{"id":28783,"date":"2023-04-27T19:27:11","date_gmt":"2023-04-27T12:27:11","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=28783"},"modified":"2023-04-27T19:27:11","modified_gmt":"2023-04-27T12:27:11","slug":"cac-nghiem-phap-kham-that-dieu-tieu-nao","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/27\/cac-nghiem-phap-kham-that-dieu-tieu-nao\/","title":{"rendered":"C\u00e1c nghi\u1ec7m ph\u00e1p kh\u00e1m th\u1ea5t \u0111i\u1ec1u ti\u1ec3u n\u00e3o"},"content":{"rendered":"<p><strong>D\u1ea5u hi\u1ec7u quan tr\u1ecdng c\u1ee7a b\u1ec7nh l\u00fd ti\u1ec3u n\u00e3o l\u00e0 th\u1ea5t \u0111i\u1ec1u (ataxia). Th\u1ea5t \u0111i\u1ec1u ti\u1ec3u n\u00e3o \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a nh\u01b0 m\u1ea5t v\u1eadn \u0111\u1ed9ng ch\u00ednh x\u00e1c hay r\u1ed1i lo\u1ea1n ph\u1ed1i h\u1ee3p (kh\u00f4ng do li\u1ec7t), thay \u0111\u1ed5i tr\u01b0\u01a1ng l\u1ef1c c\u01a1, m\u1ea5t c\u1ea3m gi\u00e1c t\u01b0 th\u1ebf hay s\u1ef1 hi\u1ec7n di\u1ec7n v\u1eadn \u0111\u1ed9ng kh\u00f4ng t\u1ef1 ch\u1ee7. Th\u1ea5t \u0111i\u1ec1u ti\u1ec3u n\u00e3o li\u00ean quan \u0111\u1ebfn r\u1ed1i lo\u1ea1n co c\u01a1 \u0111\u1ed3ng v\u1eadn v\u00e0 \u0111\u1ed1i v\u1eadn \u1edf chi, th\u00e2n, m\u1eaft v\u00e0 c\u01a1 h\u1ea7u h\u1ecdng. Th\u1ea5t \u0111i\u1ec1u do t\u1ed5n th\u01b0\u01a1ng \u1edf ti\u1ec3u n\u00e3o hay c\u00e1c \u0111\u01b0\u1eddng li\u00ean k\u1ebft \u1edf cu\u1ed1ng ti\u1ec3u n\u1eabo, nh\u00e2n \u0111\u1ecf, c\u1ea7u n\u00e3o, t\u1ee7y s\u1ed1ng hay th\u00f9y tr\u00e1n (\u0111\u01b0\u1eddng li\u00ean k\u1ebft ch\u00e9o th\u00f9y tr\u00e1n-ti\u1ec3u n\u00e3o).<\/strong><\/p>\n<figure id=\"attachment_28879\" aria-describedby=\"caption-attachment-28879\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"size-medium wp-image-28879\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/istockphoto-1406509035-612x612-1-300x158.jpg\" alt=\"\" width=\"300\" height=\"158\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/istockphoto-1406509035-612x612-1-300x158.jpg 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/istockphoto-1406509035-612x612-1.jpg 612w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-28879\" class=\"wp-caption-text\">D\u1ea5u hi\u1ec7u quan tr\u1ecdng c\u1ee7a b\u1ec7nh l\u00fd ti\u1ec3u n\u00e3o l\u00e0 th\u1ea5t \u0111i\u1ec1u (ataxia)<\/figcaption><\/figure>\n<h2>1. C\u00e1c h\u00ecnh th\u1ee9c th\u1ea5t \u0111i\u1ec1u<\/h2>\n<p>Th\u1ea5t \u0111i\u1ec1u d\u00e1ng \u0111i: li\u00ean quan \u0111\u1ebfn m\u1ea5t ph\u1ed1i h\u1ee3p khi \u0111i, n\u1ebfu n\u1eb7ng b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111i \u0111\u01b0\u1ee3c (abasia).