana kA halanacalana ghaTAyA jAe to ghisAva avazya kama hogA / jaba cetA yA karor3arajju para dabAva adhika ho taba sAdhAraNa vyAyAma tathA darda kI davAI kA upayoga karanA cAhie aura jarUrata par3ane para anya yogya kesa meM Trekazanayukta (khiMcAva) vyAyAma kiye jA sakate haiM / kabhIkabhI sTIroIDa grupa kI davAI bhI anubhavI DaoNkTara upayoga meM lete haiM / sarjarI se adhikatara bahuta acche pariNAma Ate haiM, jisase darda calA jAtA hai, calane meM saralatA hotI hai aura Age batAe gae reDikyulopathI tathA mAyalopathI ke cihna kAphI mAtrA meM kama ho jAte haiN| (2) karor3arajju kI anya prakAra kI bImArI ko nonakompresiva mAyalopathI kahate haiM jisake kaI kAraNa haiM, jisameM mukhya nimna anusAra haiM : (1) karor3arajju kI aneka prakAra ke vAirasa kI bImArI jisameM harpisa, rebisa aura eIDsa ke vAirasa bhI zAmila haiM / isako vAirala mAyalAITisa kahate hai / (2) TI.bI., mavAda ke saMkramita jaMtU, phaphUMda, siphilisa ityAdi aneka prakAra ke saMkramita roga / ye bhI mAyalAITisa (Myelitis) hai| (3) karor3arajju kI anya prakAra kI sUjana jaise ki... rebisa TIke ke duSprabhAva se karor3arajju kI kAryavAhI ruka jAnA / malTipala sklerosisa (DimAyalIneTiMga DisIz2a) kolejana udA. lyupasakA karoDarajju se hotA roga / * zarIra meM kahIM kensara ho aura karor3arajju meM sUjana aaye| reDiyezana (vikiraNa) se karor3arajju ko hAni honA / upara ke tInoM (1), (2), (3) ko mAyalAITisa (Myelitis) karor3arajju kI sUjana kahA jAtA hai /

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194 mastiSka aura jJAnataMtu kI bImAriyA~ (4) karor3arajju meM raktapravAha kama honA / (5) karor3arajju meM hemareja honA, jaise ki rakta kI nalikAoM ke jhuMDa kA phaTanA / (6) Vitamin B12 yA Folic acid kI kamI se karor3arajju ko nukasAna honaa| kabhI kabhI Vit. E kI kamI se bhI nukasAna honaa| (7) masUra kI dAla jyAdA khAne se hone vAlA Lathyrism tathA anya AhAra aura davAI, rasAyanoM se hote duSprabhAva saMbaMdhita karor3arajju ke jaharIle roga (Toxic Myelopathy) / (8) karor3arajju ke vaMzAnugata gharSaNa kI bImArI jaise ki phemiliyala spAsTika perAplejiyA (Familial Spastic Paraplegia), spAinoserIbelara Disiz2a, ityAdi / (9) moTara nyUrona Disiz2a jaise ajJAta kAraNoM se hone vAle ghisAva ke rog| (10) laMbe arase kI kaleje aura gur3ade kI bimArI se karor3arajju ko nukasAna honA / (11) ajJAta kAraNoM se karor3arajju ko hAni honA / karor3arajju kI ina sabhI bImAriyoM kA nidAna itanA adhika kaThina nahIM hai, eka prakAra kA gaNita hI hai| kucha anubhava aura sUjhabUjha ho to vistRta meDikala jAnakArI aura suyogya nyUrolojikala jA~ca dvArA nizcita nidAna ho sakatA haiN| nidAna kI nizcitatA ke lie karor3arajju ke mukhya riporTsa (jA~ca) nimna anusAra haiM : 1. karor3arajju kI ema. Ara. AI. jA~ca yA sI.TI. skaina / 2. kamara ke pAnI kI jA~ca / 3. mAyalogrAphI /

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195 16 - karor3arajju ke roga (Myelopathy) 4. viziSTa leboreTarI jA~ca, bAyokemisTrI ityAdi / 5. kabhIkabhI I.ema.jI., ena.sI.vI., vI.I.pI., aura jineTika jA~ca ityAdi kI AvazyakatA bhI rahatI haiN| upacAra : yogya upacAra hetu saMpUrNa nidAna honA bahuta jarurI hai / karor3arajju meM dabAva ke kAraNa bImArI kI paristhiti kA nirmANa ho to, sabase pahale yaha dekhanA cAhie ki zastrakriyA saMbhava hai yA nahIM ? bahuta laMbe, jaTila yA mAIkroskopa kI madada se hone vAle oNparezana se lekara alTrAsAunDa kI madada se gAMTha nikAlane (CUSA) ke oNparezana bhI hamAre deza meM upalabdha hai| karor3arajju kI sarjarI sAmAnyataH itanI kharatanAka nahIM hai, paraMtu itanA satya hai ki ise nAjukatA se, kuzalatA se bahuta jahematapUrvaka aura saMpUrNata: vyavasthita tarIke se karanI par3atI hai, kyoMki bahuta kama cauDAIvAle isa aMga meM atyaMta ThAMsakara cetAtaMtu bhare hue haiM, isa kAraNa kisI bhI prakAra kA nukasAna na ho isalie zastrakriyA ke samaya sAvadhAnI rakhanI par3atI hai| isake alAvA dabAvavihIna rogo meM cikitsA, roga anusAra kI jAtI hai, jaise ki... (1) TI.bI. kA upacAra / (2) malTipala sklerosisa aura aise anya DimAilineTiMga Disiz2a meM tathA kolejana kI bImArI meM sTiroIDsa davAI / (3) viTAmina kI kamI pUrNa karanA ityAdi / (4) nayI upacAra paddhatiyoM meM sTemaselatherapI AzAspada hai - khAsa karake akasmAta se karor3arajju ko nukasAna huA hau taba usake pariNAma kAphI acche mile hai| sAmAnyataH vaMzAnugata bImAriyA~ yA ghisAva se saMbaMdhita rogoM kI (jaise ki moTara nyUrona Disiz2a) kucha khAsa davAI abhI taka saMzodhita nahIM huii|

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mastiSka aura jJAnataMtu kI bImAriyA~ ina sabhI bImAriyoM meM vizeSataH yogya phijiyotherepI (vyAyAma) karanA jarUrI hai| sAtha hI pauSTika AhAra lenA aura pITha kI tvacA meM chAle na par3e isakA dhyAna rakhanA | mala-mUtra tyAga kI takalIpha ho to usakA yogya upacAra karavAnA cAhie / 196 karor3arajju kI sabhI bImAriyoM ke viSaya meM jagaha kI kamI ke kAraNa likhanA saMbhava nahIM haiM / surkhiyA~ karor3arajju, mastiSka se pasAra honevAlI saMvedanAoM ko cetA aura snAyuoM taka pahuMcAne vAlA prasAraNa kendra hai / isameM honevAlI bImAriyoM ke samUha ko mAyalopethI kahate hai / * sarvAikala mAyalopethI, DorsalamAyalopethI vagairaha mAyalopethI ke prakAra hai / * karor3arajju kI ema. Ara. AI. jAMca yA sITIskaina, kamara ke pAnI kI jAMca, mAyalogrAphI, viziSTa leboreTarI jAMca, i.ema.jI., ityAdi se roga ke bAre meM acchI taraha se jAnA jA sakatA hai / * karor3arajju kI sarjarI niSNAta ke pAsa sAmAnyataH sarala hai, isIliye saphalatA se kI jA sakatI hai /

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(17) malTipala skle rosisa (Multiple Sclerosis)] mastiSka aura karor3arajju kI bImAriyA~, jisameM mAyalina kI parata yA vhAiTa meTara ko nukasAna huA ho to use DimAyalineTiMga Disiz2a kahate haiM / manuSya ke zarIra ke cetAtaMtra ko kArya tathA racanAkIya draSTi se gre-meTara aura vhAiTa meTara meM vibhAjita kiyA jAtA hai / vhAiTa meTara ko ilekTrisiTI ke vAyara kI taraha mAnA jA sakatA hai, jo gre-meTara ke koSoM meM se udbhava hone vAle spaMdana aura AjJAoM ko cetAtaMtra ke anya hisse taka pahu~cAne kA mahattvapUrNa kArya karatA haiN| jisa prakAra bijalI ke tAra meM insyulezana ke lie bAhara parata hotI hai, usI prakAra vhAiTa meTara meM insyulezana ke lie mAyalina kI parata hotI haiM / vhAiTa meTara mAyalina ko hAni pahu~cAne vAlI bImAriyoM ko DimAyalineTiMga Disija kahate haiN| usameM sabase mukhya hai-atyaMta vicitra aura takalIpha denevAlA roga malTipala sklerosisa / sarala bhASA meM kaheM to kisI prakAra kI elarjI yA mastiSka kI cayApacaya kI prakriyA meM gar3abar3a hone se vhAiTa meTara ko nukasAna hotA hai, use DimAyalinezana aura glAyosisa kahate haiN| yahA~ mukhyata: mastiSka, karor3arajju aura vizeSataH A~kha ke jJAnataMtu kI takalIpha ke cihna zuru hote haiM / * malTipala sklerosisa : roga saMdarbha meM sAmAnya jAnakArI : * roga kA pramANa striyoM meM puruSoM se dugunA hotA hai / vaha sAmAnyataH 15 se 50 kI umra ke vyaktiyoM meM dekhane ko milatA hai| bahuta choTe baccoM ko aura vRddha puruSoM ko yaha sAmAnyataH nahIM hotaa| yaha roga skoTalenDa, uttarIya yuropa aura amerikA meM vizeSataH dekhane ko milatA hai| viSuvavRtta se dUra ke pradezo meM yaha adhika pracalita hai / isalie hamAre deza meM isakA pramANa kama hai aura japAna tathA sAutha aphrikA meM bhI nahIM jaisA hai / vicitra jIvanazailI ke kAraNa hamAre yahA~ bhI yaha roga bar3hatA jA rahA hai|

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198 mastiSka aura jJAnataMtu kI bImAriyA~ isa bImArI ke kAraNa mastiSka kI adhikatara bImAriyoM kI taraha jaTila hai aura vaha abhI bhI pUrNataH jAne nahIM gaye hai| kaI keso meM bImArI vaMzAnugata hai| lekina kaI keso meM vaMzAnugata kAraNa mAnA nahIM gayA haiN| vAyarasa elarjI yA to paryAvaraNa ke kAraNa aura zAyada AhAravihAra kI gar3abar3a se yaha bImArI ho sakatI hai / * bImArI ke lakSaNa : eka yA adhika aMgo kA pakSAghAta honA : 35 % kesa meM draSTi meM kamI honA yA eka cIja do dikhanA : 36 % kesa meM zarIra ke kucha hisse meM saMvedanA lupta ho jAnA (37 % kesa meM) athavA galata saMvedanA honA jaise ki sUI cubhatI ho aisA laganA (26 % kesa meN)| zarIra kA saMtulana bigar3anA, cakkara AnA, mala-mUtra tyAga meM parezAnI honaa| yAdadAsta kama honA aura mirgI AnA / / isake uparAMta hAtha-paira meM kaMpana, darda, jAtIya jIvana kI parezAnI aura unmAda se lekara hatAzA jaisI mAnasika bImArI dekhane ko milatI hai| ina sabhI meM se koI eka yA adhika lakSaNoM ke sAtha yaha bImArI zuru ho kara, yA to.... (i) Relapsing & Remitting Multiple Sclerosis - RRMS : yaha prakAra meM bImArI ke lakSaNa saMpUrNa tarIke se cale jAte hai aura bAda meM bArabAra usake aise hamale Ate rahate hai aura dardI paravaza ho jAtA hai| (ii) Primary Progressive Multiple Sclerosis - PPMS : yaha prakAra meM eka bAra lakSaNa zurU hone kA bAda hamezA ke lie roga Age bar3hatA hai|

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17 - malTipala skle rosisa (Multiple sclerosis) 199 (iii) Secondary Progressive Multiple Sclerosis - SPMS : RRMS kI taraha zurU hone vAlI yaha bImArI ke lakSaNa thoDe samaya ke bAda kAyamI bar3hane vAlI (progressive) bImArI ke rUpa meM parivartita ho jAte hai / * bImArI kA nidAna : uparyukta lakSaNa mukhyataH draSTi saMbaMdhita athavA pakSAghAta yA saMtulana saMbaMdhita dikheM to phijiziyana/nyUrolojisTa kA saMparka karanA ati mahattvapUrNa haiN| bImArI kI jA~ca meM rakta kI kucha jA~ca ke uparAMta mukhyataH megneTika resonansa imejiMga (ema.Ara.AI.) kI AvazyakatA rahatI haiN| A~kha kI jAMca malTipala skalerosisa (Fundoscopy) se reTinA meM lAkSaNika phikApana dekhA jAtA hai| isake uparAMta sI.esa.epha. (lambara paMkcara) jA~ca kI bhI khUba jarUrata par3atI hai| sI.esa.epha. meM koSoM kI saMkhyA meM bar3hottarI ke mukAbale proTIna kI mAtrA jyAdA pAI jAtI hai aura usameM bhI imyunoglobyulina (IgG) mukhyata: bar3hatA hai / olIgoklonala benDa dikhatA hai aura mAyalina besika proTIna kI mAtrA adhika hotI hai / kucha viziSTa keso meM CSF enTI ena.ema.o. enTIbaoNDI kI bhI jA~ca kI jAtI hai / VE.P., S.S.E.P., B.E.R.A. jA~ca nidAna ke samarthana meM bahuta sahAyaka siddha hotI haiN| tabIbI zArIrika jA~ca aura upara batAI gaI jA~ca dvArA bImArI kA nidAna sahI DhaMga se ho sakatA hai /

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200 mastiSka aura jJAnataMtu kI bImAriyA~ upacAra : kucha varSa pahale taka asAdhya samajhI jAnevAlI isa bImArI ke upacAra meM Adhunika cikitsA vijJAnane AMzika saphalatA prApta kI hai| (1) bImArI kA hamalA ho taba turaMta hI sTiroiDsa mukhyataH mithAila preDnisolona yA e.sI.TI.eca. (A.C.T.H.) yA preDnisolona nAmaka davAI upayoga kI jAtI haiM / (2) bImArI dhIre dhIre bar3hate hue kAyamI bane taba mithoTrekSeTa yA to ejhAthAyoprIna ityAdi davAI kabhI-kabhI dI jAtI hai| lekina ye bahuta upayogI mAlUma nahIM huI / (3) inTarapherona B1b (bITA serona), inTarapherona B1a ( evonekSa UM, rebIpha SIC), kopekSona (gleTirAmara) tathA kopolimara (Copolymer) jaisI davAI hamale ko rokane ke lie upayogI hotI haiN| ina davAI ko upacAra hetu mUlabhUta davAI kaha sakate hai| yaha davAI maha~gI hotI hai aura unheM niSNAta DokTara kI dekharekha meM hI dI jAnI caahie| (4) Mitoxantrone aura Natalizumab davAI bhI bArabAra hamalA honevAle marIjo meM asarakAraka hai / (5) kucha kesa meM gAmA-globyulina nAmaka maha~gI davAI asarakAraka sAbita huI haiN| (6) sTemasela therepI se kucha keso meM acche pariNAma mile hai, lekina Age saMzodhana kI isameM jarurata hai / (7) isake uparAMta isa bImArI meM aura bhI bahuta se cihna hote haiN| atyaMta darda, hAtha-paira kA kar3akapana athavA kaMpana, smRtibhraMza honA, mala-mUtra tyAga meM parezAnI, kamaz2orI, thakAvaTa, jAtIya jIvana kI parezAnI, hatAzA jaisI mAnasika vyathA jaise aneka cihna hote hai| jinakA yogya upacAra karanA caahie|

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201 (6) roga 17 - malTipala skle rosisa (Multiple sclerosis) malTipala skalerosisa kI sAravAra ke kucha siddhAMta : (1) jaba roga kA nayA hamalA Ae aura bhArI ho, taba sTIroIDsa (intravenous) denA caahie| (2) RRMS dardIoMko immunomodulatory davAIyA~ denI caahie| (inTarapherona, kopekjhona, mAITojenTrona ityAdi) (3) sekanDarI progresIva roga ke rogiyoM ko bahuta jaldI se bhArI sAravAra denI caahie| (4) prAimarI progresIva prakAra ke rogI ko sAmAnyataH koI davAI se phAyadA nahIM hotA hai| (5) malTipala sklerosisa eka jiMdagIbhara calane vAlI bImArI hai| isalie isakI sAravAra bhI baMda nahI karanI cAhie / roga ke dardI kI bahuta najadIka meM bArabAra zArIrika tapAsa evaM niyamita taura se ema.Ara.AI. jA~ca karanI cAhie / dimAga aura karoDarajju kA konTrAsTa ema.Ara.AI. thoDe-thoDe samaya ke bAda karate rahanA cAhie / NMO (Neuromyelitis Optica) : nyUromAyalAITisa opTikA : bilakula malTipala sklerosisa jaisI lagane vAlI yaha bImArI meM karor3arajju ke tIna se jyAdA segmenTasa meM DimAyalinezana (sUjana) hotI hai jisako mAyalAITisa kahA jA sakatA hai / sAtha meM A~kha kI dRSTi ko kSati hotI hai / isake nidAna ke lie breIna, oNpTika narva aura karor3arajju kA konTrAsTa ema.Ara.AI. aura CSF meM enTI ena.ema.o. enTIbaoNDI kI jA~ca kI jAtI hai| yaha roga sTiroIDsa se kAbU meM A sakatA hai, para gAmAglobyUlina aura plAjhamA eksaceMja se bhI bahuta phAyadA hotA hai, jo sAravAra malTipala sklerosisa meM itanI upayogI nahIM hai /

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202 // mastiSka aura jJAnataMtu kI bImAriyA~ ADEM (Acute Disseminated Encephalomyelitis) : ADEM ho sakatI hai| cecaka yA rebIz2a ke ho sakatI hai| kabhIkabhI dhanurvA ke zarIra ke kisI prakAra ke vAyarasa ke saMkramaNa (jaise ki cecaka, achabar3e yA anya) ke bAda thor3e dina meM jaba nyUrolojikala bImArI ho taba adhikAMza vaha - ADEM nAmaka bimArI ho sakatI hai, jisameM bar3e yA choTe mastiSka, karor3arajju athavA donoM se saMbaMdhita cihna - samUha dikhate haiM / vAyarasa bImArIgrasta logoM meM do hajAra meM se eka yA do ko yaha takalIpha TIke ke bAda bhI kaI bAra yaha bImArI TIke se hue kesa bhI dekheM hai / choTe baccoM meM kaI bAra yaha pramANa adhika hotA hai aura kucha kesa meM hamezA ke liye yAdadAsta vyavahAra meM parivartana yA mirgI jaise lakSaNa dekhe jAte haiM / vayaska logoM ko isameM saubhAgyavaza zIghra aura adhika lAbha hotA hai| choTe mastiSka kI takalIpha meM sudhAra adhika acchI taraha hotA hai / yaha bImArI vAyarasa se hone vAle mastiSka ke pratyakSa nukasAna se alaga hai, kyoMki mastiSka kI mAikroskopika yA anya jA~ca meM vAyarasa dikhAI nahIM dete haiM / sAmAnyataH vAyarasa kA roga hone ke kucha dinoM bAda (2 se 20 dina) yaha bImArI zuru hotI hai / isa para se yaha mAnA jAtA hai ki yaha zarIra kI rogapratirodhaka kSamatA meM huI kamI - kharAbI se saMbaMdhita roga hai (immune mediated) / hAlAMki naI atyAdhunika paddhati se, DNA ghaTakoM kI vAyarasa ke sAtha saMbaMdhita kar3I prasthApita hotI hai /

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17- malTipala sklerosisa ( Multiple Sclerosis) cihna (1) ensephelAiTisa prakAra kI yaha bImArI meM tIvra becainI, asamaMjasa, adhika mAtrA meM nIMda aura mirgI A sakatI hai| sAtha hI sira darda, bukhAra AnA ityAdi hotA hai / asaMtulana hotA hai aura jhaTake bhI Ate hai / gaMbhIra keso meM hoza - satarkatA kama ho jAtI hai marIja behoza ho jAtA hai aura bAda meM zvAsa kI layabaddhatA calI jAtI hai / 1 I : (2) mAyalAITika prakAra kI bImArI meM karor3arajju se saMbaMdhita cihna hote haiM, use Postinfective Myelitis yA Transverse Myelitis kahate haiM / usameM donoM hAtha-paira kA kamaz2ora honA, saMvedanA kA kama honA aura mala-mUtra ruka jAnA samAviSTa hai / I 203 Measles, Mumps ke vAyarasa meM tvacA para cAThe ( rash) par3anA mukhya hai| usake 2-4 dinoM ke bAda ADEM bImArI hotI hai aura bacce ko dubArA bukhAra, mirgI AtI hai aura behoza ho jAtA hai / Measles, Mumps ke bAda choTe mastiSka kI bImAriyA~ adhika dekhane ko milatI haiN| isameM zArIrika saMtulana bigar3atA hai| anya kaI vAyarasa (jaise ki epsTInabAra, mAyakoplAz2amA) ke pazcAt bhI aisI bImArI ho sakatI hai / jisameM choTe mastiSka saMbaMdhita mukhya cihna hote haiM / yaha bImArI choTe mastiSka meM saMkramita vAyarasa se hone vAlI bImArI se alaga hai (Viral Cerebellitis ) / yaha jAna lenA cAhie kyoMki yahA~ para vAyarasa se hone vAlI elarjI isa bImArI kA mukhya kAraNa hai / Age batAe anusAra rebIz2a athavA cecaka ke TIke ke bAda bhI aisI ensephelomAyalAiTisa prakAra kI bImArI ho sakatI hai / rebIz2a ke TIke (sIrama) meM hara 750 meM se eka vyakti ko aisI elarjI ho sakatI hai aura aisA hone se unameM se 25 % vyakti kI mRtyu ho jAtI hai / rebIz2a ke nae TIke ke prayoga se nyUrolojikala cihna nahIM dikhte| isa kAraNa HDCV prakAra kA rebIz2a kA TIkA prayoga meM lAnA cAhie /

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204 mastiSka aura jJAnataMtu kI bImAriyA~ lekina agara bImArI niyaMtraNa meM AyeM to sudhAra bhI atyaMta acchA. hotA hai| ADEM kI TrITamenTa meM "high potency steroids" kA prayoga karanA cAhie / koI kharAba kesa meM plAz2amA ekSacenja athavA atizaya maha~ge aise imyunoglobyulina de sakate haiM jisase jiMdagI bacane ke udAharaNa maujUda hai| surkhiyA~ mastiSka meM vhAiTa meTara kI aniyamitatA se honevAle DimAyalineTiMga DisIjha meM malTipala sklerosisa mukhya hai / * yaha roga kA pramANa strIoM meM puruSoM se jyAdA hotA hai / isa roga meM pakSAghAta hotA hai, dRSTi meM kamI AtI hai yA Dabala dikhatA hai / zarIra ke kucha hisso meM saMvedanA lupta honA, zarIra kA asaMtulana honA, yAdadAsta kama honA, Diprezana AnA vagairaha yaha roga ke anya lakSaNa hai / kabhIkabhI yaha roga meM bAra-bAra hamale Ate haiM (RRMS) yA zurU hone bAda hamezA ke lie bar3hatA jAtA hai (PPMS) I * kucha sAloM pahale taka asAdhya samajhI jAnevAlI yaha bImArI ke upacAra meM Adhunika cikitsA vijJAnane AMzika saphalatA prApta kI hai / * kabhI koI vAyarasa ke saMkramaNa ke bAda ADEM nAmakI nyurolojikala bImArI ho sakatI hai / cecaka yA rebIsa ke TIke ke bAda bhI yaha bImArI ho sakatI hai / hAIpoTensI sTIroIDa ke istemAla se ADEM meM acchA pariNAma milatA hai /

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moTara nyUrona DisIja (Motor Neuron Diseases snAyupezIo ko dhIre dhIre zithila aura niSkriya karanevAlI nyUrolojI kI yaha krUra-berahama kahane yogya bImArI hai / isameM aneka saMzodhana hone ke bAvajUda koI nizcita upacAra paddhati Aja bhI upalabdha nahIM hai aura marIz2a ko prati varSa adhika se adhika kamaz2ora aura kSINa hokara, mauta ke mu~ha meM dhaMsate hue niHsahAya hokara unake DaoNkTara tathA sage-saMbaMdhI dekhate rahate haiN| yaha durbhAgya hai ki aMta taka mastiSka pramANa meM vyavasthita kAma karane se vicAra, ehasAsa, hoza aura pIr3A kA anubhava banA rahatA hai| * moTara nyUrona DisIja ke prakAra : (1) hama prathama ajJAta kAraNa - kAraNoM se honevAlI prAImarI (iDIopethika) moTara nyUrona DisIja ke viSaya meM dekheNge| isa prakAra meM mukhya kamI moTara nyUronsa kI hotI hai, jisake kAraNa karor3arajju meM, jahA~ se cetAe~ nikalatI haiM ve enTiriara horna selsa tathA mastiSka meM breIna sTema meM yA jahA~ se mastiSka cetAe~ nikalatI hai, ve balbara nyUronsa kramaza: koI vicitra aura agamya kAraNoM se naSTa hote haiN| (2) isa kAraNa hAtha-paira ke snAyu galane lagate haiM aura halanacalana kama ho jAtA hai| hAtha meM vastu ko pakar3ane yA likhane kI kriyA meM yA hAtha upara- nIce karane meM muzkila hotI hai| usake bAda sIDI upara-nIce car3hane-utarane meM tathA cappala pahanane meM bhI muzkila zuru ho jAtI hai / marIja aMtataH bImArI kI zurUAta

