{"id":28785,"date":"2023-04-27T17:32:16","date_gmt":"2023-04-27T10:32:16","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=28785"},"modified":"2023-04-27T17:32:16","modified_gmt":"2023-04-27T10:32:16","slug":"cac-benh-ly-tieu-nao-thuong-gap","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/27\/cac-benh-ly-tieu-nao-thuong-gap\/","title":{"rendered":"C\u00e1c b\u1ec7nh l\u00fd ti\u1ec3u n\u00e3o th\u01b0\u1eddng g\u1eb7p"},"content":{"rendered":"

T\u00ecm hi\u1ec3u v\u1ec1 c\u00e1c b\u1ec7nh l\u00fd ti\u1ec3u n\u00e3o th\u01b0\u1eddng g\u1eb7p l\u00e0 r\u1ea5t quan tr\u1ecdng trong vi\u1ec7c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh. Ti\u1ec3u n\u00e3o l\u00e0 m\u1ed9t ph\u1ea7n quan tr\u1ecdng c\u1ee7a h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng v\u00e0 c\u00f3 vai tr\u00f2 quan tr\u1ecdng trong vi\u1ec7c \u0111i\u1ec1u ch\u1ec9nh v\u00e0 \u0111i\u1ec1u ph\u1ed1i c\u00e1c ch\u1ee9c n\u0103ng c\u1ee7a c\u01a1 th\u1ec3. T\u00ecm hi\u1ec3u v\u1ec1 c\u00e1c b\u1ec7nh l\u00fd ti\u1ec3u n\u00e3o th\u01b0\u1eddng g\u1eb7p 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. \u0110\u1ed1i v\u1edbi m\u1ed9t s\u1ed1 b\u1ec7nh l\u00fd ti\u1ec3u n\u00e3o nh\u01b0 \u0111\u1ed9t qu\u1ef5, \u0111i\u1ec1u tr\u1ecb th\u1eddi gian l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 gi\u1ea3m thi\u1ec3u t\u1ed5n th\u01b0\u01a1ng n\u00e3o v\u00e0 t\u0103ng kh\u1ea3 n\u0103ng ph\u1ee5c h\u1ed3i c\u1ee7a b\u1ec7nh nh\u00e2n. D\u01b0\u1edbi \u0111\u00e2y l\u00e0 m\u1ed9t s\u1ed1 b\u1ec7nh l\u00fd ti\u1ec3u n\u00e3o th\u01b0\u1eddng g\u1eb7p tr\u00ean l\u00e2m s\u00e0ng.<\/strong><\/p>\n

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T\u00ecm hi\u1ec3u v\u1ec1 c\u00e1c b\u1ec7nh l\u00fd ti\u1ec3u n\u00e3o th\u01b0\u1eddng g\u1eb7p l\u00e0 r\u1ea5t quan tr\u1ecdng trong vi\u1ec7c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh<\/figcaption><\/figure>\n

1. Tai bi\u1ebfn m\u1ea1ch m\u00e1u ti\u1ec3u n\u00e3o<\/strong><\/h2>\n

1.1. Nh\u1ed3i m\u00e1u ti\u1ec3u n\u00e3o<\/strong><\/h3>\n

Ti\u1ec3u n\u00e3o do 3 \u0111\u1ed9ng m\u1ea1ch cung c\u1ea5p m\u00e1u: \u0111\u1ed9ng m\u1ea1ch ti\u1ec3u n\u00e3o tr\u00ean, \u0111\u1ed9ng m\u1ea1ch ti\u1ec3u n\u00e3o tr\u01b0\u1edbc d\u01b0\u1edbi v\u00e0 \u0111\u1ed9ng m\u1ea1ch ti\u1ec3u n\u00e3o sau d\u01b0\u1edbi. V\u00f9ng t\u01b0\u1edbi m\u00e1u c\u1ee7a nh\u1eefng \u0111\u1ed9ng m\u1ea1ch n\u00e0y kh\u00e1c nhau r\u1ea5t l\u1edbn, kh\u00e1c nhau gi\u1eefa ng\u01b0\u1eddi n\u00e0y v\u1edbi ng\u01b0\u1eddi kh\u00e1c v\u00e0 ngay c\u1ea3 trong m\u1ed9t ng\u01b0\u1eddi s\u1ef1 cung c\u1ea5p m\u00e1u nu\u00f4i \u1edf hai b\u00ean c\u0169ng kh\u00e1c nhau. Cu\u1ed1ng ti\u1ec3u n\u00e3o tr\u00ean, gi\u1eefa v\u00e0 d\u01b0\u1edbi l\u1ea7n l\u01b0\u1ee3t do \u0111\u1ed9ng m\u1ea1ch ti\u1ec3u n\u00e3o tr\u00ean, tr\u01b0\u1edbc d\u01b0\u1edbi v\u00e0 sau d\u01b0\u1edbi cung c\u1ea5p.<\/span><\/p>\n

Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng g\u1ed3m c\u00f3 \u0111au \u0111\u1ea7u, bu\u1ed3n n\u00f4n, n\u00f4n, ch\u00f3ng m\u1eb7t, rung gi\u1eadt nh\u00e3n c\u1ea7u, n\u00f3i kh\u00f3, li\u1ec7t ch\u1ee9c n\u0103ng nh\u00ecn hay li\u1ec7t v\u1eadn nh\u00e3n, h\u1ec7t m\u1eb7t hay m\u1ea5t c\u1ea3m gi\u00e1c v\u00e0 li\u1ec7t n\u1eeda th\u00e2n \u0111\u1ed1i b\u00ean c\u00f3 th\u1ec3 x\u1ea3y ra. Th\u00e2n n\u00e3o b\u1ecb nh\u1ed3i m\u00e1u hay b\u1ecb ch\u00e8n \u00e9p do ph\u00f9 ti\u1ec3u n\u00e3o c\u00f3 th\u1ec3 g\u00e2y h\u00f4n m\u00ea v\u00e0 t\u1eed vong. Ch\u1ea9n \u0111o\u00e1n nh\u1ed3i m\u00e1u ti\u1ec3u n\u00e3o b\u1eb1ng CT hay MRI n\u00ean th\u1ef1c hi\u1ec7n ng\u00e0y cho ph\u00e9p ph\u00e2n bi\u1ec7t xu\u1ea5t huy\u1ebft v\u00e0 nh\u1ed3i m\u00e1u. Khi c\u00f3 ch\u00e8n \u00e9p th\u00e2n n\u00e3o, ph\u1eabu thu\u1eadt gi\u1ea3i \u00e9p c\u00f3 th\u1ec3 c\u1ee9u s\u1ed1ng b\u1ec7nh nh\u00e2n.<\/span><\/p>\n

1.2. Xu\u1ea5t huy\u1ebft ti\u1ec3u n\u00e3o<\/strong><\/h3>\n

Nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p l\u00e0 cao huy\u1ebft \u00e1p, \u00edt g\u1eb7p h\u01a1n l\u00e0 do d\u00f9ng kh\u00e1ng \u0111\u00f4ng, d\u1ecb d\u1ea1ng m\u1ea1ch m\u00e1u, r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u, u v\u00e0 ch\u1ea5n th\u01b0\u01a1ng. Xu\u1ea5t huy\u1ebft do cao huy\u1ebft \u00e1p kh\u1edfi \u0111\u1ea7u \u0111\u1ed9t ng\u1ed9t \u0111au \u0111\u1ea7u, c\u00f3 khi k\u00e8m bu\u1ed3n n\u00f4n, n\u00f4n, ch\u00f3ng m\u1eb7t, th\u1ea5t \u0111i\u1ec1u t\u01b0 th\u1ebf. Thay \u0111\u1ed5i tri gi\u00e1c th\u01b0\u1eddng mu\u1ed9n h\u01a1n, l\u00fac \u0111\u1ea7u t\u1ec9nh sau \u0111\u00f3 l\u00fa l\u1eabn v\u00e0 h\u00f4n m\u00ea, c\u00f3 th\u1ec3 c\u00f3 c\u00fang g\u00e1y.<\/span><\/p>\n