<\/p>\n<p>Th\u1ea5t \u0111i\u1ec1u t\u01b0 th\u1ebf: li\u00ean quan \u0111\u1ebfn th\u1ea5t \u0111i\u1ec1u \u0111\u1ee9ng v\u00e0 ng\u1ed3i v\u00e0 bao g\u1ed3m th\u1ea5t \u0111i\u1ec1u th\u00e2n. B\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 kh\u1ea3 n\u0103ng ng\u1ed3i hay \u0111\u1ee9ng m\u00e0 kh\u00f4ng c\u00f3 n\u00e2ng \u0111\u1ee1 (astasia).<\/p>\n<p>Th\u1ea5t \u0111i\u1ec1u chi: li\u00ean quan \u0111\u1ebfn s\u1ef1 m\u1ea5t ph\u1ed1i h\u1ee3p v\u1eadn \u0111\u1ed9ng chi.<\/p>\n<p>Th\u1ea5t \u0111i\u1ec1u l\u1eddi n\u00f3i: n\u00f3i l\u00edu nh\u00edu, ch\u1eadm, ng\u1eadp ng\u1eebng, d\u1eb1n t\u1eebng ti\u1ebfng v\u00e0 n\u1ed5 b\u00f9ng.<\/p>\n<h2>2. C\u00e1c nghi\u1ec7m ph\u00e1p kh\u00e1m th\u1ea5t \u0111i\u1ec1u<\/h2>\n<h3>2.1. Kh\u00e1m ph\u1ed1i h\u1ee3p t\u01b0 th\u1ebf v\u00e0 d\u00e1ng \u0111i<\/h3>\n<ul>\n<li>Quan s\u00e1t kh\u1ea3 n\u0103ng \u0111i b\u1ed9 trong 10 m: B\u1ec7nh nh\u00e2n c\u00f3 t\u1ed5n th\u01b0\u01a1ng ti\u1ec3u n\u00e3o \u0111i b\u1ed9 ch\u00e2n d\u1ea1ng r\u1ed9ng, d\u00e1ng \u0111i l\u1ea3o \u0111\u1ea3o v\u00e0 di\u1ec5n ti\u1ebfn ti\u1ebfp theo l\u00e0 h\u00ecnh ch\u1eef chi gi\u1ed1ng ng\u01b0\u1eddi say r\u01b0\u1ee3u; b\u01b0\u1edbc \u0111i ng\u1eafn, d\u00e0i kh\u00f4ng b\u1eb1ng nhau v\u00e0 kh\u00f4ng \u0111\u1ec1u; ch\u00e2n th\u01b0\u1eddng nh\u1ea5c l\u00ean qu\u00e1 cao v\u00e0 b\u1ecf xu\u1ed1ng m\u1ea1nh qu\u00e1 \u0111\u00e1ng; tay kh\u00f4ng \u0111u \u0111\u01b0a \u0111\u1ed3ng b\u1ed9 v\u1edbi v\u1eadn \u0111\u1ed9ng ch\u00e2n \u0111\u1ed1i b\u00ean. Th\u1ea5t \u0111i\u1ec1u d\u00e1ng \u0111i ch\u1ec9 c\u00f3 th\u1ec3 th\u1ea5y \u0111\u01b0\u1ee3c khi b\u1ec7nh nh\u00e2n \u0111i b\u1ed9 ch\u00e2n tr\u01b0\u1edbc ch\u00e2n sau, \u0111i l\u00f9i hay kh\u00f4ng nh\u00ecn ph\u00eda sau, th\u1ea5t \u0111i\u1ec1u ti\u1ec3u n\u00e3o n\u1eb7ng b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111i \u0111\u01b0\u1ee3c. Tri\u1ec7u ch\u1ee9ng nhi\u1ec1u h\u01a1n khi thay \u0111\u1ed5i h\u01b0\u1edbng \u0111\u1ed9t ng\u1ed9t, v\u00ed d\u1ee5 quay hay ng\u1eebng \u0111\u1ed9t ng\u1ed9t hay ng\u1ed3i d\u1eady nhanh tr\u00ean gh\u1ebf. Khuynh h\u01b0\u1edbng ng\u00e3 hay l\u1ec7ch h\u01b0\u1edbng sang b\u00ean t\u1ed5n th\u01b0\u01a1ng ti\u1ec3u n\u00e3o. B\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 b\u00f9 tr\u1eeb b\u1eb1ng b\u01b0\u1edbc ng\u1eafn l\u1ea1i v\u00e0 l\u00ea ch\u00e2n \u0111\u1ec3 gi\u1eef hai ch\u00e2n \u0111\u1ed3ng th\u1eddi tr\u00ean m\u1eb7t \u0111\u1ea5t.