{"id":28440,"date":"2023-04-27T17:33:10","date_gmt":"2023-04-27T10:33:10","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=28440"},"modified":"2023-04-27T17:33:10","modified_gmt":"2023-04-27T10:33:10","slug":"mot-so-nghiem-phap-kham-rung-giat-nhan-cau","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/27\/mot-so-nghiem-phap-kham-rung-giat-nhan-cau\/","title":{"rendered":"M\u1ed9t s\u1ed1 nghi\u1ec7m ph\u00e1p kh\u00e1m rung gi\u1eadt nh\u00e3n c\u1ea7u"},"content":{"rendered":"

Rung gi\u1eadt nh\u00e3n c\u1ea7u l\u00e0 m\u1ed9t tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p trong nhi\u1ec1u b\u1ec7nh l\u00fd kh\u00e1c nhau v\u00e0 vi\u1ec7c kh\u00e1m ph\u00e1t hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n<\/a> v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi. Khi rung gi\u1eadt nh\u00e3n c\u1ea7u x\u1ea3y ra, c\u00e1c h\u00ecnh \u1ea3nh s\u1ebd tr\u00f4ng m\u1edd ho\u1eb7c dao \u0111\u1ed9ng, g\u00e2y kh\u00f3 ch\u1ecbu v\u00e0 kh\u00f3 kh\u0103n trong vi\u1ec7c nh\u00ecn v\u00e0 ho\u1ea1t \u0111\u1ed9ng h\u00e0ng ng\u00e0y. Vi\u1ec7c ph\u00e1t hi\u1ec7n v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi t\u1ed5n th\u01b0\u01a1ng li\u00ean quan \u0111\u1ebfn rung gi\u1eadt nh\u00e3n c\u1ea7u r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 ng\u0103n ng\u1eeba c\u00e1c bi\u1ebfn ch\u1ee9ng v\u00e0 gi\u00fap b\u1ec7nh nh\u00e2n ph\u1ee5c h\u1ed3i t\u1ed1t h\u01a1n.<\/strong><\/p>\n

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Rung gi\u1eadt nh\u00e3n c\u1ea7u g\u00e2y kh\u00f3 kh\u0103n trong vi\u1ec7c nh\u00ecn v\u00e0 ho\u1ea1t \u0111\u1ed9ng h\u00e0ng ng\u00e0y<\/figcaption><\/figure>\n

1. Rung gi\u1eadt nh\u00e3n c\u1ea7u l\u00e0 g\u00ec?<\/h2>\n

Rung gi\u1eadt nh\u00e3n c\u1ea7u l\u00e0 chuy\u1ec3n \u0111\u1ed9ng \u0111u \u0111\u01b0a kh\u00f4ng t\u1ef1 ch\u1ee7 c\u1ee7a m\u1eaft. Rung gi\u1eadt nh\u00e3n c\u1ea7u \u0111\u01b0\u1ee3c chia hai lo\u1ea1i: rung gi\u1eadt nh\u00e3n c\u1ea7u lo\u1ea1i \u0111ung \u0111\u01b0a (pendular nystagmus) c\u00f9ng t\u1ed1c \u0111\u1ed9 c\u1ea3 hai h\u01b0\u1edbng chuy\u1ec3n \u0111\u1ed9ng c\u1ee7a m\u1ea5t v\u00e0 rung gi\u1eadt nh\u00e3n c\u1ea7u gi\u1eadt (jerk nystagmus) g\u1ed3m c\u00f3 1 pha nhanh v\u00e0 1 pha ch\u1eadm ng\u01b0\u1ee3c l\u1ea1i. Chi\u1ec1u gi\u1eadt nh\u00e3n c\u1ea7u l\u00e0 chi\u1ec1u nhanh, g\u1ed3m c\u00f3 rung gi\u1eadt nh\u00e3n c\u1ea7u ngang, d\u1ecdc v\u00e0 xoay.<\/p>\n

L\u00e2m s\u00e0ng c\u00f3 th\u1ec3 x\u00e1c \u0111\u1ecbnh v\u1ecb tr\u00ed h\u01b0\u1edbng nh\u00ecn c\u00f3 rung gi\u1eadt nh\u00e3n c\u1ea7u, bi\u00ean \u0111\u1ed9 v\u00e0 chi\u1ec1u c\u1ee7a pha nhanh. Pha nhanh (saccades) \u0111\u00e1nh gi\u00e1 b\u1eb1ng c\u00e1ch cho b\u1ec7nh nh\u00e2n nh\u00ecn nhanh t\u1eeb ph\u00eda n\u00e0y sang ph\u00eda kh\u00e1c, pha ch\u1eadm (pursuits) cho b\u1ec7nh nh\u00e2n nh\u00ecn ch\u1eadm theo d\u00f5i m\u1ed9t v\u1eadt nh\u01b0 ng\u00f3n tay ng\u01b0\u1eddi kh\u00e1m.<\/span><\/p>\n