Trong giai \u0111o\u1ea1n mu\u1ed9n, xu\u1ea5t hi\u1ec7n d\u1ea5u hi\u1ec7u ch\u00e8n \u00e9p v\u00e0o th\u00e2n n\u00e3o: \u0111\u1ed3ng t\u1eed th\u01b0\u1eddng c\u00f3 nh\u1ecf, li\u1ec7t ch\u1ee9c n\u0103ng nh\u00ecn c\u00f9ng b\u00ean (h\u01b0\u1edbng nh\u00ecn \u0111\u1ed1i b\u00ean xu\u1ea5t huy\u1ebft) v\u00e0 li\u1ec7t m\u1eb7t c\u00f9ng b\u00ean, li\u1ec7t chi ki\u1ec3u b\u00f3 th\u00e1p v\u00e0 c\u00f3 d\u1ea5u Babinski hai b\u00ean. D\u1ecbch n\u00e3o t\u1ee7y th\u01b0\u1eddng c\u00f3 m\u00e1u, ch\u1ecdc d\u00f2 d\u1ecbch n\u00e3o t\u1ee7y c\u00f3 th\u1ec3 g\u00e2y t\u1ee5t n\u00e3o. Ph\u01b0\u01a1ng ph\u00e1p \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n l\u00e0 ch\u1ee5p CT n\u00e3o. \u0110i\u1ec1u tr\u1ecb b\u1eb1ng ch\u1ecdc h\u00fat m\u00e1u t\u1ee5 c\u00f3 th\u1ec3 c\u1ee9u s\u1ed1ng b\u1ec7nh nh\u00e2n.<\/span><\/p>\n

2. Vi\u00eam ti\u1ec3u n\u00e3o<\/strong><\/h2>\n

Vi\u00eam nhi\u1ec5m c\u1ea5p ti\u1ec3u n\u00e3o do nhi\u1ec5m tr\u00f9ng hay c\u01a1 ch\u1ebf t\u1ef1 mi\u1ec5n. Th\u1ea5t \u0111i\u1ec1u ti\u1ec3u n\u00e3o do nhi\u1ec5m si\u00eau vi l\u00e0 bi\u1ec3u hi\u1ec7n ch\u00ednh c\u1ee7a vi\u00eam n\u00e3o Saint Louis<\/a>, vi\u00eam n\u00e3o-m\u00e0ng n\u00e3o do th\u1ee7y \u0111\u1eadu, quai b\u1ecb, s\u1ed1t b\u1ea1i li\u1ec7t, nhi\u1ec5m tr\u00f9ng \u0111\u01a1n nh\u00e2n. Nhi\u1ec5m tr\u00f9ng ti\u1ec3u n\u00e3o \u00edt g\u1eb7p, 10-20% \u00e1p xe n\u00e3o khu tr\u00fa \u1edf ti\u1ec3u n\u00e3o. Th\u1ea5t \u0111i\u1ec1u ti\u1ec3u n\u00e3o x\u1ea3y ra sau s\u1ed1t cao c\u1ea5p t\u00ednh hay sau ch\u1ee7ng ng\u1eeba \u0111\u01b0\u1ee3c quy cho ngu\u1ed3n g\u1ed1c t\u1ef1 mi\u1ec5n.<\/span><\/p>\n

3. Th\u1ea5t \u0111i\u1ec1u ti\u1ec3u n\u00e3o c\u1ea5p \u1edf tr\u1ebb em<\/strong><\/h2>\n
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  • H\u1ed9i ch\u1ee9ng th\u1ea5t \u0111i\u1ec1u ti\u1ec3u n\u00e3o n\u1eb7ng n\u1ec1, h\u1ed3i ph\u1ee5c ho\u00e0n to\u00e0n trong v\u00f2ng nhi\u1ec1u th\u00e1ng, th\u01b0\u1eddng sau nhi\u1ec5m si\u00eau vi c\u1ea5p hay ch\u1ee7ng ng\u1eeba.<\/span><\/li>\n
  • Vi\u00eam n\u00e3o t\u1ee7y c\u1ea5p lan t\u1ecfa<\/span><\/li>\n
  • C\u00f3 th\u1ec3 g\u00e2y m\u1ea5t myelin v\u00e0 vi\u00eam nhi\u1ec5m trong ch\u1ea5t tr\u1eafng ti\u1ec3u n\u00e3o, th\u01b0\u1eddng k\u1ebft h\u1ee3p c\u00e1c tri\u1ec7u ch\u1ee9ng thay \u0111\u1ed5i tri gi\u00e1c, co gi\u1eadt, d\u1ea5u th\u1ea7n kinh khu tr\u00fa hay b\u1ec7nh l\u00fd t\u1ee7y s\u1ed1ng.<\/span><\/li>\n<\/ul>\n