<\/li>\n<li>Quan s\u00e1t kh\u1ea3 n\u0103ng \u0111\u1ee9ng v\u00e0 ng\u1ed3i: T\u01b0 th\u1ebf \u0111\u1ee9ng th\u01b0\u1eddng d\u1ea1ng hai ch\u00e2n, trong th\u1ec3 nh\u1eb9 nh\u1ea5t b\u1ec7nh nh\u00e2n c\u0169ng kh\u00f3 kh\u0103n khi \u0111\u1ee9ng v\u1edbi hai b\u00e0n ch\u00e2n \u1edf t\u01b0 th\u1ebf \u0111\u1eb7t c\u00e1i tr\u01b0\u1edbc c\u00e1i sau hay \u0111\u1ee9ng m\u1ed9t ch\u00e2n. B\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 kh\u00f4ng ng\u1ed3i hay \u0111\u1ee9ng \u0111\u01b0\u1ee3c khi kh\u00f4ng c\u00f3 s\u1ef1 n\u00e2ng \u0111\u1ee1. B\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 c\u00f3 run theo nh\u1ecbp \u1edf th\u00e2n, th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n th\u00e2n \u0111ong \u0111\u01b0a ra tr\u01b0\u1edbc ra sau t\u1eeb b\u00ean n\u00e0y \u0111\u1ebfn b\u00ean kia v\u00e0 trong v\u1eadn \u0111\u1ed9ng xoay c\u00f3 th\u1ec3 ti\u1ebfn tri\u1ec3n th\u00e0nh l\u1eafc l\u01b0 n\u1eb7ng (titubation).<\/li>\n<li>R\u1ed1i lo\u1ea1n th\u0103ng b\u1eb1ng: B\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u1ee9ng v\u1eefng c\u1ea3 khi m\u1edf m\u1eaft v\u00e0 nh\u1eafm m\u1eaft do th\u1ea5t \u0111i\u1ec1u ti\u1ec3u n\u00e3o kh\u00f4ng th\u1ec3 b\u00f9 tr\u1eeb b\u1eb1ng th\u1ecb gi\u00e1c. Ch\u00fa \u00fd, d\u1ea5u hi\u1ec7u Romberg ch\u1ec9 g\u1eb7p trong t\u1ed5n th\u01b0\u01a1ng \u0111\u01b0\u1eddng c\u1ea3m gi\u00e1c s\u00e2u v\u00e0 r\u1ed1i lo\u1ea1n ti\u1ec1n \u0111\u00ecnh. B\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 \u0111\u1ee9ng v\u1eefng khi m\u1edf m\u1eaft nh\u01b0ng lo\u1ea1ng cho\u1ea1ng khi nh\u1eafm m\u1eaft.<\/li>\n<li>D\u00e1ng \u0111i n\u1ed1i g\u00f3t: B\u1ec7nh nh\u00e2n kh\u00f4ng \u0111i b\u1ed9 g\u00f3t ch\u00e2n n\u1ed1i ng\u00f3n ch\u00e2n (heel-to-toe) \u0111\u01b0\u1ee3c (ch\u00fa \u00fd: b\u1ec7nh nh\u00e2n tr\u00ean 70 tu\u1ed5i c\u00f3 th\u1ec3 kh\u00f3 kh\u0103n khi \u0111i g\u00f3t ch\u00e2n n\u1ed1i ng\u00f3n ch\u00e2n).<\/li>\n<\/ul>\n<h3>2.2. Kh\u00e1m v\u1eadn \u0111\u1ed9ng t\u1ef1 ch\u00f9<\/h3>\n<h4>2.2.1. Th\u1ea5t \u0111i\u1ec1u chi tr\u00ean<\/h4>\n<p>Th\u01b0\u1eddng r\u00f5 r\u00e0ng h\u01a1n chi d\u01b0\u1edbi v\u00e0 th\u01b0\u1eddng r\u00f5 h\u01a1n trong c\u1eed \u0111\u1ed9ng ph\u1ee9c t\u1ea1p v\u00e0 trong c\u1eed \u0111\u1ed9ng nhanh.<\/p>\n<p>&#8211;\u00a0 <a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/kham-lam-sang-xet-nghiem-can-lam-sang-va-chan-doan-dieu\/\">Nghi\u1ec7m ph\u00e1p ng\u00f3n tay ch\u1ec9 m\u0169i<\/a><\/p>\n<p>Y\u00eau c\u1ea7u b\u1ec7nh nh\u00e2n di chuy\u1ec3n ng\u00f3n tay ch\u1ea1m v\u00e0o \u0111\u1ec9nh m\u0169i c\u1ee7a h\u1ecd hay ch\u1ea1m v\u00e0o ng\u00f3n tay c\u1ee7a ng\u01b0\u1eddi kh\u00e1m (\u0111\u01b0\u1ee3c di chuy\u1ec3n \u1edf nhi\u1ec1u v\u1ecb tr\u00ed) r\u1ed3i ch\u1ec9 v\u00e0o \u0111\u1ec9nh m\u0169i.