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206 mastiSka aura jJAnataMtu kI bImAriyA~ hone ke bAda 3 se 7 varSa meM bistara vaza ho jAtA hai, vaz2ana kama hotA jAtA hai| bImArI ke isa prakAra ko "emAyoTrophika leTarala sklerosisa " ( e. ela. esa.) kahate hai| yahA~ karor3arajju ke enTiriara horna selsa aura use kaMTrola karatI upara se AnevAlI cetAoM (pirAmiDala phAibarsa) ko asara hotA hai / isalie nyUrolojI kI bhASA meM usake apara moTara nyUrona tathA loara moTara nyUrona ina donoM para asara (jA~ca dvArA ) dikhatI hai / (3) "progresiva maskyulara eTrophI" moTara nyUrona DisIz2a kA eka aisA prakAra hai jisameM pirAmiDala phAIbarsa ko asara nahIM hotA, isa lie apara moTara nyUrona prakAra ke nyUrolojikala lakSaNa (jaise ki briska jarka, ekSaTensara plAnTara ityAdi) nahIM dikhate haiN| pramANa meM yaha dhIre se phailane vAlA aura dhIre se bar3hane vAlA roga hai / (4) balbara moTara nyUrona DisIz2a meM jaise ki Age nirdezita kiyA hai, mastiSka kI cetA ke janika koSoM para asara hotI hai, jisake kAraNa AhAra nigalanA, bolanA ityAdi mahattvapUrNa kriyAoM para prabhAva par3atA hai| zvAsa meM takalIpha hotI hai / isameM mRtyu zIghra hI arthAt 1 se 3 varSa meM ho jAtI hai / (4) syUDobalbara pAlsI, vaha e. ela. esa. ke sAtha saMbaMdhita mastiSka cetAoM kA roga hai aura usameM bhI AhAra nigalanA, bolanA ityAdi kriyAoM para prabhAva hotA hai, sAtha hI anaicchika vajaha se mAtrA se jyAdA haMsanA, ronA aise vicitra lakSaNa prAraMbha hote hai /

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18 - moTara nyUrona DisIz2a (Motor Neuron Diseases) 207 (6) kucha bhAgyazAlI marIjoM meM yaha roga eka hAtha-yA paira taka sImita rahatA hai, jise monopereTika moTara nyUrona DisIz2a kahate hai / madAsa moTara nyUrona DisIja meM baharApana bhI sAtha ho jAtA hai, jo sAmAnyataH anya prakAra kI moTara nyUrona DisIja meM nahIM hotA hai| nidAna : bImArI kA nidAna i.ema.jI. jA~ca se sahI tarIke se ho sakatA hai| eka bAra isa bImArI kA nidAna nyUrolojisTa ke pAsa cauksAI se (dhyAnapUrvaka) karavAnA jarurI hai, kyoMki isa nidAna ke bAda marIja ke pAsa samaya kama rahatA hai / isaliye usake zeSa jIvana kA vyavasthita Ayojana, usakA Arthika, meDikala, sAmAjika pahalU kA Ayojana ityAdi zIghra hI kara lenA eka vyavahArika aura Avazyaka bAta ho jAtI hai| kucha bAra moTara nyUrona DisIz2a jaise hI lakSaNa kaI anya bImArI se hote hai, jaise ki hormona-perAthAIroir3a kI kamI, karor3arajju kA ghAva (vhIpleza injarI), kucha dhAtuoM kA zarIra para prabhAva (jaise ki zIzA), reDiezana, rasAyanoM kA duSprabhAva, mAyalomA tathA anya prakAra kI kensara athavA eIDsa kI bImArI se honevAle moTara nyUrona DisIz2a bhI hote hai| aisI bImArI ko sekanDarI moTara nyUrona DisIz2a kahate hai| isa prakAra kabhI bhI kisI prAImarI moTara nyUrona DisIja kA nidAna/lebala karane se pahale uparyukta batAe anusAra mukhyata: TrITamenTa se acche ho sake ese prakAra ke roga marIja ko hai ki nahi - isakI jA~ca karanA bahuta Avazyaka hai|

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208 mastiSka aura jJAnataMtu kI bImAriyA~ upacAra : * marIz2a aura sage-saMbaMdhiyoM ko yogya samaya para bImArI kI gaMbhIratA batAkara, zeSa jIvana ke Ayojana hetu sUcanA denI cAhie / phijiyotherepI, masala TreniMga aura calane kA vyAyAma ityAdi se snAyuoM ko jitanA saMbhava ho utanA sakSama rakhA jA sakatA haiM / sAtha hI sAdhanoM kI madada se calane aura hAtha kI kriyAoM meM lAbha ho, vaha dekhanA cAhie jaise ki baisAkhI, keliparsa / yaha bImArI kA koI viziSTa upacAra nahIM hai| aneka prakAra kI davAIyoM ke saMzodhana ke bAda hAla hI meM eka davA jise rAilyUjola kahate hai vaha adhika pracalita huI hai| isakA lagabhaga 6-12 mahIne kA upacAra kA korsa hotA hai / isakA pratimAsa kharca rU. 20 se 30 hajAra AtA hai, paraMtu isase darda kevala 3 se 6 mahIne ke lie maMda ho sakatA hai| isase sirpha samagrataH vedanA kI avadhi bar3hatI hai aura sAmAnya anubhava batAtA hai ki isakI koI jAdUI bhUmikA nahIM hai| phira bhI yogya kesa meM vaha dI jA sakatI haiM / ora davAIyoM meM rAsAjilina, mAinosAyaklina bhI prayogameM hai / 2008 ke naye saMzodhana mutAbika, lithiyama davAI se ye roga meM kAphI acche pariNAma mile hai| AhAra nigalane meM, bolane kI prakriyA ityAdi para prabhAva ho to usakI bhI TreniMga kucha hada taka upayogI hotI hai| bAda meM AhAra nigalane hetu rAilsa TayUba athavA bahuta acche DhaMga se gesTrosTomI phIDiMga kara sakate haiM, jisameM tvacA ke nIce Tanala banAkara, hojarI meM TyUba utArakara poSaNa diyA jAtA hai|

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18- moTara nyUraoNna DisIz2a (Motor Neuron Diseases) aMta meM jaba imozanala lebiliTI (asaMtulita, asthira bhAvukazIlatA) Diprezana, anaicchika haMsanA, ronA ityAdi ho taba usake saMbaMdhita meDikala upacAra karavAnA cAhie / zvAsa ke snAyu kA vyAyAma AraMbha se hI karanA cAhie / kavacit aMtataH venTileTara mazIna se zvAsa meM madada karake marIz2a kI Ayu kucha samaya ke lie bar3hA sakate haiM / narsiMga kera, sage-saMbaMdhiyoM kA sneha, DaoNkTara kA uSmApUrNa abhigama ityAdi, ina marIjoM kI pIr3A meM eka sahArA sAbita hotA hai / jo isa kaSTadAyaka asAdhya bImArI meM marIja ko zeSa bace jIvana meM duHkhoM ko jhelane kI tAkata detA hai / 209 vizeSataH Ajakala sTemasela therapI, ye roga ke dardIoM ke lie bhaviSyakI AzAkA kiraNa hai / zAyada isase ye roga kAbUmeM A sakatA hai / hAlA~ki aba taka koI Thosa pariNAma milA nahIM hai| isa bImArI ke marIz2oM kA eka saMgaThana bhI "moTara nyUrona DisIz2a esosiyezana" astitva meM hai, jisakA saMparka kiyA jA sakatA hai|

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210 mastiSka aura jJAnataMtu kI bImAriyA~ (surkhiyA~) - snAyu (mAMsa) pezIoM ko dhIre dhIre zithIla karanevAle yaha roga meM nizcita upacAra paddhati ke abhAva se marIz2a ke saMbaMdhI yA DAkTara niHsahAya ho kara marIz2ako dhIre dhIre mauta ke muha meM jAte dekhate raha jAte haiN| * prAimarI moTara nyurona DisIjha, progresiva maskyulara eTrophI, balbara moTara nyurona DisIjha, syuDo balbara pAlsI, monopereTika moTara nyurona DisIjha, madrAsa moTaranyurona DisIjha vagairaha yaha roga ke alaga-alaga prakAra hai / * phijIyotherapI, masala TreniMga aura calane kA vyAyAma isa roga meM mahatvapUrNa sAbita ho sakatA hai| * Adhunika saMzodhana ke anusAra rAilyujhola nAmaka davA isa roga meM kAma A sakatI hai / isa bimArI ke marIz2o kA saMgaThana-moTara nyurona DIsIja esosiezana-astitva meM hai|

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nyUropathI (Neuropathy) : isa prakaraNa meM hama mastiSka aura karor3arajju meM se nikalakara cahere, gardana, hAtha, paira aura chAtI va peTa jaise vibhinna snAyuoM taka saMdezA le jAne vAlI aura tvacA tathA anya saMvedanazIla avayava va mahatvapUrNa aMgoM meM se karor3arajju, mastiSka kI ora saMvedanA lAnevAlI nasoM, cetAoM (nerves) ke rogoM ke viSaya meM bAta kreNge| saMdezA le jAne vAlI cetAoM ko moTara narksa kahA jAtA hai| saMvedanA lAne vAlI cetAoM ko sensarI narksa kahA jAtA hai / karor3arajju meM se nikalane vAle prAraMbhika bhAga ko reDikalsa kahA jAtA hai| vaha bhI do prakAra ke moTara aura sensarI hote hai| unake rogoM ko reDikyulopathI kahate hai| jabakI cetAoM ke rogoM ko perIpherala nyUropathI kahate haiN| The n contra cantar Dorsal column Dorsal root Synapse Dorsal root ganglion Corticospinal tract Cel body of Pensory neuron Rubrospinal tract Spinotharam!! tract Dendrite of sensory neuroni White matter Grey metter Receptor Coll body of motor neuron Ventral root Axon of motor neuron Synaptic knobs Effector muscle Cross-section of Spinal cord and a scheme of peripheral nervous system

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mastiSka aura jJAnataMtu kI bImAriyA~ perIpherala nyUropathI ke kucha mukhya prakAra hai, jise polInyUropathI, enTrepamenTa nyUropathI aura mononyUropathI, mononyUropathI malTipleksa kahate haiM / aneka roga aura anya kAraNoM se aisI perIpherala nyUropathI hotI hai / 212 I kucha nyUropathI aisI hotI hai jisameM prAthamika nyUrolojikala bImArI hotI hai| jaise ki vaMzAnugata nyUropathI ( HMSN - I to HMSN-VI) yA e.aaii.ddii.pii.| kucha meM nyUrolojikala aura anya sisTama ke roga hote hai jaise ki kesara se saMbaMdhita nyUropathI aura kucha bImAriyoM meM sAloM bAda cetAoM para asara hotI haiM, jaise kI DAyAbiTIsa / ekadama zIghra hotI aura phailane vAlI nyUropathI meM adhikatara aspatAla meM bharatI honA paDatA hai, jaise ki e.AI.DI.pI. } mononyUropathI meM eka athavA adhika vibhinna cetAoM kI kAryazakti bigar3atI hai / sAmAnyataH usameM darda hotA hai / enTrepamenTa nyUropathI meM eka yA jyAdA nasa usake nirdhArita mArga meM bIca meM kahI dabatI hai / jaise ki kArpala Tanala sinDroma meM mIDIana narva hathelI kI jar3a ke Age dabatI hai / I polInyUropathI meM sAmAnyataH zarIra ke donoM tarapha barAbara pramANa meM saMvedanA kama hotI hai, snAyuoM kI kAryazakti kama hotI hai aura anya kucha muzkileM bhI A sakatI haiN| jaise ki mala-mUtra ko tyAga ne meM parezAnI hotI hai / polInyuropathI do prakAra kI hotI hai / (a) ekjhonala nyUropathI : isameM paira ke liye aura hAtha kI hathelI meM jhunajhunI hotI hai, jalana kI zuruAta hotI hai, roga dhIredhIre Upara kI ora phailane lagatA hai aura snAyu bhI kamajora ho jAte hai aura saMvedanA kama hotI jAtI hai / mukhyataH cayApacaya prakriyAoM kI bImArI (metabolic diseases), jaise ki DAyAbiTIsa, kIr3anI, lIvara ityAdi takalIpha aura kucha viTAminoM kI kamI va bhArI dhAtu, jaharIle padArtha yA kemikalsa aura mukhyataH davAI kA duSprabhAva (kucha enTibAyoTiksa, kensara kemotherapI, enTimaleriyala ityAdi) se aisI ekjhonala nyUropathI hotI haiN| adhikatara yaha dhIre se AnevAlI aura laMbe samaya taka calanevAlI bImArI hai aura kaSTasAdhya hai /

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213 19 - nyUropathI (Neuropathy) (ba) DimAyalineTiMga nyUropathI : usameM nasoM ke Upara ke insyuleTarI mAyalina kI parata meM vikRti paidA hotI hai, use eka prakAra kI elarjI mAnI jA sakatI hai| vAyarala se lekara dUsare anya kAraNoM se nasa para kI mAyalina naSTa ho to usase nasoM kI kAryakSamatA para asara hotI hai aura mukhyataH kaMdhA tathA AsapAsa ke snAyuoM meM prathama kamaz2orI A kara bAda meM zIghra phailatI hai| isameM se kucha zIghra Akara calI jAtI hai, kucha jiMdagI ko khatare meM DAla detI haiN| jaise ki e.AI.DI.pI., jisake viSaya meM hama nIce vistAra se dekheNge| kucha nyUropathI ekabAra dUra hone ke bAda phira se bhI hotI hai / kucha meM snAyu aura nasoM kI bImArI sAtha meM dekhane ko milatI hai, jaise kI mAyoTonika DisTrophI / nyUropathI kA vargIkaraNa : 1. nasoM kI sUjana yA elarjI se honevAlI nyUropathI jaise ki e.AI.DI.pI., sI.AI.DI.pI. saMkramaNa se hone vAlI nyUropathI jaise leprasI, DiptheriyA, TIka perelisisa viTAmina kI khAmI se hone vAlI nyUropathI - berI berI - pelAgrA - viTAmina bI-12 kI khAmI 4. Toksina (jaharIle dravya) se hone vAlI nyUropathI - bhArI dhAtu jaise Arsenika, sIsA, mayurI - rasAyaNa jaise theliyama, oNrgenophospharasa - davAI kI ADa asara jaise AIsoniyAjheDa, kensara kI davAIyA~, Depsona, enTIbAyoTiksa DAyAbiTIsa se honevAlI nyUropathI yA zarIra ke anya rogoM se honevAlI nyUropathI -- kIDanI kI bImArI - vAskyulAITisa (kolejana DisIja)

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214 mastiSka aura jJAnataMtu kI bImAriyA~ kensara se honevAlI nyUropathI 7. mAyalomA jaise rogoM se honevAlI perAproTInemika nyUropathI 8. vaMzAnugata nyUropathI (heriDiTarI moTara / sensarI nyUropathI) 9. nasa para dabAva Ane se hotI nyUropathI (enTrepamenTa nyUropathI) saMkSipta meM kahA jAye to vaMzAnugata kAraNoM se prAraMbha karake vAyarasa taka aura kensara se lekara davAI ke duSprabhAva taka, zarIra ke kisI bhI aMga ke roga ke kAraNa se prAraMbha karake poSaka tatvoM kI kamI taka yA leprasI se lekara DAyAbiTIsa taka, aise aneka kAraNoM se nasoM-narsa para asara ho zakatI hai yA to anya taraha se bole to narsa para asara huI ho to kvacita pUre zarIra meM roga kA udbhavasthAna DhU~DhanA par3atA hai / aura phira bhI 20 se 30 pratizata polInyUropathI ke kesa meM nyUropathI kA sahI kAraNa patA nahIM calatA hai| vaha Adhunika cikitsA paddhati ke lie eka cunautI hai| vaise to nyUropathI ke asaMkhya kAraNa hai, para hamAre deza meM pracalita aura mahatvapUrNa nyUropathI ke bAre meM nIce saMkSipta meM likhane kA prayAsa kiyA hai| (1) e. AI. DI. pI. : e.AI.DI.pI. yAnI ekyUTa inphle meTarI DimAyalineTiMga polireddikyulonyuuropthii| isake uparAMta use jI.-bI.esa. yA guliyana bAre sinDroma bhI kahA jAtA hai / isa roga meM kisI kAraNasara jJAnataMtu meM kamajorI AtI hai / marIz2a ke paira meM sabase pahale asara hone se paira meM sunApana yA baherApana AtA hai, sAtha meM sAmAnya kamajorI ke uparAMta hAtha-paira ke snAyuoM kA zithila ho jAnA aura zvAsocchvAsa kI jAnalevA takalIpha taka ke lakSaNa bhI isa bImArI ke marIja meM dekhane ko milate haiN| jJAnataMtuoM(nasoM) meM kisI kAraNasara sUjana Ane se monosAiTa mekropheja nAmaka koSoM kA pramANa bar3ha jAtA hai| isakI pratikriyA ke pariNAmasvarUpa cetAoM kA mAyalina nAmaka AvaraNa naSTa ho jAtA hai aura jJAnataMtu kamajora par3a jAte haiN| aisA mAnA jAtA hai ki jJAnataMtu ke AvaraNa 'mAyalina' ko pratikUla vaise enTiboDI (pratidravya) utpanna hone se naseM kamajora banane kI prakriyA prAraMbha hotI haiN|

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19 - nyUropathI (Neuropathy) 215 uparyukta prakriyA zurU hone ke sacoTa kAraNa abhI spaSTa nahIM hai| phira bhI 50 se 60 pratizata marIjoM meM e.AI.DI.pI. hone se pahale gale, jaThara yA AMta meM vAyarasa kA saMkramaNa lagA huA dekhA jAtA hai| uparAMta har3akavA, dhanura yA poliyo jaisI bImArI ke TIke lene ke bAda bhI kucha marIjoM meM yaha bImArI ke cihna dekhe jAte haiM / isake uparAMta kabhIkabhI koI zastrakriyA ke kucha saptAha bAda e.AI.DI.pI. ho sakatA haiM / / kisI bhI umra meM pAye jAne vAle isa roga kA vizeSataH pramANa 40 se 55 varSa kI Ayu meM vizeSa pAyA jAtA hai| kucha RtuoM ke sAtha isa bImArI kA saMbaMdha hai aisA bhI saMzodhana ke AdhAra para prasthApita huA hai| bImArI kI tIvratA anusAra yaha bImArI ko - sAmAnya, madhyama aura atitIvra, yaha tIna prakAra meM alaga kiyA jA sakatA haiM / isa roga ke prAraMbha meM marIz2a ko paira meM jhunajhunI kA anubhava hotA hai, khAlImUMgI caDha jAtI hai, paira darda hotA hai, to adhikatara marIjoM meM calate-calate acAnaka paira laDakhar3A jAte hai| donoM pairoM meM lagabhaga eka sAtha hI asara hotI hai, yA kramazaH kamajorI bar3hane se antataH donoM paira aura hAtha saMpUrNata: pakSAghAta meM parivartita ho jAte haiM / do-cAra dina se lekara do-cAra saptAha taka aisA dekhA jAtA hai| kaI marIz2oM meM jhunajhunI kI zikAyata nahIM bhI hotI hai| mastiSka meM se nikalane vAle kucha jJAnataMtu ko jaba asara hotA hai, taba marIja ke cehare ke snAyu niSkriya ho jAte haiN| AvAz2a meM pharka ho jAtA hai, AhAra nigalane meM takalIpha hotI hai| pAnI pIte samaya nAka se pravAhI bAhara A jAtA hai aura zvAsocchvAsa meM takalIpha ho sakatI haiN| dasa pratizata marIjoM ko zvAsocchavAsa meM takalIpha hotI hai, jo jiMdagI ko khatare meM DAla detI hai| aise marIjoM ko 'venTileTara' kucha dinoM taka tahata kRtrima zvAsocchvAsa diyA jA sakatA haiN| isa bImArI ke anya lakSaNa meM hRdaya kI dhar3akana kI aniyamitatA dekhI jAtI hai| kabhI bI.pI. kama yA jyAdA ho jAtA hai yA atizaya pasInA hotA hai| rakta meM soDiyama kI mAtrA kama ho sakatI hai| marIz2a saMpUrNata: hoza meM hotA hai aura kvacita marIz2a ko mala-mUtra para aMkuza banAe rakhane meM takalIpha hotI hai| lekina yaha kvacita hI dekhA jAtA hai| usake AIDP, Sensory, AMAN, AMSAN, MMN aise alaga-alaga prakAra hai|

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216 mastiSka aura jJAnataMtu kI bImAriyA~ roga kA nidAna : uparokta lakSaNavAle marIz2a kI prAthamika cetAtaMtra kI jA~ca meM bImArI ke nidAna ko samarthana detI kar3I mila sakatI hai| isameM mukhyataH 'TenDana jarksa' (snAyu ke chora para hathor3I mArane se snAyu khIMcakara halakAsA jarksa-jhaTakA utpanna hotA hai) isa roga meM nAbUda ho jAte hai / I dUsarI jA~ca meM marIz2a kI kamara meM se pAnI khIMcakara jA~ca kI jAtI hai usa pravAhI kI jA~ca karate samaya usameM proTIna kA tatva (mukhyata: IgG ) bar3hA huA mAlUma par3atA hai, kintu koSoM meM koI bar3hAvA mAlUma nahIM par3atA hai / EMG/NCV : isa meM I. ema. jI. aura ena.sI.vI. kI jA~ca zAmila hai / yaha nyUropathI, mAyopathI aura nyUromaskyUlara jaMkazana ke rogoM ke lie atimahatvapUrNa jA~ca hai / isameM cetAoM ko vidyuta ke mAdhyama se uttejita karake aura snAyuoM ko sAdhAraNa darda dene vAlI suI se jA~ca karake donoM ke bAre meM kAphI jAnakArI hAMsila kI jA sakatI hai / nyUropathI ekjhonala hai yA DimAyalineTiMga ye patA calatA hai / jisase sAravAra meM bahuta pharka par3atA hai I nyUropathI eka cetA se hai, kaI sArI alaga-alaga cetAoM se hai yA janaralAIjhar3a nyUropathI hai yaha patA calatA hai / kisI eka cetA meM hI roga ho to cetA ke kisa bhAga meM roga hai ye patA calatA hai / cetA aura snAyu ko jor3ate nyUro- maskyUlara jaMkzana ke roga kA nidAna bhI ho sakatA hai / isameM roga prAthamika taura para cetA kA hai yA snAyu kA, ye bhI patA cala sakatA hai /

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217 19 - nyUropathI (Neuropathy) upacAra : e.AI.DI.pI. ke upacAra ke liye sabhI marIjoM ko zurUAta meM ekado saptAha ke liye aspatAla meM bhartI karanA acchA rahatA hai| isa roga ke upacAra ke liye sTiroIDa samUha kI davAI, udAharaNa-mithAIla preDnisolona, e.sI.TI.eca. nAmaka davAI ke upayoga se hone vAle lAbha saMdarbha meM ekamata nahIM hone ke kAraNa naI davAI dI jAtI hai| ___ plAjhamApheresisa nAmaka paddhati meM marIz2a ke zarIra meM se eka samaya meM 1500 se 3000 mi.li. jitanA rakta nikAlakara use zuddha kiyA jAtA hai| sela separeTara dvArA koSoM ko alaga kara, use zuddhikaraNa karake rakta meM se hAnikAraka enTiboDijha (pratidravyoM) dUra karake zuddha rakta phira se marIz2a ke zarIra meM car3hAyA jAtA hai| isa paddhati se roga ko bar3hane se rokA jA sakatA hai| zvAsocchvAsa kI takalIpha dUra kI jA sakatI hai aura zIghra hI use sudhArA jA sakatA hai| yaha prakriyA eka-eka dina ke aMtara meM kula pAMca bAra kiyA jAtA hai| isa roga kI dUsarI asarakAraka davAI hai gAmA globyUlIna / raktavAhinI meM iMjekzana ke rUpa meM dI jAtI isa davAI se hAnikAraka enTiboDijha dUra hote hai| pratidina lagabhaga 20 se 30 grAma kI mAtrA meM (400 mi.grA./ki.grA. zarIra ke vajana anusAra) yaha davAI pA~ca dina dI jAtI hai / isa davAI kA duSprabhAva bhI bahuta kama hai| yaha davAI baccoM tathA hRdaya ke marIjoM ko bhI dI jAtI haiN| paraMtu yaha upacAra atizaya maha~gA hone se sabhI marIz2a isa davAI kA lAbha nahIM le sakate haiN| aise upacAra ke sivAya e.AI.DI.pI. ke marIjoM meM anya dekhabhAla rakhanI par3atI hai| ina marIjoM ko pUrA poSaNa milatA rahe, zarIra meM pITha para chAle na ho, kisI bhI prakAra kA saMkramaNa na ho usakA khUba dhyAna rakhanA par3atA hai / zvAsocchvAsa meM parezAnI lage to AvazyakatA hone para venTileTara mazIna kA prayoga kiyA jA sakatA hai| yaha prakriyA maha~gI hai lekina isase jiMdagI bacAI jA sakatI hai / isake uparAMta vyAyAma (phijiyotherapI) se bhI isa roga meM bahuta lAbha hotA haiM, jo upacAra kA eka ati mahatvapUrNa aMga hai| prAraMbhika 15 dinoM ke bhItara roga Age na bar3he aura mukhyataH zvAsa kI parezAnI na ho