    4. Th\u1ec3 Fisher(bi\u1ebfn th\u1ec3 h\u1ed9i ch\u1ee9ng Guillain-Barr\u00e9)<\/strong><\/h2>\n

    Th\u1ea5t \u0111i\u1ec1u \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn d\u00e1ng \u0111i v\u00e0 th\u00e2n, \u00edt \u1ea3nh h\u01b0\u1edfng chi, n\u00f3i kh\u00f3 \u00edt g\u1eb7p. Th\u1ea5t \u0111i\u1ec1u ti\u1ec3u n\u00e3o, li\u1ec7t v\u1eadn nh\u00e3n, m\u1ea5t ph\u1ea3n x\u1ea1 g\u00e2n c\u01a1 ti\u1ebfn tri\u1ec3n trong v\u00e0i ng\u00e0y, th\u00f4ng th\u01b0\u1eddng t\u0103ng d\u1ea7n v\u00e0 h\u1ed3i ph\u1ee5c ho\u00e0n to\u00e0n trong v\u00e0i tu\u1ea7n \u0111\u1ebfn v\u00e0i th\u00e1ng. D\u1ecbch n\u00e3o t\u1ee7y ph\u00e2n ly \u0111\u1ea1m t\u1ebf b\u00e0o.<\/span><\/p>\n

    5. \u00c1p xe ti\u1ec3u n\u00e3o<\/strong><\/h2>\n

    Th\u01b0\u1eddng kh\u1edfi \u0111\u1ea7u v\u1edbi tri\u1ec7u ch\u1ee9ng \u0111au v\u00f9ng sau tai v\u00e0 d\u01b0\u1edbi ch\u0169m, c\u1ed5 th\u1ec3 do vi\u00eam t\u1ebf b\u00e0o ch\u0169m. Rung gi\u1eadt nh\u00e3n c\u1ea7u, li\u1ec7t nh\u00ecn ngang v\u1ec1 b\u00ean t\u1ed5n th\u01b0\u01a1ng. Th\u1ea5t \u0111i\u1ec1u ti\u1ec3u n\u00e3o \u1edf chi, th\u00e2n c\u00f9ng b\u00ean, th\u01b0\u1eddng g\u1eb7p th\u1ea5t \u0111i\u1ec1u d\u00e1ng \u0111i. R\u1ea5t kh\u00f3 \u0111\u00e1nh gi\u00e1 th\u1ea5t \u0111i\u1ec1u \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng ng\u1ed3i d\u1eady hay \u0111i l\u1ea1i \u0111\u01b0\u1ee3c. Tri\u1ec7u ch\u1ee9ng t\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd chi\u1ebfm \u01b0u th\u1ebf trong \u00e1p xe ti\u1ec3u n\u00e3o, d\u1ea5u hi\u1ec7u b\u00f3 th\u00e1p \u0111\u1ed1i b\u00ean hay hai b\u00ean do ch\u00e8n \u00e9p th\u00e2n n\u00e3o hay gi\u00e3n n\u00e3o th\u1ea5t Trong giai \u0111o\u1ea1n mu\u1ed9n, b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 m\u1ea5t \u00fd th\u1ee9c do ch\u00e8n \u00e9p ph\u1ea7n tr\u00ean th\u00e2n n\u00e3o. S\u1ed1t th\u01b0\u1eddng g\u1eb7p trong giai \u0111o\u1ea1n x\u00e2m l\u1ea5n c\u1ee7a \u00e1p xe v\u00e0 tr\u1edf v\u1ec1 b\u00ecnh th\u01b0\u1eddng khi \u00e1p xe c\u00f3 v\u1ecf b\u1ecdc.<\/span><\/p>\n

    Ch\u1ea9n \u0111o\u00e1n \u00e1p xe ti\u1ec3u n\u00e3o d\u1ef1a tr\u00ean h\u00ecnh \u1ea3nh CT c\u00f3 c\u1ea3n quang hay MRI c\u00f3 c\u1ea3n t\u1eeb.<\/span><\/p>\n