<\/p>\n<p>Trong t\u1ed5n th\u01b0\u01a1ng ti\u1ec3u n\u00e3o, v\u1eadn \u0111\u1ed9ng kh\u1edfi \u0111\u1ea7u ch\u1eadm tr\u1ec5, tay th\u01b0\u1eddng g\u1ea5p v\u00e0 \u0111ong \u0111\u01b0a cho \u0111\u1ebfn l\u00fac ng\u00f3n tay ch\u1ea1m m\u0169i. \u0110\u01b0\u1eddng \u0111i ng\u00f3n tay th\u1ea5t th\u01b0\u1eddng v\u00e0 gi\u1eadt, kh\u00f3 ch\u1ea1m v\u00e0o m\u0169i c\u00f2n g\u1ecdi lo\u1ea1n t\u1ea7m \u0111\u1ed9ng t\u00e1c (dysmetria), th\u01b0\u1eddng qu\u00e1 \u0111\u00edch (hypermetria) v\u00e0 \u0111\u00f4i khi ng\u1eebng v\u1eadn \u0111\u1ed9ng s\u1edbm d\u01b0\u1edbi \u0111\u00edch (hypometria).<\/p>\n<ul>\n<li>Run khi c\u1eed \u0111\u1ed9ng h\u1eefu \u00fd<\/li>\n<\/ul>\n<p>Run do t\u1ed5n th\u01b0\u01a1ng ti\u1ec3u n\u00e3o th\u01b0\u1eddng x\u1ea3y ra \u1edf tr\u1ea1ng th\u00e1i \u0111\u1ed9ng v\u00e0 \u00edt g\u1eb7p h\u01a1n \u1edf tr\u1ea1ng th\u00e1i t\u1ec9nh. Run \u0111\u1ed9ng tr\u1ea1ng (kinetic &#8211; tremor) x\u1ea3y ra nh\u01b0 m\u1ed9t dao \u0111\u1ed9ng v\u1eadn \u0111\u1ed9ng khi b\u1eaft \u0111\u1ea7u hay trong su\u1ed1t qu\u00e1 tr\u00ecnh di chuy\u1ec3n, run tr\u1edf n\u00ean \u01b0u th\u1ebf khi chi ti\u1ebfp c\u1eadn m\u1ee5c ti\u00eau. Run khi c\u1eed \u0111\u1ed9ng h\u1eefu \u00fd (intentional trem\u00f3r) g\u1eb7p trong t\u1ed5n th\u01b0\u01a1ng nh\u00e2n r\u0103ng hay cu\u1ed1ng ti\u1ec3u n\u00e3o tr\u00ean. L\u00e2m s\u00e0ng ph\u00e1t hi\u1ec7n b\u1eb1ng c\u00e1ch cho b\u1ec7nh nh\u00e2n c\u1ea7m c\u1ed1c n\u01b0\u1edbc u\u1ed1ng, c\u00e0ng g\u1ea7n mi\u1ec7ng c\u00e0ng run r\u00f5 r\u1ec7t. Run t\u0129nh tr\u1ea1ng (static &#8211; tremor) x\u1ea3y ra khi b\u1ec7nh nh\u00e2n c\u1ed1 g\u1eafng duy tr\u00ec chi \u1edf t\u01b0 th\u1ebf c\u1ed1 \u0111\u1ecbnh.<\/p>\n<ul>\n<li>Nghi\u1ec7m ph\u00e1p B\u00e1r\u00e1ny &#8216;s pointing<\/li>\n<\/ul>\n<p>Y\u00eau c\u1ea7u b\u1ec7nh nh\u00e2n \u0111\u01b0a hai tay th\u1eb3ng ra tr\u01b0\u1edbc, ng\u01b0\u1eddi kh\u00e1m b\u1ec7nh \u0111\u01b0a hai ng\u00f3n tr\u1ecf ch\u1ea1m v\u00e0o hai ng\u00f3n tr\u1ecf ng\u01b0\u1eddi b\u1ec7nh, tay ng\u01b0\u1eddi b\u1ec7nh \u0111\u01b0\u1ee3c y\u00eau c\u1ea7u \u0111\u01b0a xu\u1ed1ng r\u1ed3i l\u00ean \u0111\u1ebfn ng\u1ed1n tay ng\u01b0\u1eddi kh\u00e1m. Sau v\u00e0i l\u1ea7n th\u1ef1c h\u00e0nh m\u1edf m\u1eaft, y\u00eau c\u1ea7u b\u1ec7nh nh\u00e2n nh\u1eafm m\u1eaft, k\u1ebft qu\u1ea3 lo\u1ea1n t\u1ea7m \u0111\u1ed9ng t\u00e1c, ng\u00f3n tay tr\u1ecf b\u00ean t\u1ed5n th\u01b0\u01a1ng l\u1ec7ch ra ngo\u00e0i.