T\u1ed5n th\u01b0\u01a1ng ti\u1ec1n \u0111\u00ecnh ngo\u1ea1i bi\u00ean rung gi\u1eadt nh\u00e3n c\u1ea7u ngang, m\u1ed9t chi\u1ec1u r\u00f5 l\u00ean khi nh\u00ecn v\u1ec1 ph\u00eda \u0111\u1ed1i b\u00ean t\u1ed5n th\u01b0\u01a1ng. T\u1ed5n th\u01b0\u01a1ng ti\u1ec1n \u0111\u00ecnh trung \u01b0\u01a1ng c\u00f3 th\u1ec3 g\u00e2y rung gi\u1eadt nh\u00e3n c\u1ea7u m\u1ed9t chi\u1ec1u hay hai chi\u1ec1u ngang, d\u1ecdc. Rung gi\u1eadt nh\u00e3n c\u1ea7u lo\u1ea1i \u0111ung \u0111\u01b0a th\u01b0\u01a1ng do t\u1ed5n th\u01b0\u01a1ng th\u1ecb gi\u00e1c b\u1eaft \u0111\u1ea7 t\u1eeb l\u00fac c\u00f2n b\u00e9.<\/span><\/p>\n

2. C\u00e1c nghi\u1ec7m ph\u00e1p kh\u00e1m rung gi\u1eadt nh\u00e3n c\u1ea7u<\/h2>\n

2.1. Nghi\u1ec7m ph\u00e1p nhi\u1ec7t<\/strong><\/h3>\n

S\u1ef1 x\u00e1o tr\u1ed9n h\u1ec7 th\u1ed1ng ti\u1ec1n \u0111\u00ecnh c\u00f3 th\u1ec3 kh\u00e1m ph\u00e1 b\u1edfi nghi\u1ec7m ph\u00e1p nhi\u1ec7t. Cho b\u1ec7nh nh\u00e2n n\u1eb1m ng\u1eeda, \u0111\u1ea7u cao m\u1ed9t g\u00f3c 30\u00b0, gi\u1eef \u1ed1ng b\u00e1n khuy\u00ean ngang \u1edf v\u1ecb tr\u00ed th\u1eb3ng \u0111\u1ee9ng, b\u01a1m v\u00e0o tai n\u01b0\u1edbc l\u1ea1nh 33 \u0111\u1ed9 C hay\u00a0 n\u01b0\u1edbc \u1ea5m 40 \u0111\u1ed9 C trong 40 gi\u00e2y, th\u1eddi gian t\u1ed1i thi\u1ec3u gi\u1eefa hai <\/span>l\u1ea7n th\u1eed l\u00e0 5 ph\u00fat, n\u01b0\u1edbc \u1ea5m g\u00e2y \u00edt kh\u00f3 ch\u1ecbu h\u01a1n n\u01b0\u1edbc l\u1ea1nh. Ch\u00fa \u00fd kh\u00e1m tai xem m\u00e0ng nh\u0129 tr\u01b0\u1edbc khi l\u00e0m nghi\u1ec7m ph\u00e1p nhi\u1ec7t.<\/span><\/p>\n

K\u1ebft qu\u1ea3: \u1edf b\u1ec7nh nh\u1eabn t\u1ec9nh b\u00ecnh th\u01b0\u1eddng, k\u00edch th\u00edch n\u01b0\u1edbc l\u1ea1nh, xu\u1ea5t hi\u1ec7n rung gi\u1eadt nh\u00e3n c\u1ea7u \u0111i chi\u1ec1u ch\u1eadm h\u01b0\u1edbng v\u1ec1 tai k\u00edch th\u00edch v\u00e0 chi\u1ec1u nh\u00e1nh h\u01b0\u1edbng v\u1ec1 ph\u00eda \u0111\u1ed1i di\u1ec7n, k\u00edch th\u00edch n\u01b0\u1edbc n\u00f3ng h\u01b0\u1edbng rung gi\u1eadt nh\u00e3n c\u1ea7u ng\u01b0\u1ee3c l\u1ea1i. B\u1ec7nh nh\u00e2n t\u1ed5n th\u01b0\u01a1ng ti\u1ec1n \u0111\u00ecnh m\u1ed9t b\u00ean k\u00edch th\u00edch kh\u00f4ng c\u00f3 gi\u1eadt nh\u00e3n c\u1ea7u, hay xu\u1ea5t hi\u1ec7n gi\u1eadt nh\u1eabn c\u1ea7u ch\u1eadm h\u01a1n hay th\u1eddi gian ng\u1eafn h\u01a1n so b\u00ean b\u00ecnh th\u01b0\u1eddng.<\/span><\/p>\n