    \u0110i\u1ec1u tr\u1ecb trong giai \u0111o\u1ea1n vi\u00eam nung m\u1ee7: Penicillin G 20-24 tri\u1ec7u \u0111\u01a1n v\u1ecb, Chloramphenicol 4-6 gam hay Metronidazol 15mg\/kg ti\u1ebfp theo 7,5mg\/kg m\u1ed7i 6 gi\u1edd, Metronidazol h\u1ea5p thu qua \u0111\u01b0\u1eddng ru\u1ed9t t\u1ed1t c\u00f3 th\u1ec3 u\u1ed1ng 500mg m\u1ed7i 6 gi\u1edd. <\/span>Vancomycin ho\u1eb7c Cephalosporin th\u1ebf h\u1ec7 3 hay 4. T\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd \u0111e d\u1ecda t\u1ee5t n\u00e3o \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb Mannitol ho\u1eb7c Dexamethasone 6-12mg m\u1ed7i 6 gi\u1edd. Ch\u1ecdc h\u00fat hay b\u00f3c t\u00e1ch \u1ed5 \u00e1p xe t\u00f9y thu\u1ed9c v\u1ecb tr\u00ed, di\u1ec5n ti\u1ebfn l\u00e2m s\u1ea3ng, m\u1ee9c \u0111\u1ed9 c\u1ee7a hi\u1ec7u \u1ee9ng cho\u00e1n ch\u1ed7 v\u00e0 ph\u00f9 xung quanh.<\/span><\/p>\n

    6. U ti\u1ec3u n\u00e3o<\/strong><\/h2>\n

    U ti\u1ec3u n\u00e3o th\u01b0\u1eddng g\u1eb7p \u1edf tr\u1ebb con l\u00e0 u t\u1ebf b\u00e0o sao v\u00e0 u nguy\u00ean t\u1ee7y b\u00e0o; ung th\u01b0 di c\u0103n ti\u1ec3u n\u00e3o th\u01b0\u1eddng g\u1eb7p \u1edf ng\u01b0\u1eddi l\u1edbn. B\u1ec7nh nh\u00e2n c\u00f3 u ti\u1ec3u n\u00e3o th\u01b0\u1eddng c\u00f3 \u0111au \u0111\u1ea7u do t\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd hay th\u1ea5t \u0111i\u1ec1u, bu\u1ed3n n\u00f4n, n\u00f4n, ch\u00f3ng m\u1eb7t, li\u1ec7t d\u00e2y s\u1ecd v\u00e0 tr\u00e0n d\u1ecbch n\u00e3o th\u1ea5t. H\u1ea7u <\/span>h\u1ebft u di c\u0103n \u1edf b\u00e1n c\u1ea7u, t\u00e1i l\u1ea1i u nguy\u00ean t\u1ee7y b\u00e0o v\u00e0 u \u1ed1ng n\u1ed9i t\u1ee7y th\u01b0\u1eddng ph\u00e1t sinh \u1edf \u0111\u01b0\u1eddng gi\u1eefa g\u00e2y tri\u1ec7u ch\u1ee9ng th\u00f9y giun v\u00e0 tr\u00e0n d\u1ecbch n\u00e3o th\u1ea5t, u di c\u0103n ti\u1ec3u n\u00e3o th\u01b0\u1eddng <\/span>xu\u1ea5t ph\u00e1t t\u1eeb ph\u1ed5i hay v\u00fa. Ti\u00ean l\u01b0\u1ee3ng x\u1ea5u h\u01a1n nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 t\u1ed5n th\u01b0\u01a1ng tr\u00ean l\u1ec1u.<\/span><\/p>\n