<\/p>\n<ul>\n<li>M \u1ea5t li\u00ean \u0111\u1ed9ng<\/li>\n<\/ul>\n<p>Ki\u1ec3m tra kh\u1ea3 n\u0103ng th\u1ef1c hi\u1ec7n nh\u1eefng thay \u0111\u1ed5i nhanh c\u00e1c v\u1eadn \u0111\u1ed9ng nh\u01b0 \u0111\u01b0a c\u1eb3ng tay l\u00ean theo chi\u1ec1u th\u1eb3ng \u0111\u1ee9ng, s\u1ea5p ng\u1eeda b\u00e0n tay nhanh. Trong t\u1ed5n th\u01b0\u01a1ng ti\u1ec3u n\u00e3o, v\u1eadn \u0111\u1ed9ng s\u1ebd kh\u00f4ng \u0111\u1ec1u (dysdiad\u1ecdchokinesis) v\u00e0 ch\u1eadm (bradydiadochokinesis). S\u1ef1 lo\u1ea1n t\u1ea7m v\u00e0\/ho\u1eb7c ch\u1eadm ch\u1ea1p c\u00f3 th\u1ec3 l\u00fac b\u1eaft \u0111\u1ea7u v\u1eadn \u0111\u1ed9ng hay \u1edf cu\u1ed1i v\u1eadn \u0111\u1ed9ng.<\/p>\n<p>&#8211; Th\u1ef1c hi\u1ec7n v\u1eadn \u0111\u1ed9ng ng\u00f3n tay ch\u00ednh x\u00e1c<\/p>\n<p>Trong t\u1ed5n th\u01b0\u01a1ng ti\u1ec3u n\u00e3o, b\u1ec7nh nh\u00e2n c\u00f3 bi\u1ec3u hi\u1ec7n v\u1ee5ng v\u1ec1 khi th\u1ef1c hi\u1ec7n c\u00e1c \u0111\u1ed9ng t\u00e1c ph\u1ee9c t\u1ea1p nh\u01b0 c\u00e0i khuy \u00e1o hay c\u00e1c c\u00f4ng vi\u1ec7c trong \u0111\u1eddi s\u1ed1ng h\u00e0ng ng\u00e0y, nh\u01b0 m\u1edf ng\u00f3n tay r\u1ed9ng qu\u00e1 m\u1ee9c v\u00e0 n\u1eafm \u0111\u1ed3 v\u1eadt v\u1edbi l\u1ef1c qu\u00e1 \u0111\u00e1ng.<\/p>\n<ul>\n<li>Ch\u1eef vi\u1ebft<\/li>\n<\/ul>\n<p>Ch\u1eef vi\u1ebft th\u01b0\u1eddng b\u1ecb \u1ea3nh h\u01b0\u1edfng, c\u1ea7m vi\u1ebft kh\u00f4ng ch\u00ednh x\u00e1c v\u00e0 \u1ea5n qu\u00e1 ch\u1eafc ch\u1eafn tr\u00ean gi\u1ea5y, vi\u1ebft tr\u1ecf n\u00ean g\u1eafng s\u1ee9c v\u00e0 ch\u1eadm, ch\u1eef vi\u1ebft kh\u00f4ng \u0111\u1ec1u v\u1ec1 k\u00edch th\u01b0\u1edbc v\u00e0 th\u01b0\u1eddng l\u1edbn (megalographia).<\/p>\n<h4>2.2.2. Th\u1ea5t \u0111i\u1ec1u chi d\u01b0\u1edbi<\/h4>\n<p>Th\u1ea5t \u0111i\u1ec1u hai chi d\u01b0\u1edbi th\u01b0\u01a1ng nh\u1eb9 h\u01a1n so v\u1edbi r\u1ed1i lo\u1ea1n d\u00e1ng di. C\u00f3 r\u1ea5t nhi\u1ec1u h\u00ecnh \u1ea3nh th\u1ea5t \u0111i\u1ec1u hai chi d\u01b0\u1edbi.<\/p>\n<p>&#8211; Nghi\u1ec7m ph\u00e1p g\u00f3t ch\u00e2n-c\u1eb3ng ch\u00e2n (heel-to-shin)<\/p>\n<p>B\u1ec7nh nh\u00e2n n\u1eb1m ng\u1eeda v\u00e0 g\u1eadp \u0111\u1ea7u \u0111\u1ec3 nh\u00ecn xu\u1ed1ng ch\u00e2n. Y\u00eau c\u1ea7u b\u1ec7nh nh\u00e2n nh\u1ea5c m\u1ed9t ch\u00e2n l\u00ean d\u1eb7t g\u00f3t v\u00e0o \u0111\u1ea7u g\u1ed1i ch\u00e2n c\u00f2n l\u1ea1i v\u00e0 tr\u01b0\u1ee3t xu\u1ed1ng d\u1ecdc theo m\u1eb7t tr\u00ean c\u1ee7a c\u1eb3ng ch\u00e2n \u0111\u1ebfn m\u1eaft c\u00e1, khi \u0111\u1ebfn kh\u1edbp m\u1eaft c\u00e1 ch\u00e2n \u0111\u01b0\u1ee3c nh\u1ea5c l\u00ean cao 40cm v\u00e0 \u0111\u1ed9ng t\u00e1c n\u00e0y \u0111\u01b0\u1ee3c l\u1eadp l\u1ea1i. T\u01b0\u01a1ng t\u1ef1 nh\u01b0 th\u1ea5t \u0111i\u1ec1u chi tr\u00ean, kh\u1edfi \u0111\u1ea7u v\u1eadn d\u1ed9ng th\u01b0\u1eddng b\u1ecb tr\u00ec