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218 mastiSka aura jJAnataMtu kI bImAriyA~ to roga pUrI taraha se mITa jAne kI saMbhAvanA bar3ha jAtI hai| lekina saMpUrNata: acche hone meM zAyada kucha mahIne bIta jAte haiM / (2) sI.AI.DI.pI. : e.AI.DI.pI. jaba lambe samaya taka bar3hatI rahe (2 mahInA) athavA lagAtAra hamalA hotA rahe taba use sI.AI.DI.pI. (Chronic Inflammatory Demyelinating Polyneuropathy ) kahate hai| kevala nyUrolojikala kAraNasara yaha roga huA ho to kaI bAra vaha moTara nyUrona DisIz2a jaisA hotA hai| kucha bAra eca.AI.vI. inphekzana, esa.ela.I., plAjhamA sela DiskrejhiyA jaise kAraNoM se bhI sI.AI.DI.pI. jaise lakSaNa hote haiN| upacAra : (1) mukhyataH uparyukta bImAriyoM meM se koI roga ho to use DhU~Dhakara TrITamenTa kI jAtI hai aura vizeSa meM sTiroIDa, plAjhamA eksacenja, ejhAthAyoprina yA mophIleTa kA upayoga kiyA jAtA hai| e.AI.DI.pI. TrITamenTa kI taraha kvacita imyUnoglobyulina kA bhI upayoga kiyA jA sakatA hai / (2) yaha aura aisI aneka nyUropathI meM vyAyAma (phijiyotherapI) atyaMta mahatvapUrNa upacAra hai / AvazyakatAnusAra bresIsa, spliMTa, bUTsa aura anya sahAyaka upakaraNa se marIjoM kI dinacaryA aura dainika vyavahAra sahaja aura sarala banAyA jA sakatA hai / (3) pIr3A meM dardazAmaka davAI AvazyakatAnusAra dI jA sakatI hai| (4) lambe samaya ke bAda kabhIkabhI choTI-bar3I sarjarI karake marIz2a ke snAyu adhika kAryazIla kiye jA sakate hai, jisase kamajora raha gaye snAyu meM adhika lAbha prApta ho zake / (3) malTIphokala moTara nyUropathI : moTara nyUrona DisIja jaisI laganevAlI yaha bImArI meM zarIra ke donoM bAju alaga-alaga cetAoM meM asamAna asara hotA hai / yaha roga meM gAmAglobyUlina aura sAIklo phosphAmAIDa se phAyadA hotA hai, jabaki sTiroIDsa aura plAjhamA eksaceMja se nhiiN| moTara nyUrona DisIz2a meM koI sAravAra kAma nahIM lagatI /

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19 - nyUropathI (Neuropathy) 219 (4) belsa pAlsI tathA anya nyUropathI : aisA hI eka anya vAyarasa se honevAlA roga hai, jo sirpha mu~ha ke snAyuoM kA pakSAghAta karatA hai, jise belsa pAlsI (Bell's palsy) kahate hai| isameM mastiSka meM se nikalane vAlI sAta naMbara kI cetA para sUjana AtI hai, jo adhikAMzataH pavana lagane se, vAIrasa ke saMkramaNa se yA to kAna meM sar3ana hone se hotI hai / lakSaNa : A~kha pUrI taraha banda na honA, mu~ha Ter3hA honA, mu~ha ke eka tarapha se lAra TapakanA, gAla barAbara nahIM phUlanA, kAna ke pIche darda honA, AvAz2a adhika sunAI denA aura jihvA kA svAda kama ho jAnA, jaise lakSaNa haiN| turanta upacAra kiyA jAye to 90 se 95 pratizata marIz2a 1 se 2 mahine meM lagabhaga sampUrNa ThIka ho sakate haiN| isake vAyarasa sAmAnyataH epasTIna bAra, harpisa aura sAyaTomigAlo ityAdi hote hai / kabhIkabhI donoM ora kI sAta naMbara kI nasa ko ekasAtha asara hotA hai, parantu adhikatara to eka hI hisse meM asara hotA hai| koI kesa meM asara laMbe samaya taka yA hamezA ke lie raha jAtA hai yA vahI roga bArabAra hamalA karatA hai aura bArabAra mu~ha kA pakSAghAta hotA hai| (5) DAyAbiTIsa se utpanna nyUropathI : DAyAbiTIsa ke marIz2a ko laMbe samaya ke bAda nyUropathI ho sakatI hai| jitanA adhika purAnA DAyAbiTIsa aura usakA niyamana jitanA kama utanI hI jaldI nyUropathI hotI hai / DAyAbiTIsa meM aneka prakAra kI nyUropathI hotI hai, jisake lakSaNa nimna anusAra paira kI cetAeM-naseM kamajora hone se calane meM yA sIDhiyA~ caDhane meM parezAnI hotI hai| paira meM se cappala nikala jAye to mAlUma nahIM par3atA, jA~gha yA paira meM adhika darda hotA hai / paira ke nIce gaddI jaisA lagatA hai, paira meM khUba jalana hotI hai, hAtha-paira meM jhunajhunI yA sunApana jaisA lagatA hai / coTa lagane kI asara nahIM hotI, snAna ke samaya garma-ThaMDe pAnI kA bheda mAlUma nahIM pdd'taa| hathelI aura paira kI saMvedanA kama hotI hai|

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220 mastiSka aura jJAnataMtu kI bImAriyA~ pezAba meM takalIpha, zArIrika azakti, yA to dasta yA to pasInA bahuta hotA hai yA kama ho jAtA hai, hRdaya kI dhar3akana meM caDhAva-utAra hotA hai| 4. chAtI yA peTa ke Upara kI kucha nasa meM adhika jalana hotI hai| DAyAbiTIsa ko sampUrNataH niyaMtrita rakhane se aura insyulIna kA upayoga karane se rAhata hotI hai| nyUropathI ke cihna ko niyaMtrita rakhane kI yogya davAI hai, jisase kucha hada taka lAbha hotA hai| (6) leprasI : apane deza meM leprasI (kuSTharoga) pracalita hai (hAlA~ki aba vaha AMzika rUpa se kama jarUra huA hai)| mAyakobekTIriyama leprI nAmaka jaMtu se yaha hotA hai aura mukhyataH saMvedanA vAhaka cetAoM (sensarI narksa) ko vaha nukasAna karate hai| isase u~galiyoM kI saMvedanA calI jAtI hai| coTa kA ehasAsa nahIM hotA aura hAtha-paira kI u~galiyA~ dhIredhIre pighala jAtI hai aura bImArI zarIra ke anya aMga meM phailatI hai / isake mukhya do prakAra hai : (1) lepromeTasa leprasI (2) TyubarakyuloiDa leprasI, jisameM tvacA ko pramANa meM kama nukasAna hotA hai, lekina nyUrolojikala nukasAna adhika hai / Depsona, riphAmpIsIna, klophAjhimIna jaisI davAI aura yogya DresiMga dvArA yaha bImArI adhikAMzataH kAbU meM lAI jA sakatI hai| paraMtu upacAra Der3ha yA do varSa se lekara dasa varSa taka calatA hai| isa bImArI ko rokanevAle TIke bhI aba upalabdha hai| (7) kensara : kensara zarIra ke anya bhAga meM ho to bhI nasoM ko asara hotA hai, jise perAnIoplAsTika sinDoma kahA jAtA hai / phephaDeM ke kensara meM aisI nyUropathI khAsa dekhane ko milatI hai / perAproTInImiA yA mAyalomA ke nAma se jAnevAle eka prakAra ke blaDakensara meM bhI nyUropathI adhika dekhane ko milatI hai| isalie nyUropathI ke tamAma kesoM meM saghana jA~ca kI ati AvazyakatA hai, vaha spaSTa hai| kucha kesoM meM oTonomika nyUropathI ho sakatI hai jaise ki DAyAbiTIsa meM blaDaprezara kA adhikamAtrA meM car3hAva-utAra, nAr3I kI dhar3akana meM car3hAvautAra, pasInA, mala-mUtra kI takalIpha Adi aneka prakAra kI anaicchika

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19 - nyUropathI (Neuropathy) 221 prakriyAoM meM takalIpha hotI hai, isa roga kI paryApta vaijJAnika jAnakArI na hone se kaIbAra DaoNkTarsa bhI isa bAre meM muzkila meM par3a sakate hai / pariNAmataH yaha bImArI ke nidAna meM adhika samaya lagatA hai| (8) enTrepamenTa nyUropathI : isa vibhAga meM sabase jyAdA pracalita enTrepamenTa nyUropathI hai-kArpala Tarnala sinDroma, jisameM mIDIana narva, hathelI ke nIce vAle volara lIgAmenTa meM dabatI hai| jisase hathelI meM darda, kamajorI aura jhunajhunI hotI hai aura kvacita kaMdhe aura hAtha taka darda phailatA hai| Age bar3hakara aMgUThe ke nIce ke snAyu sUkha jAte hai| kalAI para paTTA pahanane se aura thor3e samaya sTiroIDa Adi davAI lene se pharka na paDe to kalAI meM yogya jagaha para sTiroIDa kA injekzana diyA jA sakatA hai / antataH choTI sI sarjikala prakriyA dvArA nasa ko alaga kara sakate hai| isake uparAMta vibhinna naseM apane mArga meM alaga-alaga jagaha dabane se lagabhaga 30 prakAra ke enTrepamenTa sinDroma hote haiM / 1. mIDIana narva kA proneTara sinDroma / 2. TArDiva allara pAlsI (kohanI ke pAsa) / 3. reDiyala pAlsI (kaMdhe aura kohnI ke bIcobIca / ) reDiyala narva sote samaya daba jAne se, jo 'seTara-De nAiTa pAlsI' ke nAma se pracalita hai| merAljiyA perestheTikA : leTarala kyUTenIasa narva dabane se jA~gha meM halakA darda aura jhunajhunI utpanna hotI hai / TArsala Tanala sinDroma, jisameM posTIrIara TIbIala nasa paira ke cUMTana ke nIce dabane se paira ke talave meM darda yA jhunajhunI hotI hai| choTI sarjarI dvArA isase rAhata milatI hai| anubhava se patA calA hai ki yaha sabhI enTrepamenTa atyaMta pracalita hai / paraMtu mukhyataH binA nidAna marIz2a laMbe samaya taka parezAna hotA rahatA hai| isalie isa bAre meM jAgratatA rakhanI cAhie /

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222 mastiSka aura jJAnataMtu kI bImAriyA~ (9) nyUropathI ke anya prakAra : viTAmina kI kamI se honevAlI nyUropathI meM mukhyataH viTAmina B12 tathA Folic acid kI nyUropathI samAviSTa hai| (isa bImArI ko SCD - Subacute combined Degeneration kahate hai)| usake uparAMta zarAba kA adhika sevana karanevAle ko viTAmina B, kI kamI ho jAtI hai, berIberI nAmaka bImArI hotI hai, jisameM dardayukta nyUropathI hotI hai| davAi se honevAlI nyUropathI meM enTibAyoTika nAiTrophyUrenToina, kensara kI davAI vInkrIsTIna, mirgI kI davAI phinAIToIna aura TI.bI. kI davAI AisonAyAjhAIDa Adi hai| davAI baMda karane se dhIre dhIre nyUropathI sudhara jAtI hai / yaha yAda rakhanA cAhie ki yaha davAI lenevAle pratyeka ko nyUropathI nahIM hotI hai aura usakI rokathAma ke lie aneka upAya bhI hai, jaise ki TI.bI. kI davAI AisonAyAjAIDa ke sAtha viTAmina B6 denA cAhie / bhArI dhAtu jaise ki sIsA, sonA, pArA, Arsenika vagairaha ke sevana se yA kucha rasAyana jaise ki theliyama, hekjhokArbana, Argeno phospheTa vagairaha se bhI nyUropathI ho sakatI hai| eka bAta dhyAna rakhanI cAhie kI 20% se 30% nyUropathI meM koI kAraNa nahIM milatA / antataH ina saba nyUropathI meM apane deza meM sabase adhika dikhAI denevAlI nyUropathI DAyAbiTIsa, leprasI, eIDsa (eca.AI.vI.) tathA Alkohola se hotI viTAmina B, aura anya poSaka viTAmina kI kamI se hotI B12 tathA pholika esiDa kI nyUropathI mukhya hai / usake viruddha zIghra se phailanevAlI e.AI.DI.pI. aura kramaza: phailatI kensara aura mAyalomA kI nyUropathI khataranAka hai, isa bAta kA dhyAna rakhanA cAhie / isa lie zIghra nidAna, saMpUrNa jA~ca aura paryApta upacAra, yogya phijiyotherapI - yaha tamAma nyUropathI kI TrITamenTa ke mahatvapUrNa pahalU hai|

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19 - nyUropathI (Neuropathy) 223 -(sukhiyA~ * mastiSka aura karoDarajju meM se nikala kara cahare, gardana tathA anya snAyuoM taka saMdezA le jAnevAlI tathA anya saMvedanazIla aMgoM se karoDarajju aura mastiSka kI ora saMvedanA lAnevAlI nasoM, cetAoM ke rogoM ko peripherala nyUropathI kahate hai| * mononyUropathI meM eka athavA adhika vibhinna naso kI kAryazakti bigaDatI hai, jabaki polInyUropathI meM zarIra ke donoM tarapha barAbara pramANa meM saMvedana kama hotA hai| yaha do prakAra kI hai, ekjhonala nyUropathI aura DimAyalineTiMga nyuuropthii| * e.AI.DI.pI. ko guliyana bAre sinDroma bhI kahA jAtA hai| isameM marIz2a ke jJAnataMtu kI kamajorI ke kAraNa paira meM jhunajhunI hotI hai, bAda meM hAtha paira kA pakSAghAta aura zvAsocchavAsa meM muzkila hotI hai / e.AI.DI.pI. meM plAjhamA pheresIsa nAmaka paddhati se marIz2a kA rakta zuddha kiyA jAtA hai aura gAmAglobyulina kI madada se bahuta rAhata hotI hai| * jaba yaha roga laMbA calatA hai to use sI.AI.DI.pI. kahate * sirpha muMha ke snAyuoM ke pakSAghAta ko belsa pAlsI kahate * DAyAbiTIsa ke marIz2a ko laMbe samaya ke bAda honevAlI nyUropathI ko DAyAbiTIka nyUropathI kahate hai|

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224 mastiSka aura jJAnataMtu kI bImAriyA~ | * leprasI ke roga meM jaMtu mukhyataH saMvedanA vAhaka nasoM ko / nukasAna karate haiN| * kensara zarIra ke anya bhAga meM ho to bhI nasoM ko asara hotA hai, jise perAnioplAsTika nyUropathI kahate hai| * enTrepamenTa nyUropathI - kArpala Tanala sinDroma meM miDiyana narva hathelI ke nIcevAle volara ligAmenTa meM dabatI hai jisase hathelI meM darda aura jhunajhunI hotI hai jo kaMdhe aura hAtha taka phailatI hai| aise alaga-alaga lagabhaga 30 prakAra ke enTrepamenTa sinDroma hai| viTAmina kI kamI se, zarAba ke jyAdA sevana se, davAI ke duSprabhAva vagairaha kAraNoM se bhI nyUropathI hotI hai / / apane deza meM sabase adhika dikhAI denevAlI nyUropathI - DAyAbiTIsa, leprasI, eIDsa tathA Alkohola se hotI vITAmina-bI1 kI kamI aura vITAmIna-bI-12 tathA pholika esiDa kI kamI se hotI nyUropathI mukhya hai| * zIghra nidAna, vyavasthita jA~ca, paryApta upacAra aura yogya phijiyotherapI se bahudhA nyUropathI kI acchI taraha sAravAra ho sakatI hai|

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mAyastheniyA grevisa (Myasthenia Gravis) mAyastheniyA grevisa eka kaSTasAdhya, dIrghakAla taka calanevAlI jJAnataMtu aura snAyu kI bImArI hai / isa bImArI meM snAyu meM samaya - samaya para kamaz2orI A jAtI hai / aicchika snAyu asAdhAraNa tIvratA se thaka jAte haiM / asthitaMtra ke sAtha jur3e hue snAyu - A~kha, mu~ha, jihvA aura hAtha-paira ke halana calana para niyaMtraNa karanevAle snAyu isa bImArI meM asaragrasta hote hai | cetA aura snAyu ke bIca kI kar3I ko nyUro maskyUlara jaMkzana kahate hai, jo taraMgo ko cetA se snAyu taka pahu~cAtA hai / jJAnataMtuoM meM se snAyu taka pahu~cane vAlI taraMgo ke prasAraNa meM kSati hone kI vajaha se yaha roga hotA hai, lekina usameM jJAnataMtu aura snAyu svayaM svastha - kSatirahita hote hai / I yaha roga kA prAthamika prAraMbha mukhyataH strIoM meM 40 sAla kI umra ke pahale aura puruSo meM 40 sAla kI umra ke bAda hotA hai / lekina bAlikAoM meM yaha roga kvacita hI dekhA jAtA hai / yaha vyAdhi saMkramita yA vaMzAnugata nahIM hai / T cAra hisso meM vibhAjita yaha roga meM sarvaprathama dhyAna kendrita karanevAlA lakSaNa A~kho ke snAyu kI kamaz2orI hai (Grade - 1) / aMzata: marIz2o meM yaha roga A~kho taka sImita rahatA hai / parantu adhika samaya pazcAta anya snAyuo, jo ki ha~sane kI, cabAne kI, nigalane kI, bolane kI aura hAtha-paira calAne kI kriyA karate hai, (unake) upara bhI asara dikhane lagatI hai, anta meM zvAsocchvAsa kI kriyA karane vAle snAyu para bhI jaba bImArI kI asara hotI hai taba sAMsa lene meM bhI takalIpha hotI hai aura jAna khatare meM par3a jAtI hai (Grade-4) / mukhya lakSaNa : 1. 2. 3. 4. eka yA donoM palakeM gira jAnA / A~kha-najara idharaudhara ghumAne meM takalIpha / calane meM asthiratA, kamaz2orI, thakAna / hAtha aura U~galiyoM meM kamaz2orI / AhAra nigalane meM parezAnI / -

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226 mastiSka aura jJAnataMtu kI bImAriyA~ 6. bolane meM parezAnI honA, bolate bolate AvAz2a kSINa ho jAnA, nAka se AvAz2a nikalanA / 7. zvAsocchvAsa meM takalIpha / mAyastheniyA grevisa ke marIz2o ke liye zvAsocchvAsa kI takalIpha bahuta khataranAka ho sakatI hai| yaha takalIpha ho taba marIz2a ko aspatAla meM bhartI karanA Avazyaka ho jAtA hai / roga bar3he taba athavA zarIra meM saMkramaNa yA garbhAvasthA jaise saMyogo meM zvAsa kI takalIpha ho sakatI hai| yaha roga meM bArabAra snAyuoM kI kamajorI hotI hai| jo bAda meM khatma bhI ho jAtI hai yA kucha samaya ke pazcAta bar3ha bhI sakatI hai yA laMbe samaya taka yathAvat bhI raha sakatI hai| yaha bImArI kI ugratA pratyeka marIja meM prati ghaMTe badala sakatI hai| adhika parizrama se marIz2a dina ke aMta bhAga meM jyAdA kamaz2ora dikhAI detA hai, ArAma karane se yaha paristhiti meM AMzika sudhAra hotA hai / aise saMjoga meM Adhunika upacAra se marIz2a adhikAMzataH ArAma pAkara sAmAnya jIvana vyatIta kara sakate hai / isa roga meM thAyamasa granthi bhI mahatvapUrNa bhUmikA nibhAtI hai| usake koSoM ko zarIra ke rogapratikAraka taMtra kA eka hissA mAnA jAtA hai| chAtI meM sthita yaha graMthi bacapana meM bar3I hotI hai, jo kramaza: choTI hotI calI jAtI hai| aura vayaska umra ke sAmAnya vyaktioM meM use DhUMDhanA bahuta muzkila ho jAtA hai / lekina mAyastheniyA grevisa ke marIz2o meM adhikAMzataH thAyamasa granthi bar3I dekhI jAtI hai| 10 pratizata se 15 pratizata marIz2o meM thAyamomA nAmaka thAyamasa granthi kI gAMTha hotI hai, jo sAmAnyataH sAdhAraNa (yAni kI kensara kI nahIM) hotI hai| lekina kabhIkabhI usameM kensara hone kI saMbhAvanA hotI hai| uparAMta karIbana 5 pratizata marIz2o meM thAyaroIDa granthi kI bImArI dekhane ko milatI hai| mAyastheniyA grevisa kI zurUAta koI koI marIja meM acAnaka ho sakatI hai, jo sabhI snAyuo meM ugratApUrvaka kamajorI lAtA hai| adhikatara prAthamika lakSaNoM se yaha bImArI kA nidAna karanA muzkila hai| parantu niSNAta DaoNkTara roga kA nidAna usake lakSaNa aura cihna se kara sakate hai| mukhyataH thakAna ke lakSaNoM hetu A~kho aura hAtha-paira ke snAyuoM para dhyAna diyA jAtA hai|

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227 20 - mAyastheniyA grevisa (Myasthenia Gravis) nidAna : 1. TIlasTIgmIna TesTa : TIlasTIgmIna ke iMjekzana se roga ke cihna meM turaMta lAbha dekhA jAe to usake AdhAra para nidAna ho sakatA hai| I.ema.jI. : jJAnataMtuo ko vidyutazakti se bArabAra uttejita karane se usakI taraMgo ke prasAraNa meM rahI kamI jAnI jA sakatI hai| 3. khUna parikSaNa meM esiTAIlakolina risepTara enTiboDI levala TesTa mukhya hai| hAlA~ki roga kI gaMbhIratA batAne meM aura roga kI avasthA kI punaH nirIkSaNa meM (follow-up) ye levala kitane vizvasanIya hai, yaha bAta nizcita nahIM hai| kabhI kabhI enTImaska enTIbor3I TesTa bhI kiyA jAtA hai / 4. sI. TI. skena thoreksa : 'thAyamomA' nAmaka gAMTha DhU~Dhane ke liye yaha chAtI kA TesTa hai / 5. thAyaroIDa kA TesTa tathA anya Avazyaka blaDa TesTa / * upacAra : isa roga ke upacAra meM enTikolInesTaresa davAI upayoga kI jAtI hai, jaise ki nIosTigmIna yA pAyariDosTigmIna, jo jJAnataMtuoM meM se snAyuo kI ora jAne vAlI taraMgo kA prasAraNa majabUta karatI hai| pariNAmataH esiTAIlakolina nAmaka tattva jyAdA samaya taka upalabdha rahatA hai, jisase snAyuo kI saMkucanazakti bar3hatI hai| yaha davAI kI asara marIjo ke lie jyAdA lAbhakAraka hotI hai, lekina usase marIz2a apanI saba kriyAe~ pUrvavat kSamatA se nahIM kara sakatA / thAyamasa granthi ko oNparezana dvArA nikAla lene se bahuta phAyadA hotA hai| roga kI prArambhika avasthA meM yaha oNparezana kiyA jAya to 50 % se adhika marIjo ko lAbha hotA hai / dardI kI umra 45 se kama ho taba yaha oNparezana karane kI salAha khAsa dI jAtI hai| usase viparIta 50 % marIz2o meM sTIroIDa samUha kI davAI se lAbha hotA hai| kucha logo ko ejhAthAyoprina nAmaka davAI se ArAma milatA hai, parantu laMbe samaya taka lene se usakA duSprabhAva bhI dekhA jAtA hai / naI davAIyoM meM mAIkophinoleTa nAmaka davAI mukhya hai|

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228 mastiSka aura jJAnataMtu kI bImAriyA~ jyAdA mAtrA meM asarayukta marIz2o meM plAjhamApheresisa nAmaka upacAra kiyA jAtA hai| jisameM marIz2a kA rakta zuddha karake punaH use zarIra meM car3hAyA jAtA hai| yaha kriyA se snAyu kI ora jAne vAlI taraMgo ke prasAraNa meM kSati utpanna karane vAle esiTAIlakolina pratidravya (enTaboDija) tathA anya padArtha dUra hote hai| vAstava meM darda kI kisI bhI avasthA meM yaha upacAra paddhati se marIz2a ko phAyadA hotA hI hai| nyUrolIjasTa taya karate haiM, kauna se marIja meM kaba karanA / roga kI gaMbhIra sthiti meM jaba koI davAI asara na kare taba to yaha upacAra akasIra hai / kabhI kabhI marIz2a mAyastheniyA krAIsisa (kaTokaTIyukta sthiti)meM A jAtA hai / aura roga tIsarI, cauthI yA antima avasthA meM A jAe taba yaha upacAra arthAta, plAjhamApheresisa dvArA marIz2a kI jiMdagI bacAI jA sakatI hai| kucha marIjo meM plAjhamApheresisa eka se jyAdAbAra bhI karane kI jarUrata par3atI hai / aisA hI atyaMta sahI lekina maha~gA upacAra imyUnoglobyUlina ke injekzana kA hai, jisameM svastha manuSyoM ke rakta meM se athavA sintheTika taraha se ekatrita kiyA gayA rogapratikAraka dravya, jise imyUnoglobyUlina kahate hai, vaha marIz2a ko vipula mAtrA meM nasa dvArA diyA jAtA haiM / sAmAnyataH 400 mi.grA./ki.grAma. pratidina karIbana tIna se pAMca dina yaha davAI prayoga kI jAtI hai| usakA aMdAjita kharca do lAkha taka ho sakatA hai| isa prakAra ke upacAra dvArA bhI roga ko zIghra niyaMtraNa meM lA kara jiMdagI bacAI jA sakatI hai| yaha upacAra bhI bAra bAra kiyA jA sakatA hai| sarjarI : mAyastheniyA roga meM sarjarI do hetusara kI jAtI hai / 1. agara Age batAye mujaba thAyamomA nAmakI gAMTha ho to / 2. gAMTha na bhI ho, para vyakti kI umra-45 se kama ho to / isa sarjarI ko thAyamekTamI kahate hai aura usake laMbe arase ke pariNAma kAphI acche pAe gae hai / isake bAda davAI kramazaH baMda bhI ho sakatI hai|