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    • U t\u1ebf b\u00e0o gai th\u01b0\u1eddng x\u1ea3y ra \u1edf ng\u01b0\u1eddi tr\u1ebb t\u1eeb 2-20 tu\u1ed5i, th\u01b0\u1eddng l\u00e0nh t\u00ednh v\u00e0 c\u00f3 nang. <\/span><\/li>\n
    • U sao <\/span>b\u00e0o th\u01b0\u1eddng c\u00f3 khuynh h\u01b0\u1edbng h\u00f3a \u00e1c cao, lan r\u1ed9ng qua khoang d\u01b0\u1edbi nh\u1ec7n, n\u00e3o th\u1ea5t v\u00e0 c\u00f3 th\u1ec3 di c\u0103n ngo\u00e0i h\u1ec7 th\u1ea7n kinh.<\/span><\/li>\n
    • U n\u00e3o h\u1ed1 sau g\u00e2y tri\u1ec7u ch\u1ee9ng ti\u1ec3u n\u00e3o khi ch\u00fang ph\u00e1t tri\u1ec3n hay ch\u00e8n \u00e9p v\u00e0o ti\u1ec3u <\/span>n\u00e3o.<\/span><\/li>\n
    • U d\u00e2y th\u1ea7n kinh th\u00ednh gi\u00e1c c\u00f3 th\u1ec3 ch\u00e8n \u00e9p b\u00e1n c\u1ea7u ti\u1ec3u n\u00e3o c\u00f9ng b\u00ean g\u00e2y th\u1ea5t \u0111i\u1ec1u.<\/span><\/li>\n
    • n\u1eeda th\u00e2n k\u00e8m tri\u1ec7u ch\u1ee9ng s\u1edbm l\u00e0 ch\u00f3ng m\u1eb7t v\u00e0 gi\u1ea3m th\u00ednh l\u1ef1c. u l\u00e0nh t\u00ednh v\u00e0 th\u01b0\u1eddng c\u1eaft b\u1ecf \u0111\u01b0\u1ee3c to\u00e0n b\u1ed9.<\/span><\/li>\n
    • U nguy\u00ean b\u00e0o m\u1ea1ch m\u00e1u hi\u1ebfm g\u1eb7p th\u01b0\u1eddng \u1edf ng\u01b0\u1eddi l\u1edbn, c\u00f3 th\u1ec3 \u0111\u01a1n \u0111\u1ed9c hay g\u1eb7p trong b\u1ec7nh Von Hippel- Lindau bao g\u1ed3m u nguy\u00ean b\u00e0o m\u1ea1ch m\u00e1u \u1edf v\u00f5ng m\u1ea1c, nang th\u1eadn, t\u1ee5y hay n\u1ed9i t\u1ea1ng kh\u00e1c v\u00e0 t\u0103ng \u0111\u1ed9 nh\u1edbt m\u00e1u.<\/span><\/li>\n
    • U m\u00e0ng n\u00e3o h\u1ed1 sau u l\u00e0nh t\u00ednh ph\u00e1t sinh t\u1eeb t\u1ebf b\u00e0o m\u00e0ng nh\u1ec7n ch\u00e8n \u00e9p ti\u1ec3u n\u00e3o. U <\/span>ph\u00e1t tri\u1ec3n ch\u1eadm, th\u01b0\u1eddng g\u00e2y \u0111au \u0111\u1ea7u, ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf ho\u00e0n to\u00e0n s\u1ebd cho k\u1ebft qu\u1ea3 t\u1ed1t.<\/span><\/li>\n
    • U \u1ed1ng n\u1ed9i t\u1ee7y h\u1ea7u h\u1ebft ph\u00e1t sinh t\u01b0 th\u00e0nh hay \u0111\u00e1m r\u1ed1i m\u1ea1ng m\u1ea1ch c\u1ee7a n\u00e3o th\u1ea5t b\u1ed1n, gi\u1ed1ng nh\u01b0 u nguy\u00ean t\u1ee7y b\u00e0o l\u00e0 u \u00e1c v\u00e0 th\u01b0\u1eddng \u1edf tr\u1ebb em. Do v\u1ecb tr\u00ed kh\u1ed1i u n\u00ean g\u00e2y tr\u00e0n d\u1ecbch n\u00e3o th\u1ea5t s\u1edbm.<\/span><\/li>\n<\/ul>\n