ho\u00e3n, \u0111\u00f9i c\u00f3 th\u1ec3 g\u1eadp v\u1ec1 ph\u00eda th\u00e2n tr\u01b0\u1edbc khi g\u1eadp g\u1ed1i ho\u1eb7c g\u1ed1i c\u00f3 th\u1ec3 g\u1eadp tr\u01b0\u1edbc (m\u1ea5t \u0111\u1ed3ng v\u1eadn), \u0111\u01b0\u1eddng \u0111i c\u1ee7a g\u00f3t ch\u00e2n th\u1ea5t th\u1eebong, gi\u1eadt n\u1ea3y l\u00ean v\u00e0 \u00edt khi \u0111\u1ee5ng \u0111\u1ea7u g\u1ed1i. Run \u0111\u1ed9ng tr\u1ea1ng r\u00f5 khi b\u1ec7nh nh\u00e2n gi\u1eef g\u00f3t ch\u00e2n tr\u00ean g\u1ed1i v\u00e0i gi\u00e2y tr\u01b0\u1edbc khi k\u00e9o xu\u1ed1ng.<\/p>\n<ul>\n<li>Nghi\u1ec7m ph\u00e1p g\u1ea5p \u0111\u00f9i m\u00ecnh c\u1ee7a Babinski<\/li>\n<\/ul>\n<p>M\u1ed9t v\u00ed d\u1ee5 kh\u00e1c v\u1ec1 s\u1ef1 m\u1ea5t \u0111\u1ed3ng v\u1eadn th\u00e2n v\u00e0 ch\u00e2n \u0111\u00e3 \u0111\u01b0\u1ee3c Babinski m\u00f4 t\u1ea3: b\u1ec7nh nh\u00e2n c\u1ed1 g\u1eafng g\u1ea5p th\u00e2n ng\u1ed3i d\u1eady \u1edf t\u01b0 th\u1ebf n\u1eb1m ng\u1eeda, g\u00f3t ch\u00e2n b\u00ean b\u1ec7nh th\u01b0\u1eddng nh\u00f4 l\u00ean kh\u1ecfi m\u1eb7t gi\u01b0\u1eddng.<\/p>\n<h3>2.3. Kh\u00e1m l\u1eddi n\u00f3i<\/h3>\n<p>Y\u00eau c\u1ea7u ng\u01b0\u01a1i b\u1ec7nh l\u1eadp l\u1ea1i v\u00e0i l\u1ea7n c\u1ee5m t\u1eeb. Trong t\u1ed5n th\u01b0\u01a1ng ti\u1ec3u n\u00e3o, c\u00e1ch ph\u00e1t \u00e2m kh\u00f4ng r\u00f5 r\u00e0ng v\u00e0 ng\u1eef \u0111i\u1ec7u kh\u00f4ng \u0111i\u1ec1u h\u00f2a trong khi b\u1ec7nh nh\u00e2n v\u1eabn hi\u1ec3u v\u00e0 di\u1ec5n \u0111\u1ea1t b\u00ecnh th\u01b0\u1eddng. L\u1eddi n\u00f3i ti\u1ec3u n\u00e3o c\u00f3 th\u1ec3 ch\u1eadm v\u00e0 tr\u1edf n\u00ean g\u1eafng s\u1ee9c h\u01a1n. D\u1ea5u hi\u1ec7u c\u1ee7a n\u00f3i kh\u00f3 ti\u1ec3u n\u00e3o bao g\u1ed3m: n\u00f3i l\u1eafp, \u0111\u01a1n \u0111i\u1ec7u v\u00e0 kh\u00f4ng \u0111\u1ec1u, gia t\u0103ng bi\u1ebfn \u0111\u1ed5i \u00e2m thanh l\u1edbn v\u00e0 ch\u1ea5t l\u01b0\u1ee3ng \u00e2m thanh (b\u00f9ng n\u1ed5), ph\u00e1t \u00e2m kh\u00f4ng ch\u00ednh x\u00e1c.<\/p>\n<h3>2.4. Kh\u00e1m h\u1ec7 th\u1ed1ng v\u1eadn nh\u00e3n<\/h3>\n<p>Nhi\u1ec1u v\u1eadn d\u1ed9ng m\u1eaft b\u1ea5t th\u01b0\u01a1ng g\u1eb7p trong b\u1ec7nh ti\u1ec3u n\u00e3o, \u0111\u1eb7c bi\u1ec7t trong c\u00e1c t\u1ed5n th\u01b0\u01a1ng \u0111\u01b0\u1eddng gi\u1eefa ti\u1ec3u n\u00e3o.<\/p>\n<p>&#8211; Rung gi\u1eadt nh\u00e3n c\u1ea7u khi nh\u00ecn ch\u0103m ch\u00fa (Gaze -evoked nystagmus) th\u01b0\u1eddng g\u1eb7p v\u1edbi pha ch\u1eadm h\u01b0\u1edbng v\u1ec1 v\u1ecb tr\u00ed \u0111\u1ea7u ti\u00ean c\u1ee7a m\u1eaft. Y\u00eau c\u1ea7u ng\u01b0\u1eddi b\u1ec7nh nh\u00ecn theo ng\u00f3n tay ng\u01b0\u1eddi kh\u00e1m sang b\u00ean, \u0111\u00e1nh gi\u00e1 c\u1eed \u0111\u1ed9ng