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20 - mAyastheniyA grevisa (Myasthenia Gravis) 229 isa taraha mAyastheniyA grevisa pramANa meM kaThina aura jaTila roga hai| pratyeka marIz2a anusAra mAtrA aura car3hAva-utAra vibhinna rahane se, turanta nidAna karake niSNAta cikitsaka kA upacAra kiyA jAye to adhikAMzataH marIz2o ko bacAyA jA sakatA hai| kauna se marIja ko kauna sI davAI yA upacArapaddhati denI hai, vaha niSNAta DaoNkTara hI taya kara sakate hai / * lembarTa iTana mAyasthenika sinDroma (LEMS) : yaha bhI mAyastheniyA jaisA nyUrAmaskyUlara jaMkzana kA roga hai / 85% (pratizata) marIja 40 varSa upara kI umra ke hote hai| 67% marIja meM yaha roga phephar3e ke kensara se hone vAle perAniyoplAsTika DisorDara ke rUpa meM hotA hai / mAyastheniyA se ye alaga par3atA hai kyoMki (1) kaMdhe aura jA~gha ke snAyuoM kI kamajorI isa roga ke mukhya lakSaNa hai| (2) A~kho ke snAyu kI kamajorI isameM mAmUlI hotI hai| (3) kaI marIjoM ko bolane aura khurAka nigalane meM bhI takalIpha hotI hai| (4) anukaMpI - parAnukaMpI cetAtaMtra kI takalIpha jaise ki A~kheM sUkI ho jAnA, kama dikhanA, kabjI, kama pasInA honA vagairaha bhI isameM dekhane ko milatA hai / Electrophysiology (i.ema.jI. evaM. Ara. ena.esa.) jA~ca meM ye . roga mAyastheniyA se turaMta alaga pakar3A jAtA hai / yaha roga kI zakyatA vAle marIja kI saMpUrNa jA~ca karavAnI cAhie aura usako koI prakAra kA kensara, mukhyataH phephaDe kA hai ke nahi vaha patA karanA cAhie / agara marIja ko kensara ho to usakI sAravAra karane se LEMS ke lakSaNoM meM phAyadA ho sakatA hai /

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mastiSka aura jJAnataMtu kI bImAriyA~ mAyastheniyA meM upayoga hone vAlI davAI jaise ki mesTinona, sTIroIDsa, ejhAthAyoprina, mAyakophinoleTa vagairaha isa roga meM mAyastheniyA jitanI aksIra sAbita nahIM huI hai / DAI amAInopAyariDina nAmaka davAI isameM madadarUpa ho sakatI hai / 230 surkhiyA~ * jJAnataMtuoM meM se snAyu taka pahuMcane vAlI taraMgo ke prasAraNa meM kSati hone se yaha roga hotA hai / jisameM snAyu meM samaya samaya para asAdhAraNa kamajorI AtI hai / * A~khoM ke snAyu kI kamajorI se zurU karake zvAsocchavAsa kI kriyA karanevAle snAyu bhI kamajora ho sakate hai, taba paristhiti bigaDa bhI sakatI hai / * esITAIlakolina risepTara enTiboDI TesTa, i.ema.jI., TilasTigmIna TesTa, thoreksa siTIskaina aura thAyaroIDa kA TesTa karavAne para roga kA nidAna kiyA jAtA hai / * sTiroIDa, ejhAthAyoprIna vagairaha davAIyA; plAjhamA pheresisa nAmaka upacAra paddhati aura imyunoglobyulina ke injekzana vagairaha se yaha roga kAbU meM A sakatA hai| hAlAMki snAyu kI thakAvaTa dUra karane ke lie pAyariDosTigmIna aura nIosTigmIna kA upayoga hotA hai / jyAdAtara kensara se jUDI nyUromaskyUlara jaMkzana kI bImArI LEMS, mAyastheniyA jaisI dikhatI hai, para alaga hai /

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snAyu kI bImAriyA~ (Myopathies) abhI taka hamane mastiSka aura cetAtaMtra kI adhikatara bImAriyoM ke viSaya meM jaanaa| aba hama mukhyataH snAyu kI bImAriyoM ke saMdarbha meM kucha jaaneNge| hama jAnate hai ki hamAre zarIra ke pratyeka avayava yA pratyeka bhAga kA saMcAlana mastiSka se hotA hai / isa taMtra meM mastiSka, choTA mastiSka, karor3arajju, usameM se nikalane vAlI cetAe~, cetA aura snAyu ke bIca kI kar3I arthAt nyUromaskyulara jaMkzana aura snAyuoM kA samAveza hotA hai / nyUromaskyulara jaMkazana kI bImArI mAyastheniyA grevisa saMdarbha meM hamane Age vistAra se varNana kiyA hai / snAyuoM kI bImAriyoM kA vargIkaraNa : mukhyataH isa rUpa se kiyA jA sakatA hai / (A) maskyulara DisTrophI : (B) (C) snAyuoM ke koSoM kI vaMzAnugata bImArI jaise ki Dazena maskyulara DisTrophI cenalopathI : jaise ki hAyapokelemika yA hAyaparakelemika pIriyoDika perelisisa meTAbolika mAyopathI : zarkarA, carabI vagairaha ke cayApacaya meM khAmI ke kAraNa honevAlI snAyuoM kI kamajorI (D) mAITokonDriyala mAyopathI : zarIra ke pratyekaM koSa ke urjAstrota - mAITokonDriA meM khAmI hone se honevAlI snAyuoM kI kamajorI jaise ki karna sayAre sinDroma (E) konjanIITala mAyopathI : jaise ki senTrala kora DisIjha

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232 mastiSka aura jJAnataMtu kI bImAriyA~ (1) inphlemeTarI mAyopathI : jaise ki paoNlImAyosAyaTisa, DarmaTomAyosAyaTisa ityAdi (G) ekvAyaI mAyopathI : aba hama snAyuoM kI bImAriyoM meM mukhyataH vaMzAnugata arthAt heriDiTarI mAyopathIja ke saMdarbha meM jAneMge / (A) maskyulara DisTrophI : (1) Dazena maskyu lara DisTrophI ( Duchenne Muscular Dystrophy): 'eksa' raMgasUtra (Sex-linked recessive) se saMbaMdhita yaha vaMzAnugata bImArI eka lAkha meM se 30 kizoroM meM dekhane ko milatI hai / strIyAM isa roga se bacI hai, jaba kI bImArI kA vahana unhIM se hotA hai| vaise to yaha bImArI janma se hI hotI hai, kintu usake cihna 3-5 varSa kI umra meM najara Ate hai / baccA calate calate gira jAe, baiThakara uThane meM yA sIDhiyA~ car3hane meM parezAnI kA anubhava kare aura kramazaH kamaz2orI meM bar3hotarI ho / pIDI ke snAyu meM sUjana ho jAye, jise syUDo hAyaparaTrophI kahate hai / 10-12 varSa kI umra taka to adhikatara marIz2o ko vhIlaceyara kA sahArA lenA par3atA hai, aise marIz2o meM ugra aura kabhI jAnalevA phephaDe kA saMkramaNa lagane kI bhI saMbhAvanA rahatI hai| aise baccoM meM mAnasika vikAsa maMda hotA hai aura hRdaya kI bImArI bhI dekhane ko milatI hai| nidAna : isa bImArI kA nidAna nimna anusAra kiyA jAtA hai : (1) rakta ke namUne meM sI.pI.ke., esa.jI.o.TI., AlDolez2a jaise enjAImsa kA pramANa bar3hA huA mAlUma paDatA hai / (2) i.ema.jI. jA~ca meM kucha nizcita gar3abar3a pakaDI jAtI hai (mAyopathika pettrn)|

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21 - snAyu kI bImAriyA~ (Myopathies) 233 (3) masala bAyopsI karake mAIkroskopa jA~ca meM sunizcita nidAna hotA hai| (4) parivAra ke anya puruSa, bacce aura mAtA ke bhAI aura unake baccoM meM aisI bImArI ke lakSaNa pAe jAne kI pUrI saMbhAvanA hai| upacAra: sTiroiDa se isa bImArI para kucha mAtrA meM aMkuza lagAne ke bAda bhI isakA koI Thosa-akasIra ilAja abhI taka saMzodhita nahIM huA hai| phirabhI vyAyAma aura mAnasika sahAyatA ina marIjoM kA vizvAsa banAe rakhane meM adhika mahatvapUrNa bhUmikA nibhAte haiM / isalie maskyulara DisTrophI esosiyezana aura DI.ema.DI. saporTa grupa jaisI saMsthAe kAryarata haiN| naI paddhatiyoM meM jIna therepI / sTemasela therepI AzAspada lagatI hai / (2) bekara maskyulara DisTrophI : 'eksa' raMgasUtrayukta kI yaha bImArI meM snAyuoM kI kamajorI Dazena maskyulara DisTrophI jaisI hI hotI hai, lekina kamajorI kI tIvratA aura bImArI baDhane kI gati maMda hotI hai / bImArI ke prAraMbhika cihna 5 se 15 varSa kI Ayu meM dikhate haiM aura sAmAnyataH marIja 4 se 5 dazaka jIvita rahatA hai| (3) liMba (uddIpaka padArtha) garDala DisTrophI : / snAyuoM kI yaha bImArI puruSa aura strI donoM meM dekhane ko milatI hai| yaha jIvana ke pahale se cauthe dazaka taka hote hue dekhane ko milatI hai / kramaza: bar3hatI huI yaha bImArI meM kamara aura kaMdhe ke snAyuoM meM kamajorI mAlUma paDatI hai, jo kramazaH bar3hatI jAtI hai| udarapaTala kI kamajorI se kabhI zvAsocchvAsa kI gaMbhIra parezAnI ho sakatI hai / isake uparAMta hRdaya kI takalIpha bhI zuru ho sakatI hai /

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234 (B) mastiSka aura jJAnataMtu kI bImAriyA~ (4) mAyoTonika DisTrophI : yaha bImArI meM cahere ke snAyu kamajora ho jAte hai| marIja ke cehare para yaha bImArI spaSTa dikhatI hai| isake uparAMta gale aura hAtha ke snAyuoM ko bhI asara hotA hai / mAyoToniyA dekhane ko milatA hai, jisa meM muThThI baMdha karane ke bAda vaha saralatA se khula nahIM sktii| marIjoM meM alpamAnasika vikAsa, hRdaya kI bImArI aura motiyAbinda ityAdi dekhane ko milatA hai| isake uparAMta phesiyoskepyUlohyumarala maskyulara DisTrophI meM mu~ha, kaMdhe aura hAtha ke snAyuoM meM kamajorI hotI hai| isa darda meM mAyoToniyA hetu pheniToina nAmaka davAI dI jAtI hai| cenalopathI : Ayana cenala jo snAyuoM meM koSoM ke bIca hotI hai, unameM khAmI hone se honevAlI mAyopathI mukhyataH nIce mujaba hai / (1) hAyapokelemika pIriyoDika perelisisa : rakta meM poTeziyama tatva kama hone se hAipokelemika pIriyoDika perelisisa ho sakatA hai jisa meM hAtha meM-kaMdhe tarapha aura paira meMjAMgha tarapha ke snAyuoM meM kamajorI AtI hai| yaha bImArI bAra bAra hamalA kara sakatI hai| kabhI kabhI AMkho aura zvAsocchvAsa ke snAyuoM para bhI asara ho sakatI hai| yogya upacAra na milane para jAnalevA ho sakatI hai| hRdaya kI dhar3akana meM aniyamitatA dekhane ko milatI hai| rakta meM poTeziyama kA pramANa kama hote hue dekhane ko milatA hai| TenDana jasa kI tIvratA kama mAlUma paDatI hai / isameM mukhyataH kelziyama kI cenala meM khAmI hotI hai| poTeziyama-nasa meM iMjekzana botala ke tahata yA mu~ha dvArA dene se snAyuoM kI kamajorI dUra ho jAtI hai| isameM tabIbI dekharekha atyaMta jarUrI hai kyoMki poTeziyama kI mAtrA meM vadha-ghaTa hone se gaMbhIra duSprabhAva ho sakate hai|

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21 snAyu kI bImAriyA~ (Myopathies) (2) hAIparakelemika pIriyoDika perelisisa : rakta meM poTeziyama kI mAtrA bar3hane se bhI isa prakAra kI snAyuoM kI kamajorI A sakatI hai / isameM mukhyataH soDiyama cenala meM khAmI dekhane ko milatI hai| marIja ko kama poTeziyama aura jyAdA zarkarA yukta AhAra lenA caahie| jyAdA zrama, upavAsa aura ThaMDa se bacanA cAhie / esiTAjholAmAIDa aura klora thAyAjhAIDa davAIyoM se phAyadA ho sakatA hai / (3) perAmAyoToniyA konjenIITA : 235 isa roga meM ThaMDe vAtAvaraNa se yA to binAkAraNa kamaz2orI A sakatI hai / zArIrika pravRtti se kamaz2orI bar3hatI hai / glukojha yA anya kArbohAIDreTayukta padArthoM kA sevana karane se yaha kamajorI dUra ho sakatI hai / thAyAjhAIDa DAiyUreTika aura mekjhileTina nAmaka davAI se phAyadA hotA hai / lekina isakA asara hote samaya lagatA hai / / (C) meTAbolika mAyopathI ( Metabolic Myopathy) : snAyuoM kI janmajAta cayApacaya kI gar3abar3a, jaise ki glAyakojana sToreja, mAyo phosphorIlez2a, lipiDa sToreja tathA kucha mAyaTokonDrIyala mAyopathI isa prakAra meM samAviSTa hai / isameM marIjako zurUAta meM thoDA-sA kAma karane para bhI thakAvaTa mahasUsa hotI hai / vyAyAma karate samaya snAyuoM meM darda hotA hai, jo sAmAnya vyaktioM meM nahIM hotA / snAyuoMkI kamajorI choTI umra se hI dikhanA zurU ho jAtI hai / pezAba kA raMga kolA ke raMga jaisA lagatA hai / khUna meM zarkarA, carabI vagairaha ke cayApacaya meM upayoga meM AnevAle enajhAIma kI mAtrA kama ho jAtI hai /

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236 mastiSka aura jJAnataMtu kI bImAriyA~ cayApacaya kI jisa khAmI se yaha roga hotA hai, usakA upacAra karane se kucha roga meM phAyadA milatA hai| niyamita kasarata (Physiotherapy) to jarUrI hai hii| (D) mAITokonDriyala mAyopathI : isameM mAITokonDriyA jo zarIra ke pratyeka koSa kA UrjAstrota hai usameM khAmI dekhane ko milatI hai, jaise ki mAITokonDriA ke DI.ena.e. kA myUTezana, enjhAIma kI khAmI yA usakI racanA meM khAmI / isameM mukhyataH A~kha ke snAyuoM para jyAdA asara dekhane ko milatI hai| sAthameM hAtha aura paira ke snAyuoM meM bhI kamajorI hotI hai / isake alAvA nATApana, rIDha kI haDDI kA TeDhA ho jAnA, hRdaya ke snAyuoM kI kamajorI, nyUropathI, baherApana, hormonsa kI khAmI, khiMca, calane meM takalIpha honA, saradarda, pakSAghAta honA vagairaha kaI marIjo meM dekhane ko milatA hai| yaha saba cihna samUha para se kauna se prakAra kI mAITokaunDriyala mAyopathI hai, yaha patA cala sakatA hai| jaise ki, - karna sayAre sinDroma - ema.I.Ara.Ara.epha. - ema.I.ela.e.esa. janInoM kI viziSTa jA~ca karane se mAITokonDriyala DI.ena.e. myUTezana dekhane ko milatA hai / niyamita kasarata ke alAvA isakA koI upacAra nahIM hai| ko-enjhAIma kyU-10 aura viTAminsa dene se snAyuoM kI kamajorI meM thor3A phAyadA thoDe samaya taka dekhane ko mila sakatA hai| marIja ko kamajorI ke alAvA jo lakSaNa ho, usakA upacAra karanA caahie|

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237 21 - snAyu kI bImAriyA~ (Myopathies) (E) 'konjenAiTala' (janmajAta) mAyopathI : navajAta zizuo meM dekhane ko milanevAlI snAyuoM kI bImArI meM senTrala kora, nimelAIna aura senTronyUkliara mAyopathI kA samAveza hotA hai| isameM jyAdAtara janma se hI snAyuoM kI kamajorI dekhane ko milatI hai| navajAta zizu binA halana-calana par3A rahatA hai / yA usakA halana-calana sAmAnya baccoM ke mukAbale kama hotA hai| jaise jaise baccA bar3A hotA hai, usake snAyu kaI bAra kaDaka ho jAte hai aura usakA mAnasika vikAsa maMda ho jAtA hai / snAyuoM meM ghisAva (atrophy) dekhane ko milatA hai| kaI baccoM meM bar3hatI umra ke sAtha snAyuoM meM sAmAnya baccoM jaise hI vikAsa hotA hai aura mAnasika vikAsa bhI barAbara hotA hai / isa roga meM baccoM ko khelane kUdane ke lie protsAhita karanA caahie| jisase kI unake snAyuoM meM tAkAta bar3he aura usakA sahI DhaMga se vikAsa ho / jarUrata par3ane para vyavasAyika niSNAta kI salAha bhI lI jA sakatI hai| (E) inphlemeTarI mAyopathI : snAyuoM ke sUjana se hotI kucha jaTila bImAriyoM ke saMdarbha meM aba hama dekheNge| polImAyosAyaTisa aura DarmeTomAyosAyaTisa : polImAyosAyaTisa aura DarmeTomAyosAyaTisa kyA hai ? isa bImArI meM prathama snAyuoM meM sUjana kI-'inphlemezana' kI-prakriyA hotI hai aura usase snAyu zithila aura kamajora hote jAte hai| isa bImArI kA mukhya lakSaNa snAyuoM kI kamajorI hai, jo kramazaH bar3hakara marIja ko vikalAMga banA detA hai / DarmeTomAyosAyaTisa ke marIjoM meM cehare, pITha, chAtI, konI aura ghuTane ke bhAga para lAlAza vAle cAThe bhI dekhane ko milate hai /

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238 mastiSka aura jJAnataMtu kI bImAriyA~ kAraNa : yaha bImArI vaMzAnugata nahIM hai / zarIra kI rakSaNAtmaka imyUna sisTma ( pratikArataMtra) meM vikSepa hone se snAyuoM ko naSTa karane vAle koSa paidA hote hai, jo yaha bImArI kA kAraNa hai / yahA~ yaha batAnA Avazyaka hai ki yaha bImArI saMkramita nahIM hai I lakSaNa : 18 varSa ke najadIka kI Ayu meM hotI isa bImArI ke lakSaNa, isakI tIvratA aura bar3hane kI gati Adi meM bahuta vividhatA dekhane ko milatI hai / kucha mahInoM ke aMtargata hI snAyuoM meM kamajorI phailatI hai / kvacita yaha bImArI rUka jAtI hai, lekina adhikatara marIjo meM agara yogya upacAra na kiyA jAe to, kamajorI kramazaH bar3hatI hI jAtI hai / marIja kI cAla asthira ho jAtI hai aura vaha bAra bAra gira jAtA hai samaya bItane para calanA bilkula hI baMda ho jAtA hai aura marIja bistaravaza ho jAtA hai / zIghratA se bar3hatI huI bImArI meM marIja ko ThIka hone kI saMbhAvanA adhika hotI hai| karIbana 50 % marIjoM meM davAI se sudhAra ho sakatA hai / 1 ina marIjoM meM snAyuoM ke darda se mukhyataH sIr3hI car3hane meM yA kursI meM se khaDe hone meM takalIpha hotI hai / hAtha upara karane meM bhI takalIpha hotI hai / garadana ke snAyuoMmeM kamajorI dekhane ko milatI hai / jaise jaise bImArI bar3hatI hai, vaise vaise AhAra, pravAhI nigalane meM aura zvAsa lene meM bhI parezAnI hotI hai / nidAna : uparyukta lakSaNoM ke sAtha : (1) rakta meM sI.pI. ke. kI bar3hI huI mAtrA (2) masala bAyopsI meM snAyu ke Tukar3e meM dekhane ko milate nizcita badalAva / (3) I.ema.jI., ena.sI.vI. jaisI jA~ca se bImArI kI caukasAI hotI hai|

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239 21 - snAyu kI bImAriyA~ (Myopathies) upacAra : (a) davAI (1) sTiroIDa grUpa meM preDnIsolona, mithAIla preDnIsolona, DekSAmethAsona tathA (2) imyUnosapresiva davAI jaise ki ejhAthAyoprIna, mAyakophinoleTa, mithoTrekseTa tathA (3) sAyaklosporina jaisI davAI se yaha bImArI adhikAMza niyaMtraNa meM lA sakate hai, jo ki laMbe samaya ke bAda yaha davAI kA duSprabhAva bhI dekhane ko milatA hai / (ba) plAjhamApheresisa : marIja ke rakta meM se kharAba proTIna zuddha karane kI isa prakriyA dvArA bImArI para niyaMtraNa lAyA jA sakatA hai| (ka) imyUnoglobyUlina : yaha davAI raktavAhinI meM dene se bhI lAbha hotA hai, paraMtu yaha upacAra bahuta maha~gA hotA hai / isake bAvajUda phijiyotherepI kA mahatva bhI kama nahIM samajanA cAhie / pratidina niyamita phijiyotherepI (vyAyAma) karane se kucha aMza taka snAyuoM ko zithila hote hue rokA jA sakatA hai| isa bImArI meM kevala sAmAnya darda hotA hai, isalie bImArI ThIka hone kA intajAra kiye binA zIghra hI yogya cikitsaka kI salAha lenA adhika mahatvapUrNa hai| (G) ekvAyarDa mAyopathI : isa prakAra meM snAyuoM meM janmajAta gar3abar3a nahIM hotI, lekina thAiroIDa hormona bar3hane yA ghaTane se, perAthAiroIDa hormona bar3hane se, adhika mAtrA

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240 mastiSka aura jJAnataMtu kI bImAriyA~ meM sTiroiDa ke sevana se yA anya davAI ke duSprabhAva se, DAyAbiTIsa ke apUrNa upacAra se, mUtrapiMDa (kiDanI), yakRta (livara) kI laMbI bImArI se yA adhika zarAba ke sevana se aura viTAmina kI kamI se aura kesara se yA usakI davAI ke duSprabhAva se, aise aneka kAraNoM se snAyu kamajora ho sakate hai| yogya nidAna se aura dhyAnapUrvaka upacAra karane se yaha sthiti meM sudhAra ho sakatA hai / melignanTa hAyaparatharmiyA : yaha roga ke lakSaNa sAmAnyataH kisI marIja ko oNparezana ke lie janarala ainesthesiyA ( saksinAIla kolina, helothena) diyA jAe taba mAlUma paDate hai / yaha eka AnuvaMzika roga hai / ainesthesiyA dete vakta acAnaka snAyu kar3aka ho jAte hai / pizAba kA raMga kolA jaisA hotA hai / bhArI bukhAra AnA, dhar3akane bar3ha jAnA, zarIra nIlA par3a jAnA aura hRdaya kI dhar3akanoM meM aniyamitatA AnA vagairaha lakSaNa dekhane ko milate hai / isake nidAna ke mukhya TesTa hai khUna meM sI.pI. ke. kI mAtrA (Serum CPK level) jo kAphI bar3ha jAtI hai / isa bImArI se dardI jyAdAtara jAna ga~vA detA hai / isalie koI bhI vyakti ko janarala enesthesiyA dene se pahale yaha jAna lenA cAhie ki kuTuMba meM anya kisIko enesthesiyA ke daurAna aisI koI takalIpha yA mRtyu huI thI kyA ? zarIra ko ThaMDe karane ke upacAra ke sAtha tAtkAlika DenTrolina nAmaka davAI isa meM jAna bacA sakatI hai /

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21 - snAyu kI bImAriyA~ (Myopathies) surkhiyA~ snAyuoM kI bImAriyoM meM mukhyataH vaMzAnugata arthAt heriDiTarI mAyopathIja hotI hai / * Dazena maskyulara DisTrophI sirpha puruSoM meM hotI hai, jisameM calane meM yA caDhane - utarane meM parezAnI se lekara jAnalevA phephaDe kA saMkramaNa lagane kI saMbhAvanA rahatI hai / * liMbagarDala DisTrophI meM kamara aura kaMdhe ke snAyu kamajora hote hai aura kabhI zvAsocchavAsa meM parezAnI hotI haiM / yaha strI-puruSa donoM meM hotI hai / rakta meM poTezyama kA pramANa kama hone para hAtha meM kaMdhe tarapha aura paira meM jA~gha tarapha ke snAyuoM meM kamajorI AtI hai, use hAipokelemika pIrIyoDika perAlisIsa kahate hai / * rakta meM poTezyama kA pramANa bar3hane se honevAlI snAyuoM kI kamajorI ko hAipara kelemika pIrIyoDika perAlisIsa kahate hai / * perAmAyoToniyA konjenIITA meM ThaMDe vAtAvaraNa meM yA to binA kAraNa kamajorI AtI hai / * snAyuoM kI janmajAta cayApacaya kI gar3abar3a se hone vAlI mAyopathI ko meTAbolika mAyopathI kahate haiM / * navajAta zizu meM dekhane ko milane vAlI snAyuoM kI bImArI ko konjenAITala mAyopathI kahate hai / * polImAyosAyaTIsa meM snAyuoM meM sUjana AtI hai, vaha kamajora hote hai aura marIja vikalAMga ho jAtA hai / 241