2.2. Nghi\u1ec7m ph\u00e1p Nylen-B\u00e1r\u00e1ny (Dix- Hallpike)<\/strong><\/h3>\n

Khi b\u1ec7nh nh\u00e2n c\u00f3 ch\u00f3ng m\u1eb7t t\u01b0 th\u1ebf, nghi\u1ec7m ph\u00e1p n\u00e0y c\u00f3 m\u1ee5c \u0111\u00edch l\u00e0m l\u1eadp l\u1ea1i tri\u1ec7u ch\u1ee9ng. Cho b\u1ec7nh nh\u00e2n ng\u1ed3i quay \u0111\u1ea7u sang ph\u1ea3i, v\u00e0 nhanh ch\u00f3ng cho n\u1eb1m ng\u1eeda \u0111\u1ea7u th\u1ea5p h\u01a1n m\u1eb7t ph\u1eb3ng ngang m\u1ed9t g\u00f3c 30\u00b0, quan s\u00e1t gi\u1eadt nh\u00e3n c\u1ea7u v\u00e0 ch\u00f3ng m\u1eb7t, nghi\u1ec7m ph\u00e1p \u0111\u01b0\u1ee3c l\u1eadp l\u1ea1i v\u1edbi \u0111\u1ea7u quay sang tr\u00e1i v\u00e0 th\u1eb3ng. Quan s\u00e1t xem c\u00f3 rung gi\u1eadt nh\u00e3n c\u1ea7u v\u00e0 h\u1ecfi b\u1ec7nh nh\u00e2n \u0111\u1ec3 bi\u1ebft kh\u1ed1i \u0111\u1ea7u, m\u1ee9c \u0111\u1ed9 tr\u1ea7m tr\u1ecdng v\u00e0 khi n\u00e0o th\u00ec ng\u01b0ng ch\u00f3ng m\u1eb7t. Rung gi\u1eadt nh\u00e3n c\u1ea7u t\u01b0 th\u1ebf v\u00e0 ch\u00f3ng m\u1eb7t th\u01b0\u1eddng \u0111i k\u00e8m trong t\u1ed5n th\u01b0\u01a1ng ti\u1ec1n \u0111\u00ecnh ngo\u1ea1i bi\u00ean v\u00e0 \u0111a S\u1ed0 g\u1eb7p trong ch\u00f3ng m\u1eb7t t\u01b0 th\u1ebf l\u00e0nh t\u00ednh. Lo\u00e0i n\u00e0y \u0111\u1eb7c bi\u1ec7t g\u00e2y kh\u00f3 ch\u1ecbu d\u1eef d\u1ed9i, c\u00f3 th\u1eddi gian ti\u1ec1m \u1ea9n k\u00e9o d\u00e0i nhi\u1ec1u gi\u00e2y khi b\u1ec7nh nh\u00e2n \u1edf t\u01b0 th\u1ebf thu\u1eadn l\u1ee3i \u0111\u1ebfn l\u00fac kh\u1edfi \u0111\u1ea7u ch\u00f3ng m\u1eb7t v\u00e0 c\u00f3 rung gi\u1eadt nh\u00e3n c\u1ea7u nh\u01b0ng l\u1ea1i c\u00f3 khuynh h\u01b0\u1edbng b\u1edbt \u0111i t\u1ef1 nhi\u00ean khi l\u1eadp l\u1ea1i. Ch\u00f3ng m\u1eb7t t\u01b0 th\u1ebf c\u0169ng c\u00f3 th\u1ec3 g\u1eb7p x\u01b0\u01a1ng b\u1ec7nh l\u00fd ti\u1ec1n \u0111\u00ecnh trung \u01b0\u01a1ng.<\/span><\/p>\n