ngang l\u00e0 ch\u00ednh nh\u01b0ng c\u0169ng c\u00f5 th\u1ec3 ch\u1ebfch, xoay hay d\u1ecdc. C\u00f3 th\u1ec3 ph\u1ed1i h\u1ee3p pha ch\u1eadm v\u00e0 pha nhanh \u0111\u1ea3o ng\u01b0\u1ee3c tr\u1edf l\u1ea1i v\u1ecb tr\u00ed \u0111\u1ea7u ti\u00ean (gi\u1eadt nh\u00e3n c\u1ea7u ph\u1ea3n h\u1ed3i). Gi\u1eadt nh\u00e3n c\u1ea7u ph\u1ea3n h\u1ed3i xu\u1ea5t hi\u1ec7n \u0111\u1eb7c bi\u1ec7t trong t\u1ed5n th\u01b0\u01a1ng ti\u1ec3u n\u00e3o.<\/p>\n<p>&#8211; V\u1eadn \u0111\u1ed9ng theo \u0111u\u1ed5i (pursuit) c\u1ee7a m\u1eaft: ch\u1eadm h\u01a1n b\u00ecnh th\u01b0\u1eddng. Y\u00eau c\u1ea7u ng\u01b0\u1eddi b\u1ec7nh nh\u00ecn theo ng\u00f3n tay ng\u01b0\u1eddi kh\u00e1m \u0111ang \u0111\u01b0a qua l\u1ea1i hai b\u00ean .<\/p>\n<p>&#8211; Lo\u1ea1n t\u1ea7m chi\u1ec1u nhanh c\u1ee7a m\u1eaft (dysmetria of saccades): Hai ng\u00f3n tr\u1ecf ng\u01b0\u1eddi kh\u00e1m \u0111\u1eb7t hai b\u00ean th\u1ecb tr\u01b0\u1eddng th\u00e1i d\u01b0\u01a1ng c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh trong t\u01b0 th\u1ebf hai m\u1eaft nh\u00ecn th\u1eb3ng, sau \u0111\u00f3 y\u00eau c\u1ea7u ng\u01b0\u1eddi b\u1ec7nh nh\u00ecn sang ng\u00f3n tay ph\u1ea3i v\u00e0 tr\u00e1i. Ng\u01b0\u01a1i kh\u00e1m quan s\u00e1t \u0111\u1ec3 \u01b0\u1edbc l\u01b0\u1ee3ng s\u1ef1 di chuy\u1ec3n c\u1ee7a m\u1eaft l\u00e0 trung b\u00ecnh, qu\u00e1 \u0111\u00edch hay d\u01b0\u1edbi \u0111\u00edch.<\/p>\n<p>&#8211; Cu\u1ed3ng nh\u00e3n (ocular flutter) x\u1ea3y ra khi kh\u00f4ng c\u00f3 b\u1ea5t c\u1ee9 c\u1ed1 g\u1eafng v\u1eadn \u0111\u1ed9ng m\u1eaft, s\u1ef1 xu\u1ea5t hi\u1ec7n \u0111\u1ed9t ng\u1ed9t, ng\u1eafn, dao \u0111\u1ed9ng m\u1eaft \u1edf v\u1ecb tr\u00ed trung gian.<\/p>\n<p>&#8211; Rung l\u1eafc nh\u00e3n c\u1ea7u (opsoclonus) \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 khi m\u1eaft li\u00ean h\u1ee3p, t\u1ef1 ph\u00e1t v\u00e0 dao \u0111\u1ed9ng li\u00ean t\u1ee5c trong nhi\u1ec1u h\u01b0\u1edbng.<\/p>\n<h3>2.5. Gi\u1ea3m tr\u01b0\u01a1ng l\u1ef1c c\u01a1<\/h3>\n<p>Gi\u1ea3m tr\u01b0\u01a1ng l\u1ef1c c\u01a1, gi\u1ea3m ph\u1ea3n x\u1ea1 v\u00e0 m\u1ec7t m\u1ecfi, \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 b\u1edfi Holm, l\u00e0 tri\u1ec7u ch\u1ee9ng \u0111\u1eb7c bi\u1ec7t trong t\u1ed5n th\u01b0\u01a1ng ti\u1ec3u n\u00e3\u00f2. Gi\u1ea3m tr\u01b0\u01a1ng l\u1ef1c c\u01a1 x\u1ea3y ra trong giai \u0111o\u1ea1n c\u1ea5p v\u00e0 bi\u1ebfn m\u1ea5t trong v\u00e0i ng\u00e0y hay v\u00e0i tu\u1ea7n.