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242 mastiSka aura jJAnataMtu kI bImAriyA~ * DarameTomAyosAyaTIsa meM snAyuoM kI sUjana ke sAtha marIjhoM ke cehare, pITha, chAtI, kohanI aura ghuTane ke bhAga para lAlAza vAle cihna dekhe jAte hai / * sTIroIDa gupa kI davAI, imyunosapresiva davAI, sAiklosporina davAI, plAjhamA pheresisa kI prakriyA aura imyunoglobyulina ke injekzana se isa roga meM kAphI rAhata mila sakatI hai| ekvAyarDa mAyopathI meM hormonsa ke asaMtulana se, davAI ke duSprabhAva se, DAyAbiTIsa ke apUrNa upacAra se, kiDanI yA yakRta kI laMbI bImArI se yA adhika zarAba ke sevana se aura viTAmina kI kamI ke kAraNa yA anya aneka kAraNo se snAyu kamajora hote hai| janarala enesthesiyA ke daramyAna kucha marIjoM kI acAnaka bukhAra ke sAtha mRtyu hotI hai, usakA kAraNa melignanTa hAyaparatharmiyA nAmaka, bahuta hI kama dikhane vAlA roga hai|

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( saka tanAva denzana (Stress) * tanAva kyA hai ? tanAva arthAt zarIra ke kisI bhI taMtra para honevAlA dabAva aura usase utpanna huI sthiti| hamArI jIvanazailI yA hamAre manosAmAjika vAtAvaraNa meM uThatI huI samasyAoM aura takalIphoM se zarIra aura mana jo pratikriyAe~ pedA karatA hai use sTresa yA tanAva kahate hai| tanAva kevala nakArAtmaka yA hAnikAraka hI ho aisA nahIM hai, tanAva sakArAtmaka bhI ho sakatA hai| tanAva se anapekSita paristhitiyoM kA sAmanA karane kI kSamatA bar3hatI hai| duvidhApUrNa paristhitiyA~ jaise ki spardhA, parIkSA ityAdi meM tanAva kI prakriyA se manuSya satarka aura sajAga banatA hai| * 'sAmanA karo yA bhAga jAo' pratikriyA kyA hai ? tanAva kI paristhiti Ane se hI hamAre zarIra meM kaI jaivika rAsAyanika badalAva hote hai, jo do prakAra kI pratikriyA utpanna karate haiM / laDanA yA palAyana kara jAnA (fight or flight) - isa prakriyA ke daurAna zarIra meM vAstava meM kahA~ badalAva hotA hai yaha hama deMkhege / tanAva meM hamAre zarIra kA svayaMsaMcAlita aisA anukaMpI jJAnataMtra (Sympathetic Nervous System) uttejita hotA hai-eDrinalina nAmaka rasa kA srAva hotA hai aura isa kAraNa zarIra meM nizcita prakriyA dekhane ko milatI hai| * tanAva ke kAraNa zarIra aura mastiSka para hone vAle vibhinna tatkAlina prabhAva : (1) zvAsocchvAsa zIghra, choTe aura gaharAI vihIna banate hai / (2) hRdaya kI dhaDakana bar3ha jAnA aura rakta kA dabAva baDhanA / (3) hAtha-paira meM rakta ApUrti meM kamI honA aura snAyuoM meM rakta kA paribhramaNa bar3hanA /

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244 mastiSka aura jJAnataMtu kI bImAriyA~ (4) zarIra meM snAyuoM kA taMga ho jAnA, hAtha-paira ThaMDe ho jAnA, zarIra meM pasInA honA, roMgaTe khar3e ho jAnA, kaI bAra kaMpana-dhrujArI kA anubhava honaa| (5) rakta jama jAne kI prakriyA zIghra bananA / (6) A~kha kI putaliyA~ cauDI ho jAnA / (7) indriyA~ sateja baneM aura sunane kI, dekhane kI aura sUMghane kI tIvratA bddh'e| (8) zarIra kI cayApacaya kI prakriyA (meTAbolijhama) meM vega aanaa| (9) mastiSka kI vicArazakti bar3hanA / (10) nirNayazakti tathA paristhiti parakhane kI sUjha teja bane aura smaraNazakti satez2a bane / koI bAra 'kyA hogA?' aisA Dara bhI lagatA hai| * zarIra para laMbe samaya ke tanAva kA nakArAtmaka prabhAva : (1) vyavahAra kI samasyAe~ : svabhAva gussevAlA aura ciDaciDA ho jAnA, kAryazakti meM kamI A jAnA, svabhAva se bhulakkaDa honA, vivekahIna aura bedhyAna honA, kharAba AdatoM kA zikAra honA, jAtIya jIvana kI samasyA paidA honA, AhAra meM aruci athavA atyAdhika khAne kI Adata par3anA / pralaMba-tanAva ke kAraNa vyavahAra meM hone vAlI samasyAoM ke yaha sabhI cihna hai| (2) svAsthya kI samasyAe~ : - inameM siradarda, dama, hAI bI.pI., joDoM kA darda, tvacAroga, hRdayaroga, jaThara ke chAle, anidrA, cakkara AnA aura Diprezana ityAdi kA samAveza hotA hai| eka aMdAja anusAra karIbana 80 pratizata bImAriyA~ mAnasika tanAva kI vajaha se zarIra meM paidA hotI hai, jise manodaihika (sAyakosomeTika) bImArI kahate hai| isake uparAMta tanAva se rogapratirodhaka zakti kama hotI hai /

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245 22 - tanAva-Tenzana (Stress) * tanAva utpanna karanevAle paribala : tanAva paidA karanevAlI paristhiti/ saMyoga pratyeka vyakti anusAra bhinnabhinna hotI hai| pArivArika tathA aMgata samasyAe~ : * parivAra ke sadasyoM meM matabheda * jIvanazailI meM matabheda * durghaTanA, irSyA saMpatti se saMbaMdhita jhagaDA Arthika samasyA baccoM kI samasyA prema yA vivAha meM milatI asaphalatA, vivAda-viccheda * dAmpatya jIvana ke prazna vyavasAya aura kArakIrdi (kariyara) saMbaMdhita samasyAe~ : * kAma kA atyAdhika boz2a atyaMta U~cA kAryalakSyAMka taka(oporyuniTI) kI kamI, bekArI, kama Avaka parIkSA, inTayUM, tabAdalA, tAlIma naukarI ke sthAna para sattA kA rAjakAraNa, bhraSTAcAra * sahakarmacAriyoM ke sAtha matabheda * naukarI-vyavasAya se milane vAle saMtoSa kI kamI sAmAjika samasyAe~ : * garIbI * jAtibheda * gunehagArI * AtaMkavAda

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246 * mastiSka aura jJAnataMtu kI bImAriyA~ durghaTanA ke zikAra bane loga yA use dekhanevAle vyakti bhI tanAva ke zikAra ho sakate hai| 'e' prakAra kA ('TAipa e') vyaktitva jisameM manuSya adhika mahatvAkAMkSI, ugra, ghamaMDI hotA hai, yaha paristhiti bhI tanAva paidA karatI hai| janma, vivAha, garbhAvasthA, vivAha-viccheda (talAka), nivRtti, parivArajana kA mRtyu jaise jIvana ke prasaMga bhI tanAva paidA karate hai| isake sAtha hI Adhunika jIvanazailI tathA Adhunika jIvana kI bhAgadauDa-spardhA meM aura adhika kamAne kI dauDa meM lage rahane ke lie jhUjhatA huA vyakti AsAnI se tanAva aura tanAvajanya bImAriyoM kA zikAra ho jAtA hai| tanAva para niyaMtraNa hetu aura tanAva se dUra rahane ke upAya : sabase pahale to hameM tanAva utpanna karanevAlI paristhiti ko samajhanA par3egA aura zAMta citta se yogya samAdhAna karane kA prayatna karanA pdd'egaa| isake alAvA tanAva ke cihnoM ko sAvadhAnI kA saMketa mAnakara, tanAva para niyaMtraNa pAne ke lie tvarita yogya kadama uThAne caahie| * upacAra : tanAva ke kAraNoM aura cihnoM ke viSaya meM jAgRti lAnI ho to, tanAva paidA karanevAlI paristhitiyoM kA mUlyAMkana karake use hala karane ke vikalpoM ko pahacAne aura sunizcita kreN| * pravartamAna paristhiti-saMyoga saMdarbha : (1) paristhiti kA samajhadArI aura svasthatA se mukAbalA kareM: udAharaNa - parIkSA ke samaya dinacaryA meM badalAva lAkara, par3hane ke lie samayatAlikA banAkara yogya mArgadarzana ke sAtha taiyArI kreN|

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22 tanAva - Tenzana (Stress) ( 2 ) paristhiti se dUra ho jAe~ : udAharaNa kisI ke sAtha anaapekSita vyavahAra yA ghaTanA se tanAva paidA hotA ho aura saMbaMdha sudhare nahIM aisA ho to saMbaMdha ko khatma kara deM / naye saMbaMdha jyAdA bar3hAnA nahIM cAhie, naI javAbadArI se dUra raheM | kucha samaya ke lie ekAMtavAsa apnaayeN| nae manuSyoM se samparka jitanA bar3hegA, utanA tanAva bhI bar3hegA / isa kAraNa medhAvI manuSya yaha saba paristhiti se aura naye saMyogoM se dUra rahatA hai yA use sImita pramANa meM rakhatA hai / (3) kucha bhI na kareM : kevala yogya samaya kA iMtajAra kre| udA. parIkSA ke pariNAma ke lie svastha citta se intajAra kareM / manozArIrika paribala saMdarbha : - (1) niyamita dhyAna : dhyAna aneka prakAra ke ho sakate haiM / bhArata meM aneka dhyAnapaddhatiyA~ vikasita hai / yaha dhyAnapaddhatiyoM meM pAtaMjala, anApana sati aura smRti upasthAna mukhya hai / usI taraha vipazyanA aura prekSAdhyAna bhI hai, jo aMzataH Upara batAI gaI paddhatiyoM kA saMvardhana hai / anya adhikatara paddhatiyA~ uparyukta paddhatiyoM ke ekAda aMga para se banI hai / manana, maMtrajApa, zvAsocchvAsa kA dhyAna, pUrNayoga dhyAna, spaMdadhyAna, nAbhi dhyAna, svapna dhyAna, nAda dhyAna, yoga nidrA, nyAsa, trATaka, sUryasaMyama, arUpa dhyAna, kAyotsarga dhyAna, jaina dhyAna, tathAtA dhyAna, sahaja dhyAna, sAdhumauna, hU dhyAna, ityAdi aneka dhyAna paddhatiyA~ haiM / lekina sabhI paddhatiyoM kA hetu aMtima dhyeya aMtima sAdhyabiMdu eka hI hai, aura vaha hai mana kI zAMti aura usakA vikAsa | 247

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248 mastiSka aura jJAnataMtu kI bImAriyA~ kisI bhI dhyAna paddhati meM ekAda cIja para kendrita honA hotA hai - cAhe vo zvAsa ho, cAhe vicAra ho, cAhe zabda ho, cAhe koI . darzanIya cIja (chavI, mUrti Adi) ho, yA phira koI AnaMdaprada smRti yA kalpanA ho / zAMta citta, samatAbharA cita aura sajagatAbharA citta ye tInoM Avazyaka hai koI bhI dhyAna kI saphalatA hetu / aise citta se dekhanA aura jAnanA-dhyAna hai| svayaM kI zArIrika tathA mAnasika prakRti aura svayaM ke Atmika vikAsa ko lakSya meM rakhakara khuda ko jo yogya lage vaha dhyAna kA niyamita abhyAsa kreN| dhyAna, tanAva dUra karane kI eka zreSTha auSadhi mAnA jAtA hai| yaha pratidina karanA hitakAraka aura Avazyaka bhI hai / dhyAna tanAvayukta paristhiyoM meM vizeSataH karanA caahie| pratidina tIsa miniTa dhyAna karane kI salAha dI jAtI hai| (2) prANAyAma : zvAsocchvAsa ke vyAyAma (brIdhiMga eksarasAiz2a), tAtkAlika tanAva aura kAyamI tanAva ke sAmane rakSaNa kA zreSTha aura sarala upAya mAnA jA sakatA hai| (3) vyAyAma : calanA, daur3anA, erobika vyAyAma, jimnesTika, yogAsana, khelanA, tairanA ityAdi yogya mAtrA meM niyamita karane se sTresa avazya hI kama ho sakatA hai| aise vyAyAma kA samaya 5 minaTa se 40 minaTa taka bar3hAyA jA sakatA hai / haphte meM 4 se 5 dina niyamita vyAyAma karanA caahie| choTA-choTA vyAyAma to kAmakAja daurAna bhI 2-5 miniTa ke lie kiyA jA sakatA hai, jaise ki gardana ghumAnA, hAtha aura kalAI kA vyAyAma, cahere kA vyAyAma athavA khaDe hokara 1-2 sIDhiyA~ cddh'naa-utrnaa|

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249 22 - tanAva-Tenzana (Stress) (4) bAyophIDabeka : kramazaH zithilIkaraNa (progresiva rileksezana), hAsyacikitsA (lAphTara therepI), prekSAdhyAna, vipazyanA, selphahipnoTiz2ama, sisTemeTika DisensiTAijhezana ityAdi se bhI adhika lAbha hotA hai, yaha eka vaijJAnika satya hai / (5) saMgIta cikitsA : mana kI zAMti, zithilIkaraNa, AnaMda kI anubhUti aura tanAva se mukti ke lie saMgIta (sunanA yA gAnA yA vAdya bajAnA) se bahetara kyA ho sakatA hai ? (6) AhAra meM yogya badalAva : pauSTika AhAra, proTInayukta AhAra, phalaphalAdi, yogya nAstA aura AhAra meM resAyukta padArthoM kA adhika upayoga tanAva (sTresa) ke sAmane rAhata detA hai| prajIvako (viTAminsa) aura enTioksiDanTa dravya yogya mAtrA meM lene se nizcita hI lAbha hotA hai| carbIyukta, tIkheM aura ati garmauSma AhAra yA phAsTaphUDa se hAni hotI hai| "jaisA AhAra vaisI soca" yaha kahAvata yahA~ yathArtha hai| (7) AvazyakatAnusAra DokTara yA anya kI sahAya : prophezanala vyakti kI sahAya le sakate hai / sTresa ko dUra karane ke lie vibhinna korsa kiye jA sakate hai, jaise ki jIvana jIne kI kalA (ArTa oNpha liviMga), siddha samAdhiyoga aura leMDamArka phorama ityAdi bhI acchA lAbha pahu~cA sakate hai / svaupacAra : isa ke alAvA yahAM nirdiSTa kaI dainika upayogI upAya bhI AjamAyeM jA sakate hai / yaha upAyoM meM anya vyakti kI sahAya Avazyaka nahIM hai / isalie 10-15 dinoM kI chuTTI lekara, hilasTezana para jAne kI jarUrata nahIM haiM, adhika kharca kI bhI jarUrata nahIM hai / * calane phirane yA bAIka para ghUmane jAo / * bAgabAnI (gArDaniMga) karo yA bAga meM ghUmane jAo /

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250 mastiSka aura jJAnataMtu kI bImAriyA~ Tenisa yA TebalaTenisa yA beDaminTana kI gema khelo / mitra ko patra likheM yA use phona kareM (phone a friend) yA usake sAtha bhojana lo / koI zauka kI cIja yA kalA-kArIgarI (krAphTa) ke lie samaya nikaalo| dina meM do bAra 10 se 15 minaTa prArthanA karo / yaha eka adbhuta vidhi hai, jisameM mana ko saMpUrNataH svastha rakhane kI tAkata hai| samasyAoM ke bAre meM jyAdA mata soco, usakA hala kyA ho sakatA hai usa para apanI soca kendrita karo / / mAnad sevA jaisI sAmAjika pravRtti kareM, anAtha Azrama ke lie samaya nikAle, mitra yA sage-saMbaMdhiyoM se milane jAe~ / koI acche grUpa meM sadasya bneN| calacitra yA nATaka dekhane jAo / acchI pustakeM yA sAmayika par3heM, satsaMgI sajjanoM ko mileN| dhArmika paThana kreN| baccoM ke sAtha 15-30 minaTa khelane jaisA uttama aura nirdoSa AnaMda kahAM milegA ? baccoM jaise banakara unake sAtha khelo| saMgrahAlaya (myujiyama)-ArTa gelerI meM jAe~ / masAja, pheziyala, babalabAtha yA sTImabAtha leM / phona sAIDa meM rakhakara, khir3akiyA~ baMdha kara, lAITa tathA AMkhe baMdha karake saMgIta suneM / isa samaya phona kI ghaMTI baje to uThAe nahIM, AnsariMga mazIna kA upayoga kreN| mana kA abhigama arthAt Attitude sudhAreM, use hakArAtmaka aura samAdhAnakArI banAyeM / yaha gurumaMtra hai| yogya paThana, satsaMga aura manana se hI abhigama badalA jAtA hai aura aisA ho to koI bhI paristhiti meM svasthatA rhegii|

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251 22 - tanAva-Tenzana (Stress) * upasaMhAra : sTresa ke daurAna koI bhI nirNaya jaldabAjI meM-acAnaka mata karo / tAtkAlika binA soce nirNaya na kareM, zavAsana kreN| saMpUrNa ArAma aura gahare zvAsa zAyada zreSTha upAya hai / saMbhava ho to usa daurAna prekSAdhyAna, progresiva rileksezana yA yoganidrA sIkha kara usakA abhyAsa kreN| acAnaka sTresa kisI vyakti yA jagaha ke kAraNa huA ho to usa vyakti yA sthAna ko chor3a kara dUra cale jaao| maMdira meM, mitra ke vahA~ jAe~ / darpaNa meM apanA pratibiMba dekho| gusse se pratibhAva na do / gussA Aye to 1 se 10 taka ginatI karo, yaha eka siddha prayoga hai| isase gussA dUra ho jaaegaa| usa kSaNa ko sAvadhAnIpUrvaka lenA hI mahatvapUrNa hai| kucha minaTa ke bAda sTresa zAMta ho jAegA / saMbhava ho to dhyAna karo / saMkSipta meM yaha kahA jA sakatA hai ki jisase sTresa hotA ho una saMyogoM yA una vyaktiyoM se dUra raho, aura manakI galata pratyAghAta denevAlI vRtti ko zAMta karo / zubha dhyAna meM, zubha pravRtti meM aura acche vicAroM meM apane Apako jor3a dene kI kalA hastagata karanI caahie| pratyeka kSaNa jAgrata raha kara AnaMda se jInA sIkhanA caahie| pratidina kI jIvanazailI meM prArthanA, dhyAna, yoga, vyAyAma aura prANAyAma niyamita kara denA cAhie / sAttvika-pauSTika AhAra, phalaphalAdi niyamita lene cAhie / jIvanazailI aura apane ApakA abhigama (Attitude) badalane se sTresa avazya hI kama ho jAegA aura sTresa kI paristhiti paidA ho to bhI usakA sAmanA karane kI kSamatA avazya hI bddh'egii|

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252 mastiSka aura jJAnataMtu kI bImAriyA~ surkhiyA~) * hamArI jIvana zailI meM uThatI huI samasyAoM aura takalIphoM se zarIra aura mana jo pratikriyAeM paidA karatA hai use sTresa kahA jAtA hai| sTresa kevala nakArAtmaka nahi hotA hai, vaha kabhI-kabhI sakArAtmaka bhI ho sakatA hai / * tanAva ke kAraNa hRdaya kI dhaDakana baDhatI hai, zvAsocchavAsa zighra hote hai, indriyA~ sateja hotI hai, zarIra kI cayApacaya kI kriyA meM vega AtA hai, zarIra pe pasInA AtA hai, roMgaTe khaDe ho jAte hai, kaMpana hotI hai, mastiSka kI vicAra zakti baDhatI hai aura nirNaya zakti teja hotI hai| laMbe samaya ke tanAva se kaI vyavahAra samasyAe~ aura svAsthya saMbaMdhI samasyAe~ A sakatI hai| * tanAva paidA karanevAlI paristhiti pratyeka vyakti ke anasAra bhinna-bhinna hotI hai, jaise ki pArivArika aura aMgata samasyAe~, vyavasAya aura kariyara saMbaMdhI samasyAeM yA sAmAjika smsyaaeN| tanAva ke upAya meM use paidA karanevAlI paristhiti kA svasthatA se sAmanA karanA, paristhiti se dUra jAnA yA kucha bhI na karanA, yaha saba vikalpa meM se jo yogya ho usakA cayana karanA hai| * niyamita dhyAna, prArthanA, prANAyAma, vyAyAma aura bAyophIDabeka kI madada se bhI tanAva para kAbU pAyA jA sakatA hai| * sAttvika - pauSTika AhAra aura phalaphalAdi niyamita lene cAhie / * jIvanazailI sudhArane se aura apanA abhigama hakArAtmaka karane se sTresa avazya kama ho jAegA aura paristhiti kA sAmanA karane kI kSamatA baDhegI /

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kI zastrakriyA (Neurosurgery)| __ aba taka ke sabhI prakaraNoM para se samajhA jA sakatA hai ki mastiSka aura cetAtaMtra, mahatva kA aura ati nAjuka taMtra hai / usakI kAryapaddhati bilakula viziSTa-bhinna aura itanI hI nAjuka prakAra kI hai| usake vibhinna hissoM ko nukasAna pahu~ce to vibhinna cihnasamUha udbhavita hote hai, jisake nivAraNa hetu meDikala jA~ca tathA ema.Ara.AI., sI.TI. skaina, I.ema.jI., rakta kI jA~ca, kamara ke pAnI kI jA~ca jaise vibhinna TesTa karavAne paDate hai, jisake lie nyUrophijiziyana (yA anubhavI phijiziyana) kI madada lI jA sakatI hai| yaha DaoNkTarsa ina bimArIoM kA nivAraNa, adhikatara davAI-upacAra se karate haiM / jaba kucha paristhiti meM davAI-upacAra se roga kA nivAraNa na ho athavA mukhyata: mastiSka meM yA karor3arajju meM gAMTha ho, karor3arajju para dabAva ho, rakta nalikA meM rUkAvaTa ho athavA girane se yA akasmAta se mastiSka yA karor3arajju ko koI coTa lagI ho to sarjarI karane kI AvazyakatA paidA hotI hai / taba nyUrosarjana kI sevA lenI paDatI hai| isa taraha cetAtaMtra kI zastrakriyA meM mastiSka, khopar3I, rIr3ha kI haDDI, karor3arajju, jJAnataMtu tathA mastiSka meM rakta pahu~cAne vAlI nalikAoM kI sarjarI samAviSTa hotI hai| yaha saba aMga Age batAyeM anusAra atinAjuka hote hai, isalie kudaratane use bahuta surakSita tarIke se rakhe haiM / isa lie unakI zastrakriyA meM bhI nipuNatA, sAvadhAnI bahuta mahatvapUrNa hai| eka bAra yaha aMgo ko jyAdA mAtrA meM nukasAna ho jAe to sAmAnyataH vaha ThIka nahIM ho pAte / kucha rogo meM sirpha davAI dvArA hI upacAra mukhya nahIM hotA, jaise ki kucha prakAra ke breIna Tyumara, jisameM oNparezana karane se hI chUTakArA milatA hai| usake viruddha kucha rogoM meM meDikala aura sarjikala upacAra eka sAtha yA to kramazaH karane par3ate hai|

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254 mastiSka aura jJAnataMtu kI bImAriyA~ * sarjarI kI AvazyakatA raheM, vaise kucha roga nimna nirdiSTa hai : (1) mastiSka yA karor3arajju kI coTa (durghaTanA yA anya kAraNa) khopaDI yA maNake kA phekcara eksTrADyUrala yA sabaDyUrala hImeTomA (mastiSka ke AvaraNoM meM rakta jama jAnA) mastiSka yA karoDarajju kA ghisAva honA yA coTa laganA (Contusion) / mastiSka ke pAnI kA nAka meM se srAva honA (CSF rhinorhoea) / mastiSka kI IjA se hotA ekasTrA DyUrala raktastrAva (2) mastiSka meM saMkramaNa phailanA - mavAda kI gAMTha (Abscess) - TI.bI. kI bar3I gAMTha (Tuberculoma) - mastiSka meM pAnI kI thailI phUla jAnA (hAIDrosIphelasa) (3) mastiSka yA karor3arajju meM gAMTha honA __ - sAdhAraNa gAMTha jaise ki meninjiomA, nyUromA, epIDaramoIDa, DaramoIDa yA piTyUTarI graMthi kI gAMTha - kensara kI gAMTha jaise ki glAyomA, meTAsTesisa

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255 23 - mastiSka kI zastrakriyA (Neurosurgery) (4) rakta nalikA meM kSati yA vikRti - nalI para gubbArA honA (enyurijhama) nalI meM jhuramuTa honA (e-vI. mAlaphormezana) keroTiDa nalI meM carabI-kSAra jamane se rAstA avaruddha honA (sTenosisa) breIna hemareja ke kucha marIja (5) janmajAta vikalAMgatA khopar3I kI vikRti-krenIosTenosisa hAIDrosIphelasa mastiSka kI janmajAta gAMTha rIr3ha kI haDDI meM kSati hone se karor3arajju khula jAnA (meningomAyalosila) krenIovarTibrala enomalI (6) cetAtaMtra ke ghisAva kI bImArI garadana yA kamara ke maNake kI gaddI kA ghisAva-khisakanA (Diska prolepsa) sarvAIkala sponDilosIsa laMbara kenAla sTenosisa (kamara ke maNake ke bIcameM jagaha kI kamI) (7) nasa - cetA dabAva meM A jAnA, jaise ki kArpala Tanala sinDroma athavA nasa kaTa gaI ho to narva ripera yA narva TrAnsaplAnTa kI srjrii| (8) pArkinsonijhama (kaMpavAta), mirgI Adi ke lie phaMkzanala nyUrosarjarI (isake uparAMta anya kaI kesa meM sarjarI ho sakatI hai ) /