B\u1ea3ng \u0110\u1eb7c \u0111i\u1ec3m tung gi\u1eadt nh\u00e3n c\u1ea7u t\u01b0 th\u1ebf<\/span><\/p>\n\n\n\n\n\n\n\n
\u0110\u1eb7c \u0111i\u1ec3m<\/span><\/td>\nTi\u1ec1n \u0111\u00ecnh ngo\u1ea1i bi\u00ean<\/span><\/td>\nTi\u1ec1n \u0111\u00ecnh trung \u01b0\u01a1ng<\/span><\/td>\n<\/tr>\n
Ch\u00f3ng m\u1eb7t<\/span><\/td>\nN\u1eb7ng\/<\/span><\/td>\nTrung b\u00ecnh<\/span><\/td>\n<\/tr>\n
Th\u1eddi gian ti\u1ec1m \u1ea9n<\/span><\/td>\n2- 40 gi\u00e2y<\/span><\/td>\nKh\u00f4ng c\u00f3<\/span><\/td>\n<\/tr>\n
D\u1ec5 m\u1ec7t m\u1ecfi<\/span><\/td>\nBi\u1ebfn m\u1ea5t khi l\u1eadp l\u1ea1i<\/span><\/td>\nKh\u00f4ng<\/span><\/td>\n<\/tr>\n
S\u1ef1 th\u00edch nghi<\/span><\/td>\nC\u00f4<\/span><\/td>\nKh\u00f4ng<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

B\u1ea3ng Ph\u00e2n bi\u1ec7t rung gi\u1eadt nh\u00e3n c\u1ea7u trung \u01b0\u01a1ng v\u00e0 ngo\u1ea1i bi\u00ean<\/span><\/p>\n\n\n\n\n\n\n
\u00a0<\/span><\/td>\nT\u1ed5n th\u01b0\u01a1ng ngo\u1ea1i bi\u00ean<\/span><\/td>\nT\u1ed5n th\u01b0\u01a1ng trung \u01b0\u01a1ng<\/span><\/td>\n<\/tr>\n
T\u1ef1 ph\u00e1t<\/span><\/td>\nM\u1ed9t h\u01b0\u1edbng, pha nhanh \u0111\u1ed1i b\u00ean t\u1ed5n th\u01b0\u01a1ng, ph\u1ed1i h\u1ee3p ngang xoay, \u1ee9c ch\u1ebf khi c\u1ed1 \u0111\u1ecbnh.<\/span><\/td>\nHai b\u00ean hay m\u1ed9t b\u00ean, th\u01b0\u01a1ng ngang, d\u1ecdc hay xoay \u0111\u01a1n thu\u1ea7n, kh\u00f4ng \u1ee9c ch\u1ebf khi c\u1ed1 \u0111\u1ecbnh.<\/span><\/td>\n<\/tr>\n
T\u01b0 <\/span> th\u1ebf t\u0129nh tr\u1ea1ng<\/span><\/td>\nH\u01b0\u1edbng c\u1ed1 \u0111\u1ecbnh hay thay \u0111\u1ed5i, \u1ee9c ch\u1ebf khi c\u1ed1 \u0111\u1ecbnh.<\/span><\/td>\nH\u01b0\u01a1ng c\u1ed1 \u0111\u1ecbnh hay thay \u0111\u1ed5i, kh\u1ed1ng \u1ee9c ch\u1ebf khi c\u1ed1 \u0111\u1ecbnh.<\/span><\/td>\n<\/tr>\n
T\u01b0<\/span> th\u1ebf k\u1ecbch ph\u00e1t<\/span><\/td>\nD\u1ecdc-xoay \u0111\u00f4i khi ngang-xoay, ch\u00f3ng<\/span><\/p>\n

m\u1eb7t \u01b0u th\u1ebf, bi\u1ebfn m\u1ea5t khi l\u1eadp l\u1ea1i, ti\u1ec1m t\u00e0ng.<\/span><\/td>\n

Th\u01b0\u1eddng d\u1ecdc \u0111\u01a1n thu\u1ea7n, \u00edt ch\u00f3ng m\u1eb7t, kh\u00f4ng ti\u1ec1m t\u00e0ng v\u00e0 dai d\u1eb3ng.<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