<\/p>\n<h3>2.6. Ph\u1ea3n x\u1ea1 \u0111ong \u0111\u01b0a<\/h3>\n<p>Th\u1ea5t \u0111i\u1ec1u ti\u1ec3u n\u00e3o th\u01b0\u1eddng \u0111i k\u00e8m gi\u1ea3m tr\u01b0\u01a1ng l\u1ef1c c\u01a1 g\u00e2y \u1ea3nh h\u01b0\u1edfng duy tr\u00ec t\u01b0 th\u1ebf, chi l\u1eafc l\u01b0 d\u1ec5 d\u00e0ng v\u1edbi l\u1ef1c t\u00e1c \u0111\u1ed9ng nh\u1ecf. S\u1ef1 gia t\u0103ng m\u1ee9c \u0111\u1ed9 \u0111ong \u0111\u01b0a th\u1ea5y r\u00f5 khi l\u1eafc tay b\u1ec7nh nh\u00e2n v\u00e0 t\u0103ng r\u00f5 khi \u0111i. T\u01b0\u01a1ng t\u1ef1, khi g\u00f5 ph\u1ea3n x\u1ea1 g\u00e2n c\u01a1 chi \u0111ong \u0111\u01b0a r\u1ea5t nhi\u1ec1u m\u1eb7c d\u00f9 s\u1ee9c c\u01a1 hay ch\u00ednh ph\u1ea3n x\u1ea1 kh\u00f4ng t\u0103ng (pendular reflexes).<\/p>\n<h3>2.7. Hi\u1ec7n t\u01b0\u1ee3ng d\u1ed9i<\/h3>\n<p>Khi cho co c\u01a1 ch\u1ed1ng l\u1ea1i kh\u00e1ng l\u1ef1c r\u1ed3i th\u1ea3 ra, c\u01a1 \u0111\u1ed1i kh\u00e1ng kh\u00f4ng ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c v\u1eadn \u0111\u1ed9ng v\u00e0 gi\u00e3n c\u01a1 kh\u00f4ng \u0111\u01b0\u1ee3c b\u00f9 tr\u1eeb t\u1ea1o hi\u1ec7n t\u01b0\u1ee3ng d\u1ed9i ng\u01b0\u1ee3c c\u1ee7a chi (d\u1ea5u Stewart- Holmes).<\/p>\n<p>Ngu\u1ed3n tham kh\u1ea3o: <em>Th\u1ea7n kinh h\u1ecdc- \u0110H Y TP H\u1ed3 Ch\u00ed Minh<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>D\u1ea5u hi\u1ec7u quan tr\u1ecdng c\u1ee7a b\u1ec7nh l\u00fd ti\u1ec3u n\u00e3o l\u00e0 th\u1ea5t \u0111i\u1ec1u (ataxia). Th\u1ea5t \u0111i\u1ec1u ti\u1ec3u n\u00e3o \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a nh\u01b0 m\u1ea5t v\u1eadn \u0111\u1ed9ng ch\u00ednh x\u00e1c hay r\u1ed1i lo\u1ea1n ph\u1ed1i h\u1ee3p (kh\u00f4ng do li\u1ec7t), thay \u0111\u1ed5i tr\u01b0\u01a1ng l\u1ef1c c\u01a1, m\u1ea5t c\u1ea3m gi\u00e1c t\u01b0 th\u1ebf hay s\u1ef1 hi\u1ec7n di\u1ec7n v\u1eadn \u0111\u1ed9ng kh\u00f4ng t\u1ef1 ch\u1ee7. Th\u1ea5t \u0111i\u1ec1u [&hellip;]<\/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":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>C\u00e1c nghi\u1ec7m ph\u00e1p kh\u00e1m th\u1ea5t \u0111i\u1ec1u ti\u1ec3u n\u00e3o - Vinmec<\/title>\n<meta name=\"description\" content=\"D\u1ea5u hi\u1ec7u quan tr\u1ecdng c\u1ee7a b\u1ec7nh l\u00fd ti\u1ec3u n\u00e3o l\u00e0 th\u1ea5t \u0111i\u1ec1u (ataxia). Th\u1ea5t \u0111i\u1ec1u ti\u1ec3u n\u00e3o \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a nh\u01b0 m\u1ea5t v\u1eadn \u0111\u1ed9ng ch\u00ednh x\u00e1c hay r\u1ed1i lo\u1ea1n...\" \/>\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=\"C\u00e1c nghi\u1ec7m ph\u00e1p kh\u00e1m th\u1ea5t \u0111i\u1ec1u ti\u1ec3u n\u00e3o - Vinmec\" \/>\n<meta property=\"og:description\" content=\"D\u1ea5u hi\u1ec7u quan tr\u1ecdng c\u1ee7a b\u1ec7nh l\u00fd ti\u1ec3u n\u00e3o l\u00e0 th\u1ea5t \u0111i\u1ec1u (ataxia). 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