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256 mastiSka aura jJAnataMtu kI bImAriyA~ * sAmAnya jAnakArI : yaha kahanA ekadama yathArtha hai ki kisI bhI prakAra kI aisI sarjarI karAne se pahale nizcitatApUrvaka nidAna karanA anivArya hai| sarjarI kI AvazyakatA aura yaha sarjarI se kitanA phAyadA hogA usakA aMdAja nikAlakara marIja aura usake parivArajanoM ko mAhitagAra karanA nyUrosarjana kA pharja hai| sarjarI ke bhayasthAna ho to usakI bhI jAnakArI denI caahie| aise to nidAna aura oNparezana kI AvazyakatA kA nirNaya lenA nyUrophijiziyana DaoNkTara ke hAtha meM hotA hai, paraMtu yaha Avazyaka hai ki oNparezana ke pahale yogya kesa meM nyUrophijiziyana aura nyUrosarjana ko sAtha baiThakara carcA karanI cAhie aura jahA~ saMzaya ho, vahA~ adhika jA~ca karavA ke nidAna ke bAre meM saMpUrNa saMtoSa hone ke bAda hI sabhI pahelUoM ko dhyAna meM rakha ke donoM tajajJoM ko sAtha meM nirNaya lenA caahie| . oNparezana kI paddhati aneka prakAra kI hotI hai| enesthesiyA meM jyAdA vikAsa hone se aba aisA kahA jA sakatA hai ki adhika laMbe samaya calanevAle aura jaTila kesoM meM bhI oNparezana ke kAraNa jiMdagI kA khatarA nahi jaisA ho gayA hai| phira bhI anya sarjarI kI tulanA meM mastiSka kI sarjarI thoDI khatarevAlI to hogI hI, aisA kahanA ayogya nahIM hai / mastiSka kI sarjarI lagabhaga do se cAra ghaMTe taka calatI hai, kabhIkabhI 16 se 20 ghaMTe yA adhika samaya taka bhI calatI hai| sAmAnyataH acche phijiziyana ke pAsa oNparezana ke lie phiTanesa kI jA~ca hone ke bAda enesthesiyA kA DaoNkTara marIja enesthesiyA ke lAyaka-phITa hai yA nahIM vaha taya karatA hai| paraMtu mRtyu kA khatarA ho aura samaya adhika na ho to saba kucha bhUla kara nyUrosarjana DaoNkTara jokhima uThAkara bhI imarajansI oNparezana karate hai| udAharaNa-mArga durghaTanA meM mastiSka kA hemareja honA / __ mastiSka ke oNparezana bhI aneka prakAra ke hote hai| jo bImArI ho usa taraha se aMgo kA oNparezana hotA hai / jisa aMga taka pahu~canA ho usake anusAra oNparezana kA plAniMga kiyA jAtA hai / mastiSka ke kauna se bhAga

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23 * mastiSka kI zastrakriyA (Neurosurgery) 257 meM aura usameM bhI kitanA aMdara aura kitane kSetra meM oNparezana ke lie jAnA par3egA, usakA triparimANiya skeca banAkara aura nikaTa meM koI raktanalikA ko nukazAna na ho usakA dhyAna rakhanA hai| yaha saba pahalu kA niyojanaplAniMga pahale se hI kiyA jAtA hai / (1) jaise ki mastiSka ke bAhara ke AvaraNa taka hI jAnA ho to use Burr hole (bara hola) kahA jAtA hai, jisa meM khopar3I meM chidra kiyA jAtA hai| sabaDyurala hImeTomA meM aisA kiyA jAtA hai / (2) khopaDI kA bhAga kATakara kholanevAle oNparezana ko krenIoTomI aura krenIekTamI kahate hai / usake dvArA sIdhA mastiSka taka pahu~cA jA sakatA hai| karor3arajju ke maNake ko AdhA kholeM to use hemIlemInekTamI kahA jAtA hai, saMpUrNa kholo to lemInekTamI kahA jAtA hai / (4) karoDa ke maNake meM chidra karake choTI-moTI sarjarI kI jA sakatI hai| mastiSka aura karor3arajju jitane nAjuka aura saMvedanazIla hai, utane hI surakSita hai yaha Age batAyA gayA hai| isa vajaha se vahA~ pahu~cane ke sAdhana alaga prakAra se vikasita karane par3ate hai| susajja oNparezana thiyeTara se lekara yogya oNparezana Tebala, suAyojita prakAza vyavasthA kI jarUrata par3atI hai| jyAdAtara oNparezana mAikroskopa kI madada se adhika ThIka kiye jA sakate hai| chidra karane ke lie teja Drila, acche riTrekTara aura yogya koTarI (rakta baMda karane ke lie) kI AvazyakatA paDatI hai| kucha gAMThe pighAlane ke lie teja alTrAsonika sisTama kA upayoga hotA hai| oNparezana daurAna bhI alTrAsAunDa se moniTariMga karane se mastiSka kI gaharAI meM huI kharAbI aura usakI nizcita jagaha kA patA calatA hai / sTIrIoTeksI ke sAdhana mastiSka aura karor3arajju meM gaharAI taka kI gAMTha kI bAyopsI karane aura use dUra karane ke lie upayoga meM lie jAte

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mastiSka aura jJAnataMtu kI bImAriyA~ naye saMzodhana ke anusAra pArkinsonijhama, epilepsI jaisI bImAriyoM meM yaha sTIrIoTeksI paddhatine kamAla kara diyA hai / mastiSka ko saMpUrNa khole binA khopar3I meM eka choTA chidra (Burr-hole) karake mastiSka meM gaharAI taka sUI aura ilekTroDa kI madada se ati jaTila bImArIyoM kA ilAja kiyA jA sakatA hai / 258 epilepsI ke lie mAIkrosarjarI dvArA atisuMdara pariNAma milate hai, khAsa taura para Temporala loba epilepsI meM aisA dekhA gayA hai / usa prakAra sTIrIoTeksI sarjarI bhI epilepsI meM kAma lagatI hai / vegala sTimyulezana bhI eka aisI hI choTI prakriyA hai, jisameM mAikroilekTroDa dvArA aura sTimyuleTara dvArA mastiSka meM honevAle vidyutakiya jhaTakoM ko kompyuTarAijhaDa paddhati se rokA jA sakatA hai| isake alAvA AvazyakatA ho to lobekTamI, komIsaroTomI tathA korpasakelojhoTomI jaisI baDI sarjarI bhI kI jA sakatI hai / eka cetAsamUha se dUsare cetAsamUha taka phailanevAle taraMgo ko rokane ke lie kI jAnevAlI TrAnsekzana sarjarI jaisI kaI prakAra kI viziSTa sarjarI kI jAtI hai / lejhara : isakA prasAra kramazaH bar3hatA jAegA aisA lagatA hai| jina aMgo meM cheda na kiyA jA sake, use isake tahata jalAyA jA sakatA hai| proTonabIma bhI aisI hI paddhati hai, jisase rakta ke jhuramuTa (A-V Malformation) ko jalAyA jA sakatA hai / reDiyophikavansI lIjana janareTara : TrAijeminala nyUroljiA tathA aisI anya dardanAka bImAriyA~ aura pArkinsonijhama prakAra ke muvamenTa DisaorDarsa meM yaha paddhati asarakAraka sAbita huI hai| jisameM nAma anusAra reDiyophikavansI karanTa se kisI cetA kA kArya sthagita karake athavA jalAkara bImArI meM rAhata prApta kI jA sakatI hai / gAmA - nAipha aura lInIyara eksalareTara : oNparezana ke binA gAMTha athavA anya aisI bImArIyoM ko rokane kI yaha paddhati tejI se phaila rahI hai / vaha atyAdhika maha~gI hone se bhArata meM kucha saMsthAoM meM hI upalabdha haiM /

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259 23 - mastiSka kI zastrakriyA (Neurosurgery) usase oNparezana ke khatare se jyAdAtara bacA jA sakatA hai, lekina usameM asaphalatA kI mAtrA bhI hotI hai| meninjiomA aura zvAnomA Adi prakAra kI sAdI gAMTho meM yaha ilAja khUba pracalita hai| usakA kharca lagabhaga eka se do lAkha rupaye hotA hai| enDoskopika nyUrosarjarI : yaha bhI eka prakAra kI minimama Invejhiva sarjarI hai / arthAt isameM mastiSka ko saMpUrNa khole binA gaharAI meM AI huI bImAriyA~, jisameM mukhyataH gAMTha, rakta kI nalI ke enyUrijhama (gubbArA) ko rokA jAtA hai| isase oNparezana kA khatarA atyaMta kama ho jAtA hai| paraMtu khUba choTI jagaha meM dUrabIna se oNparezana karanA hotA hai, usa kAraNa usameM pUrA anubhava jarUrI hai| tharDa yA phortha venTrikala Tyumara, enyUrijhama Adi meM isakA vyApa jyAdA hai| isa sarjarI kI hRdaya kI 'bITiMga hArTa sarjarI' ke sAtha tulanA kI jAtI hai| usI prakAra opareTIMga mAikroskopa kI madada se sarjarI karane se atyaMta sAvadhAnI aura kuzalatApUrvaka nukasAnIvAlA bhAga hI dUra kiyA jAtA hai / anya bhAgoM ko nukasAna nahIM hotA hai / yaha sarjarI dIrgha samaya calatI hai| dhIraja aura kuzalatA kI usameM khAsa AvazyakatA hai| udAharaNa-epilepsI ke lie Temporala loba sarjarI / Ajakala binA enesthesiA, behoza kie binA aveika (jAgRta avasthA meM ) krenioTomI dvArA bhI jAgrata aura hoza meM ho aise marIjoM kA oNparezana karane meM nyUrosarjanone nipuNatA prApta kara lI hai| roga jaba khUba phaila gayA ho, kAbU meM na ho taba hoziyArI kA upayoga kara ke sarjana thor3A-bahuta bhAga nikAlakara saMtoSa lete hai| gAMTha kA pUrA hissA kATanA saMbhava na ho, aisA karane se oNparezana Tebala para yA thor3e hI vakta meM mRtyu kA Dara ho yA oNparezana se zarIra ke aMgo kA jyAdAtara hissA nirjIva hone kA Dara ho to vyavahArikatA apanAkara thor3A hissA kATakara marIz2a ko mRtyu se bacAkara thor3I rAhata dene kA hetu hotA hai aura ise pelieTiva sarjarI kahA jAtA hai|

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260 mastiSka aura jJAnataMtu kI bImAriyA~ isa taraha nyUrosarjarI ke tIna prakAra hai : (1) risekTiva sarjarI : isameM saMbhava ho utanA kharAba hissA sarjarI se nikAla diyA jAtA hai / (2) pelieTiva sarjarI : isameM upara batAe anusAra thor3A hissA dUra kiyA jAtA hai / (3) phaMkazanala nyUrosarjarI : isameM mastiSka kA jo bhAga kAryarata nahIM hai, use kisI nae upAya se kAryarata kiyA jAtA hai / usameM AvazyakatAnusAra naye koSoM kA siMcana (grafting) karane se lekara mastiSka meM sTimyuleTara rakhA jAtA hai athavA to kemikalsa yA davAI kA upayoga kiyA jA sakatA hai yA choTe-baDe cheda karake nayeM rAste banA sakate haiM / yaha batAte hue AnaMda hotA hai ki inameM se sabhI sarjarI aba bhArata meM hotI hai / 90 % sarjarI ahamadAbAda meM ho sakatI hai| muMbaI aura dillI jaiseM mahAnagaro meM sabhI prakAra kI sarjarI upalabdha hai aura uttama zikSita tathA vizva meM jinakA nAma hai aise suvikhyAta nyUrosarjano kI sevA bhArata deza ko upalabdha hai / yaha apane deza ke lie gaurava kI bAta hai / jyAdAtara oNparezana kA khatarA acche senTaro meM sirpha 2 se 4 pratizata hotA hai / paraMtu yadi marIz2a vRddha ho aura sAtha meM DAyAbiTIsa, hRdayaroga yA blaDaprezara ho athavA imarjansI meM oNparezana karanA par3e ho to khatarA 10 se 20 pratizata taka rahatA hai / sarjana aura enestheTisTa ko khatarA jyAdA lage to zastrakriyA kI tulanA meM sAmAnyataH meDikala TrITamenTa ke bharose hI marIz2a ko rakhanA cAhie aisA abhiprAya milatA hai / phira bhI marIja ke kuTuMbIjano kI icchA cAnsa lene kI ho to usameM sahakAra diyA jA sakatA hai / jaise ki breIna eka bar3A ho aura mastiSka meM hemareja ke sAtha adhika sUjana ho, mRtyu kI saMbhAvanA ativizeSa ho to kabhIkabhI khopar3I kholakara, mastiSka ko bAhara

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23 - mastiSka kI zastrakriyA (Neurosurgery) 261 ke hisse meM ubharane kA cAnsa liyA jAtA hai, athavA hemareja ko khIMca lene kI koziza kI jAtI hai| isa prakAra 5 se 25 pratizata adhika jIvana mila sakatA hai, aisA vyAvahArika anumAna kara sakate hai| oNparezana acchI taraha pUrA huA ho to aise kesa meM usa oparezana ke pramANa meM marIz2a ko chuTTI dI jAtI hai| mukhyataH 6 se 9 veM dina marIz2a ghara jA sakatA hai| khatarevAle oNparezana meM sAmAnyataH vilaMba se chaTI dI jAtI hai / ghara jAne ke bAda marIz2a ko jaldI se calane aura kAryarata karane para vizeSa dhyAna diyA jAtA hai / phijiyotherepI haoNspiTala meM hI zuru kara dI jAtI hai aura phira marIz2a ghara para bhI saMpUrNa ThIka na ho taba taka vaha cAlU rakhanA hai| oNparezana ke bAda phira se meDikala upacAra meM nyUrophijiziyana kI jarUrata par3atI hai, paraMtu pratyeka kisse meM aisA honA jarUrI nahIM hai| sarjarI se kucha bimArIyA~ ekadama ThIka ho jAtI hai, kucha meM rAhata milatI hai, kucha meM oNparezana ke bAda thor3e yA adhika samaya ke lie davAI cAlU rakhanI par3atI hai / oNparezana ke pahale jaise nidAna ke lie sI.TI. skaina, ema.Ara.AI. kI jarUrata par3atI hai, usI prakAra oNparezana kA pariNAma kaisA AyA hai vaha jAnane ke lie kucha kesa meM (mukhyataH gAMTha ke keso meM) posTa opareTiva sI.TI. skaina yA ema.Ara.AI. kI AvazyakatA rahatI hai| ina sabhI prakriyA meM marIz2a aura usake kuTuMbIjano ko parezAna dekhA jAtA hai| ArthikasAmAjika prazna unheM parezAna kara dete haiN| zreSTha bAta yaha hai ki oNparezana ke pahale aura bAda meM DaoNkTaro ke sAtha khule dila se carcA kara lenI cAhie aura DaoNkTaro ko bhI spaSTa citra pahale se hI peza karanA cAhie / eka-dUsare ke vizvAsa, prema aura sahakAra se yaha kaThina mizana pUrNa karanA cAhie / isa prakAra nyUrosarjarI sirpha nyUrosarjana kA hI kSetra hai aisA nahIM hai / isameM nyUrophijiziyana, nyUrosarjana, phijiyotherApisTa, okyupezanala therApisTa, phijiziyana kA TImavarka honA caahie| yadi aisA ho to hI marIz2a kA saMpUrNa aura sahI upacAra ho sakatA hai|

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mastiSka aura jJAnataMtu kI bImAriyA~ nyUrosarjarI kA kharca vibhinna keso meM alaga-alaga hotA hai / isameM bImArI kA prakAra usakI gaMbhIratA, imarajansI sarjarI kI AvazyakatA, sarjana kA anubhava, sarjarI kA zahara - sthala, aspatAla kI susajjatA aura enesthesiA kA qhatarA (jaise ki vRddha logoM aura hRdayaroga - DAyAbiTIsa ke marIz2a ko qhatarA jyAdA hotA haiM, aise aneka prakAra ke paribalo para kharca nirbhara rahatA hai / paradeza meM jyAdAtara kharca insyoransa ejansI para hone se DokTara yA marIz2a ko ina praznoM para samaya yA zakti naSTa nahIM karanI par3atI haiM / AzA rakheM ki hamArA samAja bhI isa prakAra jAgrata ho / 262 surkhiyA~ roDa akasmAta yA anya tarIke se dimAga yA karor3arajju ko IjA ho to tAtkAlika nyUrosarjikala sArakhAra kI jarUrata paDatI hai / Ajakala breIna TyUmara se le kara narva ( cetA) taka kI nyUrosarjarI atyAdhunika prakriyA se kI jAtI hai aura usake bahota acche pariNAma pAe jAte hai /

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para RTERRAHANENERANCE (dIrgha samaya taka upayoga kI jAne vAlI nyUrolojI kI davAI saMbaMdhita mAhitI (Neurological Medicines to be used for longer duration) ___ Age ke prakaraNoM meM hamane dekhA ki nyUrolojI ke kaI roga laMbIkronika bImArI lAte hai aura unake upacAra adhikatara laMbe samaya taka arthAt 6-12 mahIne yA kucha bImAriyoM meM jIvanaparyaMta bhI karane par3ate hai| ina davAI ke acche prabhAva ke sAtha duSprabhAva bhI hote hai| ina davAI ke viSaya meM yogya samaja ho to kaI muzkileM aura duvidhAe~ samayasara hala ho sakatI hai| yaha prakaraNa kA uddezya ina davAi ke prabhAva aura duSprabhAva kI sahI jAnakArI denA hai| lekina yaha spaSTataH samaja le ki upacAra karane vAle DaoNkTara kI salAha binA kisI bhI davAI kA sevana atyaMta khataranAka ho sakatA hai aura sabhI davAI DokTara kI dekharekha meM hI leM / * sTiroIDa davAI (steroids) : sTiroIDa davAI nyUrolojI meM kaI mahattvapUrNa athavA gaMbhIra bImAriyoM meM upayoga kI jAtI hai| ye davAI dodhArI talavAra kI taraha hai| arthAt yogya tarIke se, yogya mAtrA meM, yogya samaya taka upayoga karane se acche pariNAma milate haiM, yaha jIvana bacA sakatI hai aura marIjha ko bImArI se saMpUrNataH bAhara nikAla sakatI haiN| anya koI davAI itane sahI tarIke se kAma nahIM kara sakatI haiN| paraMtu yadi ise ayogya, aniyaMtrita yA DokTara kI dekharekha binA laMbe samaya taka di jAe to gaMbhIra muzkileM bhI ho sakatI hai / duHkhada bAta yaha hai ki aksara isakA sahI upayoga karane ke bajAya galata aura duSprayoga (abuse) adhika hote hue dekhA gayA hai| sTiroIDa zarIra kI eDinala graMthi meM viTAmina-C se paidA hote prAkRtika aMtaHsrAva kI zreNI kI hI hai, jaise ki korTikosTeroiDa, minaralo korTikosTeroIDasa / zarIra kI graMthiyA~, aMga aura sisTama (vividha taMtra) ke prAkRtika niyaMtraNa meM tathA mukhya kArya banAe rakhane meM, roga pratirodhaka zakti banAe rakhane meM aura sTresa ke pratibhAva meM zarIra ko sakSama rakhane meM sTiroIDa

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264 mastiSka aura jJAnataMtu kI bImAriyA~ kI mukhya bhUmikA hai / samaja sakate hai ki sTiroIDa kI kamI se hone vAlI gaMbhIra bImAriyoM meM bAhara se sintheTika taiyAra kiye hue sTiroIDa diye jAte hai / blaDaprezara kama ho jAne se, zaoNka hone se lekara mAyestheniyA krAisisa taka yA viziSTa AdhAzIzI (klasTara heDeka) se lekara mastiSka kI sUjana (breIna iDimA) taka aura nyurolojI kI vividha anya paristhitioM meM sTiroiDa jarUrata ke anusAra upayoga karane se acchA pariNAma mila sakatA hai / kucha nyUropathI, DimAilineTiMga bImAriyA~ (malTipala sklerosisa), breIna TyUmara, polimAyosAITisa, TI. bI. meninjAiTisa ke kucha kesa - aisI anya bimArIoM meM sTIroIDa davAI kI jarurata rahatI hai / sTIroiDsa samUha meM prenisolona, DeksAmithAsona, mithAIla prenisolona mukhya hai / kucha TebleTa ke svarUpa meM, kucha iMjekzana ke svarUpa meM, to kucha pravAhI ke svarUpa meM milate hai / jaisA ki Age batAyA hai, yaha sTiroiDsa davAI kA aniyaMtrita upayoga kucha gaMbhIra pariNAma bhI lA sakate hai / I laMbe samaya taka sTiroIDa davAI lene ke duSprabhAva : (1) esiDITI (peTa tathA chAtI meM jalana honA) ho aura jaThara meM chAle par3e aura purAne chAle phira se ubhara Ae / (2) rakta meM cInI (zugara) kA pramANa bar3he, DAyAbiTIsa ho jAe yA bar3he / (3) blaDaprezara baDha jAe / (4) phaphUMda (phUga), saMkramaNa kA zIghra asara ho aura pariNAmataH kenDiDiAsisa aura riMgavarma inphekzana jaisI bImAriyA~ ho sakatI hai 1 (5) atyAdhika bhUkha laganA, anidrA honA aura svabhAva cir3acir3A ho jAnA / (6) zarIra phUla jAnA, vaz2ana atyAdhika bar3ha jAnA aura mu~ha, peTa aura gardana ke pIche ke bhAga meM carbI jamA honA / (7) kamara ke aura jAMgha ke bhAga meM snAyuoM kI kamaz2orI baDhane se z2amIna para se khar3e hone meM takalIpha / (8) haDDIyAM narama ho jAne se maNake aura kamara meM darda honA /

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24 - dIrgha samaya taka upayoga kI jAne vAlI nyUrolojI kI davAI saMbaMdhita mAhitI 265 (9) jA~dha kI haDDI kamajora hone se vahA~ darda hotA hai, aura kabhI phekcara hone se sarjarI Avazyaka ho sakatI hai| (Avascular Necrosis) (10) TI.bI., harpisa jaise saMkramaNa saralatA se laga sakate hai| (11) pezAba meM mavAda ho sakatA hai| (12) svAdupiMDa meM saMkramaNa ho sakatA hai / (13) rakta meM poTeziyama kA tattva kama ho jAnA / (14) sTiroIDa acAnaka baMda karane se bI.pI. bahuta kama ho jAtA hai| yaha kAraNoM se sTiroIDa adhika mAtrA meM kevala kucha haphtoM taka hI diyA jAtA hai| yadyapi kucha bImAriyoM meM kucha hI mAtrA meM lAbha hotA hai aura isalie kabhI laMbe samaya taka sTiroIDa davAI lenI par3atI hai| niyamita DaoNkTarI salAha atyaMta Avazyaka hai tathA niSNAta DaoNkTara kI dekharekha tathA niyamita leboreTarI jA~ca jarurI rahatI hai| aise saMjogoM meM dIrgha sTiroIDa korsa meM niSNAta DaoNkTara sTiroIDa ke duSprabhAva rokane ke lie niyamita rupa se kelziyama, poTeziyama, viTAminsa tathA sajana rokane hetu DAiyureTika davAI nizcita mAtrA meM dete haiM / marIja ko saMkramaNa na ho isalie yogya salAha sUcana diye jAte hai / AhAra hetu yogya mArgadarzana diyA jAtA hai / samaya samaya para DAyabiTIsa kI jA~ca, kelziyama, rakta meM poTeziyama kI mAtrA, blaDaprezara cekiMga yaha saba bhI niSNAta DokTara karate hai aura usameM marIz2a kA sahayoga Avazyaka hai| uparAMta anya kucha davAIyA~ nyUrolojI ke kesa meM laMbe samaya taka upayoga kI jAtI haiM, jaise ki epilepsI (mirgI) hetu upayoga hotI davAI, siradarda hetu kI davAI, pArkinsonijhama hetu kI davAI, ityAdi... yahAM kucha davAI ke saMdarbha meM saMkSipta meM dekheNge| (a) epilepsI (mirgI) : (1) DAiphinAila hAiDenToina (Diphenyl Hydantoin) : __yaha davAI se kvacita hI atyAdhika gaMbhIra prakAra kI elarjI zuru hotI hai, jise sTIvansa-jhonsana sinDroma kahate hai| isase tvacA para cAThe ho kara bukhAra AtA hai / jIvana ko khatarA rahatA hai| isake alAvA yaha davAI ke pracalita duSprabhAvoM meM masUr3oM kA kharAba honA yA sUjana honA, cehere kI