T\u00f3m l\u1ea1i, kh\u00e1m rung gi\u1eadt nh\u00e3n c\u1ea7u lc\u00f3 t\u1ea7m quan tr\u1ecdng trong vi\u1ec7c ph\u00e1t hi\u1ec7n v\u00e0 ch\u1ea9n \u0111o\u00e1n c\u00e1c b\u1ec7nh l\u00fd li\u00ean quan \u0111\u1ebfn th\u1ea7n kinh v\u00e0 th\u1ecb gi\u00e1c. Rung gi\u1eadt nh\u00e3n c\u1ea7u l\u00e0 m\u1ed9t tri\u1ec7u ch\u1ee9ng ph\u1ed5 bi\u1ebfn v\u00e0 c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n trong nhi\u1ec1u b\u1ec7nh l\u00fd kh\u00e1c nhau, t\u1eeb b\u1ec7nh l\u00fd th\u1ea7n kinh \u0111\u1ebfn c\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 th\u1ecb gi\u00e1c v\u00e0 c\u00e1c b\u1ec7nh l\u00fd kh\u00e1c. Vi\u1ec7c kh\u00e1m ph\u00e1t hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng s\u1edbm c\u00f3 th\u1ec3 gi\u00fap b\u00e1c s\u0129 x\u00e1c \u0111\u1ecbnh nguy\u00ean nh\u00e2n ch\u00ednh x\u00e1c c\u1ee7a tri\u1ec7u ch\u1ee9ng v\u00e0 \u0111\u01b0a ra ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p. \u0110i\u1ec1u n\u00e0y gi\u00fap ng\u0103n ng\u1eeba c\u00e1c bi\u1ebfn ch\u1ee9ng v\u00e0 t\u0103ng c\u01a1 h\u1ed9i ph\u1ee5c h\u1ed3i v\u00e0 \u0111i\u1ec1u tr\u1ecb th\u00e0nh c\u00f4ng. Do \u0111\u00f3, kh\u00e1m rung gi\u1eadt nh\u00e3n c\u1ea7u l\u00e0 m\u1ed9t ph\u1ea7n quan tr\u1ecdng trong qu\u00e1 tr\u00ecnh kh\u00e1m s\u1ee9c kh\u1ecfe v\u00e0 ch\u1ea9n \u0111o\u00e1n c\u00e1c b\u1ec7nh l\u00fd li\u00ean quan \u0111\u1ebfn th\u1ea7n kinh v\u00e0 th\u1ecb gi\u00e1c. Ngo\u00e0i ra, kh\u00e1m rung gi\u1eadt nh\u00e3n c\u1ea7u c\u00f2n gi\u00fap \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe t\u1ed5ng qu\u00e1t c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 ph\u00e1t hi\u1ec7n c\u00e1c b\u1ec7nh l\u00fd kh\u00e1c c\u00f3 th\u1ec3 g\u00e2y ra tri\u1ec7u ch\u1ee9ng rung gi\u1eadt nh\u00e3n c\u1ea7u, gi\u00fap b\u00e1c s\u0129 \u0111\u01b0a ra ch\u1ea9n \u0111o\u00e1n ch\u00ednh x\u00e1c v\u00e0 \u0111i\u1ec1u tr\u1ecb hi\u1ec7u qu\u1ea3.<\/p>\n

Ngu\u1ed3n tham kh\u1ea3o: Th\u1ea7n kinh h\u1ecdc- \u0110H Y TP H\u1ed3 Ch\u00ed Minh<\/em>\u00a0<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

Rung gi\u1eadt nh\u00e3n c\u1ea7u l\u00e0 m\u1ed9t tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p trong nhi\u1ec1u b\u1ec7nh l\u00fd kh\u00e1c nhau v\u00e0 vi\u1ec7c kh\u00e1m ph\u00e1t hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi. Khi rung gi\u1eadt nh\u00e3n c\u1ea7u x\u1ea3y ra, c\u00e1c h\u00ecnh \u1ea3nh s\u1ebd tr\u00f4ng m\u1edd ho\u1eb7c dao \u0111\u1ed9ng, g\u00e2y kh\u00f3 ch\u1ecbu v\u00e0 kh\u00f3 […]<\/p>\n","protected":false},"author":5,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[10,33],"tags":[],"yoast_head":"\nM\u1ed9t s\u1ed1 nghi\u1ec7m ph\u00e1p kh\u00e1m rung gi\u1eadt nh\u00e3n c\u1ea7u - Vinmec<\/title>\n<meta name=\"description\" content=\"Rung gi\u1eadt nh\u00e3n c\u1ea7u l\u00e0 m\u1ed9t tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p trong nhi\u1ec1u b\u1ec7nh l\u00fd kh\u00e1c nhau, v\u00e0 vi\u1ec7c kh\u00e1m ph\u00e1t hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 ...\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"M\u1ed9t s\u1ed1 nghi\u1ec7m ph\u00e1p kh\u00e1m rung gi\u1eadt nh\u00e3n c\u1ea7u - 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