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266 mastiSka aura jJAnataMtu kI bImAriyA~ suMdaratA - nAjukatA kama honA, anAvazyaka bAla uganA, yAdadAsta kama honA, gale meM gAMTha honA, choTe mastiSka ko hAni pahu~canA yA aisI anya parezAniyA~ hote hue dekhA jAtA hai| davAI kI mAtrA adhika ho to marIz2a ko eka cIja do dikhAI detI hai, lar3akhar3AhaTa zuru ho jAtI hai / isalie yaha davAI rakta meM kitanI mAtrA meM hai, yaha samaya samaya para dekhanA cAhie / jise 'blaDa phinAiToina levala' kahate hai / yaha rakta nizcita samaya para lenA cAhie, (Doz2a ke pahale), varanA usakA koI matalaba nahIM rahatA / garbhavatI mahilAoM ko aksara anya davAI dI jAtI hai, kyoMki isase kabhIkabhI (0.7 pratizata) bacce vikalAMga paidA hote haiM / (2) kArbAmejhepina ( Carbamazepine ) : yaha davAI se bhI upara batAye anusAra, lekina kvacita dekhane ko milatI sTivansa - jhonsana nAmaka elarjI jiMdagI ke lie khatarA bana jAtI hai| tvacA aura myuksa membrena kI gaMbhIra elarjI bhI kabhIkabhI ho sakatI hai / uparAMta zvetakaNa mukhyataH nyUTrophilsa kama ho sakate haiM, jisase gale meM aura jihvA para chAle par3akara saMkramaNa ho sakatA hai / isa kAraNa yaha davAI lene vAleM marIja ke rakta kI tapAsa niyamita hara 3-4 mahine meM jA~ca karavAnI cAhie / yaha davAI garbhAvasthA daurAna nirdoSa yA hAni rahita hai / bacce ko kisI prakAra kA duSprabhAva hotA ho aisA koI khAsa riporTa nahIM hai / (3) vAlproIka esiDa ( valproic Acid ) : yaha davAI vividha prakAra kI epilepsI meM upayoga kI jAtI hai| usase vaz2ana bar3he, bAla jhare yaha sAmAnya hai, paraMtu vaha kabhIkabhI yakRta (livara) ko hAni pahu~cAtI hai| isalie yaha davAI upayoga meM ho taba taka niyamita 3 se 4 mahIne meM eka bAra esa. jI. pI. TI. nAmaka blaDaTesTa karavAnA cAhie / yadyapi isa salAha meM kaI duvidhAe~ bhI haiM jaise ki haphte pahale esa. jI. pI. TI. kA riporTa normala ho aura acAnaka livara bigar3ane lge| aisA ho to dubArA TesTa karavA kara davAI baMda kara denI caahie| garbhavatI mahilA ko yaha davAI dene se bacce ko karor3arajju ityAdi meM takalIpha zuru hone ke riporTa mile hai| lekina isakI mAtrA pratyeka 1000 meM se 10 bAlaka taka sImita haiM / yaha jAnakArI garbhAvasthA daurAna niyamita rUpa se sonogrAphI aura AlphA-phiToproTIna nAmaka

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24- dIrgha samaya taka upayoga kI jAne vAlI nyUrolojI kI davAI saMbaMdhita mAhitI 267 rakta TesTa dvArA yA emniosenTesisa dvArA milatI hai / usameM samasyA ho to garbhAvasthA ( preganansI) rokanI par3atI hai| jahA~ taka mumakina ho to garbhAvasthA meM yaha davAI nahI denI cAhie / ( 4 ) phinobArbITona ( Phenobarbitone ) : yaha davAI bahuta hI purAnI aura asarakAraka aura sastI hai, lekina choTe baccoM ko adhika samaya taka dene se ve jiddI aura zarAratI bana sakate hai / kabhIkabhI isa davAI se yAdadAsta bhI bigar3atI hai aisA mAnA jAtA hai, jyAdA nidrA Ane lage vaha bhI isakA eka duSprabhAva hai / isalie yaha davAI Ajakala kama upayoga kI jAtI hai / aba usameM badalAva lAkara yuropa meM iTarobArbITona davAI prayoga kI jAtI hai, jisase duSprabhAva kama ho jAtA hai / (ba) pArkinsonijhama roga kI davAI kA duSprabhAva : yaha jiddI bImArI kI davAI bhI adhikatara logoM ko AjIvana lenI par3atI hai / isalie isake duSprabhAva jAnanA Avazyaka ho jAtA hai ( 1 ) TI. eca. pI. eca. ( pesiTena ) - T. H. P.H. (Pacitane) : : yaha davAI 65 varSa se adhika Ayu ke vyakti ko dene se qhatarA bar3hatA hai / pezAba meM rukAvaTa, duvidhA (confusion) honA aura yAdadAsta bigar3anA vaha eka bahuta sAmAnya duSprabhAva hai / isa lie yaha davAI adhikAMza 40 se 60 varSa ke praur3ha vyakti aura jise prosTeTa kI bImArI na ho, vaise marIz2o ko hI denI cAhie / (2) livoDopA ( Levodopa ) : sinemeTa, TAiDomeTa aura sinaDopA ityAdi nAma se pracalita yaha davAI pArkinsonijhama bImArI kI mAsTara davAI hai| lekina hRdaya roga ke marIz2o ke lie upayoga karane meM bahuta sAvadhAnI baratanI caahie| marIja acAnaka khar3A hotA hai taba usakA bI. pI. kama ho jAtA aura marIja gira jAtA hai, aisA kaI bAra ho sakatA hai, jise poscarala hAipoTenzana kahate hai / kvacita jAtIyavRtti bar3ha jAtI hai| laMbe samaya ke prayoga se hAtha-paira vicitra halacala karate hai, jise DiskAInesiA, DisTonIA yA koriA kahate hai / aisA ho to yaha mAsTara davAI alaga rupa meM denI par3atI hai, badalanI par3atI hai yA anivArya saMjoga meM zastrakriyA karanI paDatI hai /

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268 mastiSka aura jJAnataMtu kI bImAriyA~ (3) emenTiDina (Amantidine) : mUlataH phlU kI bImArI meM upayoga hone vAlI yaha davAI Akasmika hI pArkinsonijhama meM asarakAraka hai, aisA 1934 meM saMzodhana huA / bAda meM nizcita hI vaha bahuta asarakAraka hai, aisA bArabAra sAbita huA hai| lekina usase bhI paira meM tvacA ke roga (liviDo reTikyUlArisa), hRdaya kI bimArI, paira meM sUjana, mAnasika duvidhA aura Diprezana ityAdi samasyAe~ hotI hai, isalie yaha davAI bIca meM kucha samaya ke lie baMda karanI par3atI haiN| (4) bromokripTina (Bromocriptine) : yaha eka upayogI davAI hai lekina isakI adhika mAtrA ke sevana se ulTI -DakAra yA kama-bI.pI. ityAdi hotA hai aura laMbe arase ke bAda duvidhA, bhrama, paira meM sUjana aura lAlAza jaisI vicitra samasyAe~ hotI hai / naI davAI jaise ki premipeksola (Pramipexole ), ropinirola (Ropinirole), Tolakepona (Tolcapone) ityAdi ke duSprabhAva kama hai aura tulanA meM adhika asarakAraka sAbita huI hai / lekina maha~gI hai, aura dIrgha samaya ke duSprabhAva ke bAre meM hameM isa davAI ko bArIka nirIkSaNa meM rakhanA pdd'egaa| (ka) anya davAIyAM : (1) espirina : chUTa se upayoga hone vAlI mukhya davAI meM espirina ( Aspirin) hai, jisakA vizeSa upayoga nyUrolojisTa DaoNkTara, marIz2a kA pakSAghAta rokane, rakta patalA karane ke lie adhikatara AjIvana upayoga karane kI salAha dete haiN| yogya tarIke se prayoga kiyA jAe to nizcita hI yaha sabase adhika asarakAraka hai, paraMtu usakI sakhta elarjI se marIja kA mRtyu hone ke kesa bhI kvacit dekhe gayeM hai| ulTI, DakAra, esiDiTI yaha saba pracalita duSprabhAva hai aura pepTika alsara (hojarI meM chAle) hokara rakta kI ulTI bhI ho sakatI haiN| uparAMta zarIra meM se rakta bahanA, anya adhika duSprabhAva isa davAI ke dIrghakAlIna upayoga se hote haiM, isalie DaoNkTara ko bahuta sAvadhAnI baratanI cAhie / pakSAghAta rokane kI aisI anya davAI TiklopiDina (Ticlopidine)

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24 - dIrgha samaya taka upayoga kI jAne vAlI nyUrolojI kI davAI saMbaMdhita mAhitI 269 hai, jisase karIbana 2 se 3 pratizata kesa meM zvetakaNa kama ho jAne kI gaMbhIra samasyA hotI hai| vizeSataH elarjI, peTa meM takalIpha aura dasta Adi ho sakate hai / I isI kAraNa, TIklopiDIna kI jagaha Ajakala klopIDogrela nAmaka davAne le lI hai / jo marIja duSprabhAva ke kAraNa espIrIna nahi le sakate haiM athavA espIrIna ke uparAMta eka aura davAI kI jarurata dikhatI ho to klopIDogrela kA upayoga kiyA jAtA hai / isake alAvA kucha khAsa saMjoga meM orala enTikoegyulanTa (vorapherIna, esiTroma) davAI bhI rakta patalA karane ke lie dI jAtI haiN| marIja kA Prothrombin Time yaha davAI dene se pahele liyA jAtA hai / usake bAda hara 2-3 dina para Prothrombin Time (blaDa TesTa) karavA kara rakta sahI mAtrA meM patalA huA hai vaha jAMcA jAtA hai / rakta adhika mAtrA meM patalA hone se Prothrombin Time jarurata se jyAdA bar3ha jAtA haiM aura kabhI kabhAra to gaMbhIra prakAra kA hemareja bhI ho sakatA hai, davAI kI jo mAtrA taya hotI hai vaha mAtrA meM marIja ko davAI niyamita lene kA kahA jAtA hai| DaoNkTara kI sUcanA anusAra Prothrombin Time karAte rahanA hotA hai / kisI bhI prakAra kI bliDIMga ho to davAI baMdha karanI par3atI hai / (2) siradarda mAigrena kI davAI : 1 mAIgrena rokane meM tathA blaDaprezara ityAdi meM bahuta upayoga hone vAlI bITAblokara davAI proprenolola (Propranolol ) (inDirAla, siplAra) dama ke marIz2o ko diyA jAe to dama kA hamalA ho sakatA hai / kabhI blaDaprezara kama ho jAtA hai, nAr3I kI dhar3akana kama ho jAtI hai| adhika mAtrA meM laMbe samaya taka lene se puruSo meM napuMsakatA A sakatI hai aura paira kI naso meM rakta kA paribhramaNa kama ho sakatA hai / isake uparAMta anya asara bhI DaoNkTara ko dekhanI hotI hai / mAIgrena meM upayoga hone vAlI anya asarakAraka davAI phlUnArijhina (Flunarizine ) hai| isake laMbe samaya taka prayoga se Diprezana, pArkinsonijhama ho sakatA hai| vaz2ana bar3he, bAla jhare tathA mahilAoM meM mAsika aniyamita ho sakatA hai /

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270 mastiSka aura jJAnataMtu kI bImAriyA~ (3) enTibAyoTika davAI : mastiSka kI bhayaMkara saMkrAmaka bImArI jaise ki meninjATisa ityAdi meM yogya mAtrA meM AvazyakatA anusAra upayoga karane se jIvana bacAne meM ye davAI behada asarakAraka-upakAraka sAbita huI hai| Ajakala aisA dekhane meM AtA hai ki ye davAI ayogya mAtrA meM sAdhAraNa bImArI meM bhI adhikattara anAvazyaka tarIke se upayoga kI jAtI hai| unameM se kucha livara (yakRta) athavA kiDanI (mUtrapiMDa) ko kharAba karatI hai, jaise ki emAInoglAIkosAIDa davAI / kucha enTibAyoTika se kisI kI zravaNazakti bigar3a jAtI hai, aura lar3akhar3AhaTa zuru hotI hai (sTrepTomAisina), kabhI rakta patalA ho jAne para bliDIMga hotA hai (siphelosporina) / penisilIna samUha kI kucha davAI se kisI marIz2a ko iMjekzana lene ke bAda minaTo meM hI jAnalevA riekzana hotA hai, aura kvacita DaoNkTara ke sAmane hI marIja kI mRtyu ho sakatI hai| penisilIna kI TebaleTa yA marahama se bhI aisA elarjika riekzana ho sakatA hai| isalie penisilIna yA usa prakAra kI davAI kA upayoga karane se pahale marIz2a ko pUchakara jAnakArI lenI cAhie ki unheM bhUtakAla meM aisI koI elarjI haI thI? isa kAraNa yogya jagaha para hI aisI enTibAyoTika kA upayoga kareM aura tvacA para TesTaDoz2a dekara Adhe ghaMTe taka riekzana to nahIM hotA, yaha dekhane ke bAda hI pUrA Doz2a deM / saubhAgya se aise kesa atyaMta kama hote hai| anAvazyaka enTibAyoTika davAI se resisTansa ho, to bAda meM bhArI davAI kA hI upayoga karanA par3atA hai| (4) kvinAina (Quinine) : kvinAina jaharI maleriyA ke upAya hetu upayoga hotI hai| usase kAna meM sITI jaisI AvAz2a AnA, ghabarAhaTa honA, cakkara AnA, duvidhA se lekara mirgI AnA yA kir3anI kharAba ho jAnA (blekavoTara phivara) jaise bhayaMkara pariNAma A sakate haiN| saubhAgya se aisI ghaTanA atyaMta kama hotI hai| jI.6-pI.DI. nAmaka blaDaTesTa kvinAina dene se pahale karavAnA hitakara hai| aMta meM phira se eka bAra doharAtA hU~ ki uparyukta gaI davAI cikitsakIya salAha aura dekharekha binA kadApi svayaM na le / uparyukta mAhitI kevala jAnakArI hetu hI hai /

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aspatAla meM bhartI kie hae. saMbaMdhita jarUrI sUcanAeM / (Tips for a hospitalised patient) marIz2a ko nyUrolojikala yA anya bImArI ke upacAra hetu aspatAla meM bhartI karane ke bAda usakI dekharekha ke lie jo kuTuMbIjana/svajana marIz2a ke sAtha rahate hai, unakA bhI kucha pharja banatA hai / mukhyataH marIz2a behoza ho, sthiti gaMbhIra ho yA atyAdhika kamajorI ho taba usakI vizeSa dekhabhAla karanA jarUrI bana jAtA hai| aspatAla meM aise marIz2a ke nimna batAe hue vibhinna upacAra ke saMdarbha meM jAnakArI sAmAnyataH kuTuMbIjana ko bhI honI cAhie, jisase upacAra meM saralatA rhegii| oNksIjana TyUba, nasa meM pravAhI denA, yurInarI ketheTara, nAka dvArA TyUba se phIDiMga ityAdI narsiMga sTApha kA kAma hai| phirabhI sage saMbaMdhI isa para nigarAnI rakha kara sahayoga de sakate hai / (1) oksijana - 02 : marIz2a ko AvazyakatA ho taba lagAtAra yA eka-eka ghaMTe ke bAda oksijana diyA jAtA hai| nAka meM rakhI huI TyUba ThIka hai yA nahIM yaha dekhate rahanA cAhie / oksijana ke silinDara ke pAsa rakhI huI botala meM dikhane vAle bulabule batAte haiM ki marIz2a ko oNksijana pahu~ca rahA hai| isalie isa botala ke tarapha bAra-bAra naz2ara rakhanI caahie| usake samApta hone se pahale aspatAla ke sTApha ko batA denA cAhie / adhikatara sthAna para aba senTrala lAina dvArA oksijana diyA jAtA hai, jisameM isa prakAra kI sAvadhAnI kI jarUrata nahIM rahatI hai| (2) pravAhI (botala) denA (IV Fluid) : marIz2a ko agara botala lagAI ho to marIz2a ke sage-saMbaMdhI ko mukhyataH nimna bAtoM kA dhyAna rakhanA cAhie :

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272 mastiSka aura jJAnataMtu kI bImAriyA~ * sage-saMbaMdhI ko marIz2a ke pAsa baiThakara marIz2a ko jo hAtha yA paira para suI (niDala) lagAI ho, vaha nalIvAlA hAtha-paira adhika na hilAe usakA dhyAna rakhanA cAhie / * botala meM se pravAhI/davAI pratyeka minaTa meM kucha bUMda Tapake aisI vyavasthA kI jAtI hai| isameM agara kSati dikhe to turaMta hI narsa ko bulaaeN| pravAhI baMda yA lIka ho jAe, pravAhI Tapakane kI gati bar3ha yA ghaTa jAe athavA jahA~ se pravAhI zarIra meM DAlA jA rahA hai, vahA~ sUjana ho yA camar3I lAla ho jAe yA marIz2a ko ThaMDa lage yA bukhAra Ae to bhI narsa ko bulAnA caahie| (3) nAka dvArA pravAhI AhAra dene kI TyUba (Ryle's Tube ) : (1) marIz2a ko TyUba dvArA nAka se phIDiMga (pravAhI AhAra) dene kA kArya narsa karatI haiN| kabhI marIz2a ke sage-saMbaMdhiyoM ko yaha kAma saMbhAlanA par3e to yaha prakriyA spaSTataH samajha lenI cAhie / (2) DaoNkTara kI sUcanA ke bAda phIDiMga (pravAhI AhAra) zuru kiyA jAtA hai| (3) isa phIDiMga hetu cAya, dUdha, kophI, nImbUpAnI, nAriyala pAnI, ilekaTrAla pAUDara kA pAnI, mikasara meM pisA huA cAvala, khicar3I, proTIna pAUDara yA zakti-kelarI hetu taiyAra pekeTa jaise ki enazyora, narIza, pighAlI huI dAla kA pAnI, bejiTebala sUpa yA phUTa jyUsa-phUTa zeIka ityAdi pravAhI jitanI mAtrA meM denA ho utanA hI do yA tIna ghaMTe ke bAda dete rahanA cAhie / isakI noMdha rakhakara DaoNkTara ko batAnI cAhie / (4) marIz2a ko mu~ha se yA TyUba se pravAhI diyA jA rahA ho, usa vakta aMtarAsa Ae yA zvAsa car3ha jAe to turaMta hI pravAhI denA baMda kara ke DaoNkTara ko turaMta jAnakArI denI cAhie /

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25- aspatAla meM bhartI kie hue marIz2a saMbaMdhita jarUrI sUcanAeM / (5) jaba pravAhI denA ho taba sabase pahale siriMja dvArA peTa meM se TyUba dvArA pravAhI vApasa khIMca kara caukasAI kara lenI cAhie / agara pravAhI 50 CC se adhika nikale to usa samaya phIDiMga nahIM dI jA sakatI hai| eka ghaMTe ke bAda phira se usI taraha caukasAI karane ke bAda hI phIDiMga denA caahie| vApasa khIMcA huA pravAhI rakta yA kophI raMga kA ho to turaMta hI DaoNkTara ko batAnA cAhie / (6) koI bhI pravAhI dene ke bAda TyUba meM 10-15 ml jitanA pAnI DAlakara use bilakula sApha kareM / 273 (7) TyUba hara paMdraha dina meM badalanA jarUrI hai / (8) kisI kAraNa TyUba kI pojhizana badala jAye yA TyUba thoDI bAhara A jAe to use phira se na DAlate hue TyUba badalakara dUsarI DAlanI cAhie / (9) marIz2a laMbe samaya taka behoza yA ardhajAgrata raheM to nAka dvArA TyUba phIDiMga dene se kucha khatare bar3hate hai / mukhyataH chAtI meM nyUmoniyA hotA hai, jise espirezana nyUmoniyA kahate hai / behoza marIz2a kI mRtyu hone ke mahatvapUrNa pAMca kAraNoM meM isa prakAra kA nyUmoniyA mukhya hai, jise rokane ke lie nAka kI TyUba nikAla kara gesTrosTomI TyUba se phIDiMga denA cAhie / yaha prakriyA meM peTa kI tvacA para Tanala banAkara vizeSa prakAra kI lambe samaya (mahInoM taka) cale aisI TyUba rakhI jAtI hai / sAmAnyataH 1 se 2 haphte se vizeSa samaya taka marIz2a behoza rahe to isa prakAra kI gesTrosTomI TayUba rakhakara khatare kA nivAraNa karake jiMdagI bacAI jA sakatI hai /

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(2) 274 mastiSka aura jJAnataMtu kI bImAriyA~ (4) pezAba karavAne kI TyUba - ketheTara (Urinary catheter) : (1) marIz2a ko caubIsa ghaMTe meM kitanA pezAba hotA hai, isakA dhyAna rakheM aura usakI noMdha DaoNkTara ko batAe~ / marIz2a ko caubIsa ghaMTe meM pezAba 2500 mi.li. se adhika ho yA 1000 mi.li. se kama ho aura pezAba atyAdhika pIlA (haldI ke raMga jaisA), lAla yA mavAda jaisA dikheM to DaoNkTara ko bulAnA caahie| (3) prati ghaMTe marIz2a ko hone vAlI pezAba kI mAtrA dekhate rheN| agara yaha kama lage to DaoNkTara yA narsa ko batAe~ / (4) sAmAnyata: ketheTara aMdara kA ho (Indwelling Catheter) to use paMdraha dinoM meM badalanA caahie| agara vaha bAhara kA ketheTara ho to pratyeka tIsare dina badalanA cAhie / (5) silikona kA (silAsTika) ketheTara rakhA jAe to vaha laMbe samaya taka cala sakatA haiM / (6) ketheTara lage hue bhAga ko DresiMga se sApha rakhane meM sAvadhAnI rkheN| (5) malatyAga ( Motion) : marIz2a kA peTa pratidina sApha ho vaha hitakAraka hai / lekina do dinoM ke bAda bhI malatyAga na ho to DaoNkTara ko batAe~ / DaoNkTara phIDiMga TyUba dvArA davAI yA gudA mArga se enimA dekara yA sapojhiTarI rakhane kI salAha de to usakA pAlana kreN| (6) A~kha kI darakAra : behoza marIz2a kI A~kha khulI rahatI hai to vaha kabhI lAla ho jAtI hai, aura korniyA ke nAjuka hisse para chAle (Ulcer) hone se A~khoM meM aMdhApana A sakatA hai| isalie DaoNkTara ke sUcana anusAra peDa se AMkhe DhA~ka de aura Moisol Adi yogya pravAhI kI buMda DAleM / Avazyaka lage to ainTibAyoTika buMda ddaaleN|

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275 25 - aspatAla meM bhartI kie hue marIz2a saMbaMdhita jarUrI sUcanAeM / (7) mu~ha kI darakAra (mAUtha-kera) : mu~ha meM chAleM, parata na ho isaliye pratidina mu~ha kI jA~ca karanI cAhiye / dina meM do bAra meDikeTer3a glisarina tathA mAUthaphezanara lagAnA cAhie, dAMta sApha karanA bahuta Avazyaka hai| marIz2a hoza meM ho to kullI karAnI caahie| (8) vyAyAma (Physiotherapy) : marIz2a ko kaI bAra laMbe samaya taka vyAyAma cAlU rakhanA par3atA hai| marIz2a kI vaha kAryavidhi meM sahAyatA ho isaliye aura ghara jAne ke bAda vyAyAma cAlU rakhane ke liye phijiyotherepisTa yA DaoNkTara se usa viSaya meM jAnakArI le lenI cAhie / kauna sA vyAyAma kaba, kitane samaya ke liye karanA hai, isa saMdarbha meM dI gaI sUcanA kA pAlana karanA cAhiye aura usake mutAbika hI vyAyAma karAnA cAhiye / (1) marIz2a ko pakSAghAta ho to usa aMga kA vyAyAma karAnA caahiye| (2) marIz2a agara behoza ho to usake donoM hAtha-paira prati do ghaMTe para hilAkara vyAyAma karavAnA cAhiye / (3) sAmAnyataH vyAyAma dina meM cAra se cha: bAra aura dasa se bIsa minaTa ke liye karavAnA cAhie, thakAna nahi laganI cAhie / (4) marIz2a ke paira para sUjana ho, paira para lAlAza ho to DaoNkTara ko jAnakArI deN| kabhIkabhI vaha bahuta hI khataranAka roga (DVT) kA cihna ho sakatA haiN| (9) chAtI meM se kapha nikAlanA (Suction) : marIz2a laMbe samaya taka sote rahatA hai taba zvasanataMtra meM muzkileM AtI hai| chAtI meM kapha bhara jAnA, chAtI meM se AvAz2a AnA / usameM se nyUmoniyA hone kA Dara rahatA hai| zvAsa kI kriyA bhI usase bigar3atI hai| aise marIz2a ko bArabAra patalI TyUba ke tahata gale aura chAtI meM se sakzana karavA

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276 mastiSka aura jJAnataMtu kI bImAriyA~ kara zvAsamArga svaccha rakhanA cAhiye / yaha kriyA sAmAnyataH aspatAla kA sTApha karatA hai, parantu marIz2a ke sajAga sambandhI bhI yaha acchI taraha se sIkha ke kara sakate haiM / vAstava meM isake lie Dispojhebala ketheTara kA prayoga bahuta hI yogya hai / vaha bahuta hI sAvadhAnI se karanA cAhiye / marIz2a ko zvAsa meM parezAnI rahatI ho yA kapha adhika rahatA ho athavA behoza avasthA meM rahe to porTekSa kI enDroTrekIala TyUba rakhI jAtI hai / vaha 7 se 14 dina taka rakhI jA sakatI hai| usase sakzana bahuta acchI taraha hotA hai / zvAsocchvAsa meM ArAma milatA hai / Tracheostomy : marIz2a ko chAtI meM jyAdA kapha rahatA ho athavA usakI behozI zIghra ThIka ho jAe aisA na lagatA ho to, aise saMjoga meM DaoNkTara tracheostomy kA nirNaya lete hai / isa prakriyA meM gale ke Upara ke Age ke bhAga zvAsanalI meM choTA chidra karake plAsTika yA meTala TyUba rakhakara usake dvArA zvAsa kI prakriyA vyavasthita kI jAtI hai / usakA vizeSa lAbha yaha hai ki kapha jamA huA ho to AsAnI se nikAlA jA sakatA hai, jisase nyUmoniyA kA Dara nahIM rahatA hai / zvasanakriyA meM bhI ArAma ho jAtA hai| marIz2a kA zvAsocchvAsa sudharatA jAe, use hoza Ane lage, kapha kama hone lage, taba chidra choTA karane ke liye TyUba kI caur3AI kramazaH kama karate rahanA caahiye| antataH chidra banda ho jAtA hai aura jakhma bhara jAtA hai / zvAsocchvAsa acchA rahe, kapha na ho tathA hAyaposTeTikanyUmoniyA na ho isaliye prArambha se hI Chest Physiotherapy Arambha kara denI caahiye| AvazyakatAnusAra marIz2a ko nebyulAiz2ara mazIna se zvAsamArga meM yogya davAI tathA bASpa pahu~cA kara zvAsa mArga khullA, svaccha aura uSmAyukta rakha kara kapha ko rokA jA sakatA haiM /

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277 25 - aspatAla meM bhartI kie hue marIz2a saMbaMdhita jarUrI sUcanAeM / (10) sAmAnya darakAra (Nursing Care) : 1. marIz2a kA bistara svaccha rakhanA cAhiye / bistara meM AvazyakatAnusAra pAuDara chir3akanA cAhiye / svajanoM ko marIz2a ke bistara meM zakyataH baiThanA nahIM cAhiye / saMkramaNa hone kI saMbhAvanA ho to svajanoM ko mu~ha para mAska aura sira para kepa pahanane kI DaoNkTara salAha dete hai| 2. marIz2a behoza ho taba usakA sira 30 se 40 DigrI U~cA rahe usa taraha use sulAnA cAhiye / 3. marIja ko karavaTa se eka tarapha sulAe~ ( lateral semiprone position ) aura pratyeka eka-do ghaMTe ke bAda zarIra kI karavaTa badalate rahanA cAhie / marIz2a ke pITha aura anya presara poinTsa para cAThe na par3e usake lie khUba sAvadhAnI rakhanA cAhie / 4. marIz2a ko chAle yA cAThe na par3e usakA vizeSa dhyAna rakhanA cAhiye / tvacA kA raMga badale yA tvacA para gharSaNa ho to DaoNkTara yA narsa ko dikhAnA cAhiye / lambe samaya kI bImArI ho aura marIz2a bistara para hI rahatA ho to aise saMjoga meM marIz2a ke liye pAnI bhare bistara ( water-bed) kI AvazyakatA rahatI hai / cikitsaka kI salAha anusAra hI marIja ko voTara-beDa para sulAne kI vyavasthA karanI caahie| kabhIkabhI havA bharA bistara (yA ilekTrIka eara-beDa) athavA spaMjaber3a bhI upayoga kiyA jA sakatA hai| 6. marIz2a ko pratidina spaMja (gIle kapar3e se zarIra sApha) karanA caahiye|

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278 7. * mastiSka aura jJAnataMtu kI bImAriyA~ dina meM do bAra sisTara ke hAthoM marIz2a kA mu~ha sApha karavAnA caahiye| uparAMta marIz2a ke riztedAroM ke dvArA bhI do bAra sApha karAyA jA sakatA hai / 8. marIz2a hoza meM ho taba zakyataH use baiThAkara hI AhAra denA cAhiye / ( 11 ) mahatvapUrNa mudde ( vital points ) : * marIz2a ke hRdaya yA nAr3I kI dhar3akana adhika lage to zIghra hI DaoNkTara ko batAnA cAhiye / marIz2a ke riztedAra kArDiyAka moniTara prAthamika taura se dekhanA aura samajhanA sIkha le to bahuta acchA rhegaa| marIz2a ko zvAsa adhika ho jAe, athavA vaha acAnaka phIkA yA bhUrA par3a jAye to DaoNkTara yA sisTara ko turaMta hI jAnakArI denI cAhiye / bukhAra AyA ho to DaoNkTara yA sisTara ko batAnA cAhiye / parivArajanoM kI viziSTa jimmedArI : marIz2a ko ThIka karane meM bahuta sI cIz2oM kA yogadAna hotA hai, jisameM parivArajanoM dvArA dI jAne vAlI sevA mahatvapUrNa hai / marIz2a kI cikitsA uparAMta pyAra bharI bAteM jAdUI asara karatI hai, jisase marIz2a kA manobala bar3hatA hai / aura usakI ThIka hone kI AMtarika zakti bar3ha jAtI hai / aspatAla meM riztedAroM ko marIz2a kA dhyAna rakhane ke lie ekaeka karake dina-rAta rahanA cAhiye / marIz2a ko kabhI akelA na choDeM / aise samaya meM kaI bAra marIz2a palaMga para se nIce gira sakatA hai / AvazyakatAnusAra palaMga para reliMga rakhI jA sakatI hai|

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25- aspatAla meM bhartI kie hue marIz2a saMbaMdhita jarUrI sUcanAeM / 279 * marIz2a ko zAMti aura ArAma kI AvazyakatA hone se usake bistara ke pAsa zoragula nahIM macAnA cAhiye / * kamareM meM svacchatA rakheM / * marIz2a ke pAsa adhika bhIr3a nA kreN| usase marIz2a ko saMkramaNa lagane kA Dara rahatA hai| rogiSTa svajana marIz2a ko milane AyeM vo ThIka bAta nahIM hai / marIz2a kA hAla pUchane Aye vyakti ko marIz2a suna sake isa taraha usakI bImArI, mRtyu yA dUsarI koI AghAtajanaka bAteM nahIM karanI cAhiye / aisI koI bhI bAta marIz2a ke manobala ko kama karatI hai| aise loga marIz2a ke pAsa na jAye usakA khAsa dhyAna rakhanA cAhiye / usI taraha darda, davAI, DokTara yA aspatAla ke bAre meM sune hue kharAba anubhava, mAnyatAe~ kI bAte marIz2a ko aura usake riztedAroM samakSa nahIM karanI cAhiye / marIz2a ke roga ke bAre meM sUcanA, dI jAtI davAI ThIka hai yA nahIM, DaoNkTara acche hai yA nahIM - aisI sambandhita kisI bhI prakAra kI ulaTI sulaTI bAteM nahIM karanI cAhiye / aisA hone se marIz2a aura unake riztedAra duvidhA meM par3a jAte hai, jisase marIz2a ke svAsthya upacAra meM vikSepa hotA hai / eka sAtha marIz2a kA hAlacAla pUchane jAne kI prathA meM aura vahAM ke vAtAvaraNa meM badalAva karane kI khAsa AvazyakatA hai| marIz2a ke lie phala, pustaka, Get Well Soon kArDa arpaNa karake zubhecchA dI jA sakatI hai / ghara para yA dhArmika sthaloM para jAkara prArthanA kI jA sakatI hai| marIz2a ko bhI prArthanA ke liye samajAyA jA sakatA hai| prArthanA meM acchA karane kI bahuta

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280 mastiSka aura jJAnataMtu kI bImAriyA~ tAkata hai| marIz2a ko pasaMda ho aisI sumadhura saMgIta kI keseTa dhIre svara meM rakhI jA sakatI hai| hamArA durbhAgya hai ki meDikala insyoransa kI prathA ke saMdarbha meM bhAratIya nAgarika meM jitanI cAhie utanI jAgRti nahIM hai| usake viruddha meDikala upacAra dinapratidina maha~gA hotA jA rahA hai / aisI paristhiti meM jisakA insyoransa nahIM hai aura marIz2a Arthika taraha se kamajora ho aise marIz2a ke upacAra ke kharca ke liye Arthika madada kI AvazyakatA ho to, DaoNkTara ko isa saMdarbha meM batAnA cAhiye / unake mArgadarzana se sAmAjika saMsthA dvArA davAI kama dAma meM mila sakatI hai| aisI saMsthAyeM bar3e zaharoM meM kAryarata hai| aspatAla ke sAmAjika kAryakartA yahA~ mArgadarzana de sakate hai| kucha rogoM meM viziSTa, ghaniSTa aura maha~ge upacAra kI AvazyakatA rahatI hai| jaise ki AIDP meM plAjhamA eksacenja, AIDP yA mAyestheniyA meM gAmAglobyUlina, zvasanayaMtra (venTileTara) ityAdi ke lie kharca ru. 50 hajAra se ru. 3-4 lAkha se bhI adhika taka pahu~ca jAtA hai| aise samaya meM rAhata dara se upacAra ke lie, yA adhika jAnakArI ke lie yA phira upacAra ke kharca ke liye cikitsaka zAyada mArgadarzaka bana sakate hai /

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DaoNkTara ke pAsa jAo taba ... (1) DaoNkTara ke pAsa jAne se pahale apanI epoinTamenTa (mulAkAta kA samaya) nizcita kara lenI cAhiye / (2) ApakI sabhI samasyA kI lisTa, samayAnusAra, nizcita krama meM saMkSipta noMdha karake le jAnI cAhiye / " (3) DaoNkTara samakSa ApakI samasyAe~ saMkSipta meM muddAnusAra batAnI cAhiye / DaoNkTara samakSa ApakI samasyA kA varNana kreN| Apane mAna liyA hai aisA nidAna nahIM batAnA cAhie (jaise ki "mujhe gale meM duHkhatA hai, ' aisA kaho / "Tonsila ho gayA hai" aisA nahIM kahanA cAhiye) / (4) Apake bhUtakAla kI sabhI mahatvapUrNa bImAriyA~, usase sambandhita tabIbI parIkSaNa, upacAra, zastrakriyAe~ ina sabhI ko dhyAna meM rakhakara vyavasthita phAIla banAkara sAtha meM rakhanI cAhiye / yadi ApakI vartamAna samasyA kA pichalI bImArI yA bImAriyoM se sambandha ho to vaha DaoNkTara ko batAnA cAhie, kabhI rakta liyA ho to bhI avazya batAnA cAhie / (5) Apake parivAra meM najadikI riztedAra ko kSaya, hAI blaDa prezara, DAyAbiTIsa, hRdayaroga, mirgI, yakRta yA mUtrapinDa kI bImArI, janmagata vikalAMgatA, asthamA, jor3o kA darda yA anya koI vizeSa bImArI ho to yaha bAta tathA usa vyakti ke sAtha ApakA kyA riztA hai vaha bhI DaoNkTara ko batAnA cAhiye / (6) duvidhA meM rahakara DokTara se kisI bhI prakAra kI jAnakArI chUpAnI nahIM cAhiye / mukhyataH Ayurveda, homiyopathI, yUnAnI ityAdi koI davAI calatI ho to usakI jAnakArI pUrI taraha se DaoNkTara ko denI cAhiye / zakya ho to davAI sAtha meM hI lekara jAnA cAhiye /

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282 mastiSka aura jJAnataMtu kI bImAriyA~ (7) ApakI marjI anusAra upacAra, davAI yA leboreTarI parIkSaNa kA Agraha na rakheM / DaoNkTara se milane ke pahale apane Apa hI kisI prakAra kI davAI yA leboreTarI parIkSaNa nahIM karavAnA cAhiye / (8) yadi Apako kisI davAI kI pratikriyA ho (riokazana A rahA ho) to DaoNkTara ko isakI jAnakArI de / ApakI bImArI aura usake upacAra ke viSaya meM apane DaoNkTara ke sAtha ThIka se aura khule dila se carcA kara lenI cAhiye / yaha jAnakArI lenA Apake liye bahuta upayogI hogaa| (10) Apake DaoNkTara para pUrA vizvAsa rakheM / nizcita vajaha ke binA DaoNkTara badalanA nahIM cAhiye / yadi Apa apanI bImArI ke saMdarbha meM anya kisI DaoNkTara kA abhiprAya lenA cAhate ho to apane DaoNkTara ko batAkara aura unakI salAha ke anusAra karanA cAhiye / ho sake to unakI ciThThI le lenA cAhiye / (11) yadi ApakI samasyA dIrghakAlina ho to nimna likhita cihna, usake samayAnusAra noMdha kareM : prAya: koI gaMbhIra roga ho sakatA hai - jaise ki kensara vajana kama honA / zarIra meM kahIM bhI gAMTha yA sUjana / AvAz2a meM badalAva / zarIra ke kisI bhI prAkRtika mArga se rakta bahanA / dIrghakAlina khAMsI / dIrghakAlina bukhAra / Upara varNita anusAra jAnakArI apane sAtha rakhakara DaoNkTara ko milane se ApakI samasyA kA upacAra karane meM unheM saralatA rhegii| Apako bhI bImArI kA yogya upacAra milegA /

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Patient Information Guide 283 Patient Information Guide ALZHEIMER'S DISEASE Alzheimer's Association 225 North Michigam Avenue Suite 1700 Chicago, IL 60601-7633 312-335-8700 800-272-3900 info@alz.org www.alz.org AUTISM AUTISM Research Institute (ARI) 4182 Adams Avenue San Diego, CA 92116 619-281-7165 www.autismeresearchinstitute.com.or www.austin.com/ari AMYOTROPHIC LATERAL SCLEROSIS BRAIN TUMOR The ALS Association (ALSA) American Brain Tumor Association 27001 Agoura Road 2720 River Road Suite 150 Suite 146 Calabasas Hills, CA 91301-5104 Des Plaines, IL 60018-4117 818-880-9007 847-827-9910 800-782-4747 800-886-2282 info@alsanational.org info@abta.org www.alsa.org www.abta.org ATAXIA National Ataxia Foundation 2600 Fernbrook Lane North Suite 119 Minneapolis, MN 55447-4752 763-553-0020 naf@ataxia.org www.ataxia.org CEREBRAL PALSY United Cerebral Palsy (UCP)/ UCP Research & Education Foundation 1660 L Street, NW Suite 700 Washington, DC 20036 202-973-7140 800-USA-5UCP (872-5827) national@ucp.org www.wcp.org and www.ucpresearch.org ATTENTION DEFICIT DISORDER Attention deficit Disorder Association P.O. Box 543 Pottstown, PA 19464 484-945-2101 mail@add.org www.add.org DISABILITY National Institute on Disability & Rehabilitation Research (NIDRR) Department of Education Office of Special Education and Rehabilitative Services 400 Maryland Avenue, SW Washington, DC 20202-7100 202-245-7460 202-245-7316 (TTY) www.ed.gov/about/offices/list/orders/nidrr

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284 mastiSka aura jJAnataMtu kI bImAriyA~ of COMA Coma Recovery Association 8300 Republic Airport, Suite 106 Farmingdale, NY 11735 631-756-1826 inquiry@comarecovery.org www.comarecovery.org HUNTINGTON'S DISEASE Huntington's Disease Society America 505 Eighth Avenue Suite 902 New York, NY 10018 212-242-1968 800-345-HDSA (4372) hdsainfo@hdsa.org www.hdsa.org EPILEPSY Epilepsy Foundation 8301 Professional Place Landover, MD 20785-2267 301-459-3700 800-EFA-1000 (332-1000) postmaster@efa.org www.epilepsyfoundation.org INDIAN EPILEPSY ASSOCIATION Indian Epilepsy Association 37, State Bank of India Road, Banglore - 560001 Phone : 080-255 88 274, 255 88 390 ieabir @vsnl.net INDIAN EPILEPSY SOCIETY C-1/10, AIMS Campus Ansari Nagar New Delhi-110029 FIBROMYALGIA American Autoimmune Related Diseases Association 22100 Gratiot Avenue Eastpointe Ease Detroit, MI 48201-2227 586-776-3900 800-598-4668 aarda@aarda.org www.aarda.org LANGUAGE & LEARNING DISABILITIES International Dyslexia Society 8600 LaSalle Road Chester Building, Suite 382 410-296-0232 800-ABCD123 (222-3123) info@interdys.org www.interdys.org HEADACHE MENTAL RETARDATION (see also pain) The ARC of the United States American Council for Headache 500, East Border Street, Suite-300 Education Arlington, TX-76010 19 Mantua Road Contact : Alan Abeson, Ed.D., Executive Director Mt. Royal, NJ 08061 Phone: 817-216-6003, 856-423-0258 TTY : 817-277-055; 800-255-ACHE (2243) Fax : 817-277-3491 achehq@talley.com Website : http/l/thearc.com www.achenet.org Email : thearc@metronet.com

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Patient Information Guide MOVEMENT DISORDERS We move (Worldwide Education & Awareness for Movement Disorders) 204 West 84th Street New York, NY 10024 212-875-8312 wemove@wemove.org wemove@wemove.org MULTIPLE SCLEROSIS Multiple Sclerosis Association America 706 Haddonfield Road Cherry Hill, NJ 08002 856-488-4500 800-532-7667 msaa@msaa.com www.msaa.com MUSCULAR DYSTROPHY Muscular Dystrophy Association 3300 East Sunrise Drive Tucson, AZ 85718-3208 520-529-2000 800-344-4863 mda@mdausa.org www.mda.org MYASTHENIA GRAVIS Myasthenia Gravis Foundation of America, Inc 1821 University Avenue West Suite $256 St. Paul, MN 55104 651-917-6256 800-541-5454 mgfa@myasthenia.org www.myasthenia.org MYOSITIS The Myositis Association 1233 Twentieth Street, NW Suite 402 Washington, DC 20036 202-887-0088 800-821-7356 tma@myositis.org www.myositis.org MYOTONIC DYSTROPHY of International Myotonic Dystrophy Organization P.O. Box 1121 Sunland, CA 91041-1121 818-951-2311 866-679-7954 (toll-free in USA and Canada) mytonicdystrophy@yahoo.com www.mytonicdystrophy.org PAIN Americam Chromic Pain Association P.O. Box 850 Rocklin, CA 95677-0850 916-632-0922 800-533-3231 285 ACPA@pacbell.net www.theacpa.org PARALYSIS American Paralysis Association (APA) 500, Morris Avenue Springfield, NJ-07081 Toll Free: 800-255-0292 Phone: 201-912-9433 Fax: 201-912-9433

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286 PARKINSON'S DISEASE Parkinson American Association 135 Parkinson Avenue Staten Island, NY 10305-1425 718-981-8001 800-223-2732 Califormia: 800-908-2732 apda@apdaparkinson.org www.apdaparkinson.org PERIPHERAL NEUROPATHY Neuropathy Association 60 East 42nd Street Suite 942 New York, NY 10165-0999 212-692-0662 info@neuropathy.org www.neuropathy.org SHY-DRAGER SYNDROME Shy-Drager/Multiple System Atrophy Support Group, Inc. P.O. Box 279 Coupland, TX 78615 866-SDS-4999 (737-4999) www.shy-drager.oprg SLEEP DISORDERS American Sleep Apnea Association 1424 K Street, NW, Suite 302 Washington, DC 20005 202-293-3650 asaa@sleepapnea.org www.sleepapnea.org STEM CELL RESEARCH National Institutes of Health 1 Center Drive Bethesda, MD 20892 www.nih.gov/news/stemcell STROKE Disease American Stroke Association : A Division of American Heart Association mastiSka aura jJAnataMtu kI bImAriyA~ 7272 Greenville Avenue Dallas, TX 75231-4596 888-4stroke (478-7653) strokeassociation@heart.org www.strokeassociation.org STROKE National Stroke Association 9707 East Eastler Lane Englewood, CO 80112-3747 303-649-9299 800-STROKES (787-6537) info@stroke.org www.stroke.org TRANSVERSE MYELITIS Transverse Myelitis Association 1787 Sutter Parkway Powell, OH 43065-8806 614-766-1806 info@myelitis.org www.myelitis.org TRAUMA Brain Injury Association of America, Inc. 8201 Greensboro Drive Suite 611 McLean, VA 22102 703-236-6000 800-444-6443 familyhelpline@biausa.org www.biausa.org

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mastiSka aura jJAnataMtu kI bImAriyA~ 287 Book Review by International Experts (Neuro Scientists) for the English Edition 2002 Prof. Martin Brown Prof. of Stroke Medicine NHN & N, Queensquare, London, UK. Dear Dr. Shah It was a great pleasure to meet you again at the meeting in Mumbai. Thank you very much for giving me a copy of your excellent book, which I enjoyed reading. It provides an excellent introduction to neurology. I realise you wrote it for the lay person, but I think medical students would also profit from reading it. Prof. Louis R Caplan Prof. of Neurology, Harvard medical school, Director of stroke service: Boston, USA. I liked the book very much. The writing is clear and concise. It was a honor to read and review this book. It is badly needed for the public. Prof. David Bates Prof. of Neurology, Multiple Sclerosis New Castle, UK Dr. Shah, pleasure to meet you last week, I am impressed by your useful little book. "The book is a readable explanation of Neurology which can be easily understood by layman and medical student. The distilled wisdom and explanation in each chapter will help allay worries in the family of those with neurological disorders and in the student fearful of questions in neurological examinations. It provides a succinct summary of the nervous system and its common disorders, Dr. Sudhir V. Shah is to be complemented in the clarity of his writing."

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288 mastiSka aura jJAnataMtu kI bImAriyA~ S IMS Prof. James C Grotta Chair, Stroke medicine U.T. Medical School Houston, USA Thank you very much for the book - we will use it for our resident and nursing education. Prof. Amado M. San Luis President, Asia-oceanic association of Neurology Manila, Philipines Your book is very informative, simplified and indeed friendly for medical students and residents who are often intimidated by the subjects, neuroanatomy and neurology. Prof. Mauriedavid Emeritus Clinical Professor of Psychiatry Temple University, Health Science Center Philadelphia, Pa. 19106 This is a book of that times. It is an important book, delivering a message of clear understanding, to the peoples (not only of his country of origin, India) but also in its very clear translation, to the community of the Western World. Importantly, Dr. Shah is a Neurological physician of considerable reputation, This makes his message all the more compelling and significant His work is complete in scope and very, very clear in the messages delivered as to the nature of neurological diseases. These messages are accompanied with advice as to their origins (so far as they are known) and as to their treatment. This is a book, also, which is completely in attune with Dr. Shah's very humanistic desire to help the world. Knowing him as I do, his intention to promote the welfare of all humanity is successfully and well delivered. Maurie D. Pressman, MD. Romeo Chu Philippines Thank you very much for the book you gave me. It is indeed an excellent book ! The topics covered were quite comprehensive and represents the most common cases that are encountered in clinical practice. The clear photographs and illustrations makes it easier for the reader to appreciate the subject matter as well.

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jagaha jagaha pe, bahuta sI bhASAoM meM hRdayaroga, blaDaprezara, medasvitA (sthUlatA) aura DAyAbITIsa ke bAre meM kAphI jAnakArI Apa dekheMge, parana jAne kyU~ mastiSka (dimAga) aura cetAtaMtra ke bAre meM aisA kahIM likhA nahIM gayA hai| yaha pustaka isI dizA meM kiyA gayA eka namra prayAsa hai, jisameM Apako mastiSka aura cetAtaMtra kI kAryapaddhati se lekara unakI bImAriyA~, inake upacAra aura aTakAva ke lie sUcana ke bAre meM ciMtana prApta hogaa| prathama prakaraNa meM mastiSka aura cetAtaMtra kI prAthamika mAhitI aura unake rogoM kA vargIkaraNa diyA gayA hai| usake bAda nyUroreDiyolojI dvArA jaTila nidAna kaise sarala banAyA jAtA hai vaha jAnakArI dUsare prakaraNa meM hai| bAda ke ATha prakaraNa se dimAga ke pramukha aura pracalita rogoM ke bAre meM Apako adhikRta mAhitI milegii| gyArahavA~ nidrA kA prakaraNa Apako Azcarya ke sAtha kucha ajIba jAnakArI degaa| bAraha se paMdraha taka ke prakaraNa tabIbI jagata ke lie abhI taka muzkila kahe jAnevAle rogoM ke bAre meM haiN| solaha naMbara ke prakaraNa dvArA karoDarajju (Spinal Cord) ke rogoM kI jAnakArI Apa prApta kreNge| 17 se 21 prakaraNa meM aise viziSTa rogoM ke bAre meM jAgarukatA lAne kA prayAsa hai, jo ki kama vikhyAta hai, phira bhI dardI ko kramazaH paravaza aura behAla banA DAlate hai| 22 veM prakaraNa dvArA Ajake vizva kI gaMbhIra samasyA tanAva aura usake upacAra ke bAre meM tArkika aura vaijJAnika samajha dI gaI hai| jaba kabhI davAI aura sAravAra se darda ThIka na ho aura jahA~ jarurata ho vaise roga meM zastrakriyA-sarjarI kI bAta AtI hai - vaha nyUrosarjarI ke bAre meM rasaprada mAhitI prakaraNa teIsa meM milegii| prakaraNa 24 aura 25 meM roga ke sAravAra meM lI jAtI huI davAIyA~ kI mAhitI tathA aspatAla meM kI jAtI sAravAra aura khAsa kara ke dardI ke sAtha rahanevAle riztedAroM ko dardI kI dekhabhAla meM kyA dhyAna rakhanA usakA atimahatvapUrNa vivaraNa kiyA hai| viSaya-vastu kI samajhadArI baDhe vaha hetusara, yathAyogya AkRti kA AdhAra liyA hai| jahA~ kahIM suyogya hindI zabda nahIM mile hai, vahA~ mUla aMgrejI (English) zabda lene paDe hai, jisake lie sujJavAcakagaNa mujhe kSamA kreNge| vizeSata: kucha davAI janarikanAma se jyAdA bAjAru nAma se pracalita hai - isalie una nAma kA upayoga mAtra pAThakoM kI saralatA ke lie karanA par3A hai| isa pustaka meM aba taka prApya aura paryApta mAhitI dvArA vivaraNa diyA gayA hai| kintu, Apa sabako ye bAta lakSya meM rakhanA bahuta jarurI hai ki tabIbI zAstra meM aura vijJAna meM avirata vikAsa aura saMzodhana kI prakriyA cAlu hI rahatI hai| aMtata: yaha pustaka samAja ke lie khUba lAbhadAyI siddha ho, aisI paramakRpAlu paramAtmA ko vinamra praarthnaa| pro. DaoN. sudhIra vI. zAha ema.DI., DI.ema. (nyUrolojI) nyUrolojI senTara, 206-207-208, saMginI kaoNmpleksa, parimala relave kraoNsiMga ke pAsa, elisabrija, ahamadAbAda-380006 Te.naM.079-26467052, 26467467 website : www.sudhirneuro.org Personal use