      7. Th\u1ea5t \u0111i\u1ec1u ti\u1ec3u n\u00e3o di truy\u1ec1n<\/strong><\/h2>\n

      7.1. Th\u1ea5t \u0111i\u1ec1u t\u1ee7y s\u1ed1ng ti\u1ec3u n\u00e3o d i truy\u1ec1n<\/strong><\/h3>\n

      Th\u1ea5t \u0111i\u1ec1u di truy\u1ec1n c\u00f3 \u0111\u1eb7c \u0111i\u1ec3m l\u00e0 th\u1ea5t \u0111i\u1ec1u ti\u1ec3u n\u00e3o di\u1ec5n bi\u1ebfn t\u1eeb t\u1eeb, \u1ea3nh h\u01b0\u1edfng d\u00e1ng \u0111i s\u1edbm, c\u00e1c r\u1ed1i lo\u1ea1n n\u00e0y kh\u00e1c nhau v\u1ec1 l\u00e2m s\u00e0ng r\u1ea5t nhi\u1ec1u. Th\u1ea5t \u0111i\u1ec1u t\u1ee7y s\u1ed1ng ti\u1ec3u n\u00e3o nhi\u1ec5m s\u1eafc th\u1ec3 \u0111\u1ecbnh h\u00ecnh t\u00ednh tr\u1ed9i kh\u1ecfi b\u1ec7nh tu\u1ed5i tr\u01b0\u1edfng th\u00e0nh, di truy\u1ec1n d\u1ecb h\u1ee3p t\u1eed.<\/span><\/p>\n

      7.2. Th\u1ea5t \u0111i\u1ec1u Friedreich<\/strong><\/h3>\n

      Ch\u1ec9 g\u1eb7p \u1edf tr\u1ebb con, di truy\u1ec1n qua gen l\u1eb7n, lo\u1ea1i \u0111\u1ed9t bi\u1ebfn m\u1ea5t ch\u1ee9c n\u0103ng, h\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n \u0111\u1ed3ng h\u1ee3p t\u1eed. T\u1ed5n th\u01b0\u01a1ng \u1edf t\u1ee7y s\u1ed1ng g\u1ed3m tho\u00e1i h\u00f3a b\u00f3 t\u1ee7y s\u1ed1ng ti\u1ec3u n\u00e3o, c\u1ed9t sau <\/span>v\u00e0 r\u1ec5 sau, suy gi\u1ea3m t\u1ebf b\u00e0o th\u1ea7n kinh trung \u01b0\u01a1ng c\u1ed9t Clarke, tho\u00e1i h\u00f3a myelin c\u1ee7a d\u00e2y th\u1ea7n kinh ngo\u1ea1i bi\u00ean, t\u1ebf b\u00e0o c\u1ea3m gi\u00e1c h\u1ea1ch sau.<\/span><\/p>\n

      Tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng kh\u1edfi \u0111\u1ea7u t\u1eeb 8 \u0111\u1ebfn 15 tu\u1ed5i nh\u01b0ng c\u0169ng c\u00f3 th\u1ec3 s\u1edbm ho\u1eb7c mu\u1ed9n h\u01a1n. B\u1ec7nh nh\u00e2n th\u1ea5t \u0111i\u1ec1u d\u00e1ng \u0111i theo sau th\u1ea5t \u0111i\u1ec1u chi; m\u1ea5t ph\u1ea3n x\u1ea1 g\u1ed1i v\u00e0 g\u00f3t, n\u00f3i kh\u00f3, y\u1ebfu c\u01a1, v\u1eb9o c\u1ed9t s\u1ed1ng l\u00e0 h\u00ecnh \u1ea3nh \u0111\u1eb7c tr\u01b0ng. C\u00e1c tri\u1ec7u ch\u1ee9ng \u00edt g\u1eb7p l\u00e0 gi\u1eadt nh\u00e3n c\u1ea7u, b\u00e0n ch\u00e2n qu\u1eb7p, teo d\u00e2y th\u1ecb, d\u1ecb c\u1ea3m, run, ch\u00f3ng m\u1eb7t v\u00e0 \u0111i\u1ebfc. C\u1ea3m gi\u00e1c v\u1ecb tr\u00ed kh\u1edbp v\u00e0 rung \u00e2m thoa gi\u1ea3m \u1edf ch\u00e2n, gi\u1ea3m c\u1ea3m gi\u00e1c s\u1edd n\u00f4ng, \u0111au nhi\u1ec7t \u00edt g\u1eb7p. G\u00f9 v\u1eb9o c\u1ed9t s\u1ed1ng n\u1eb7ng c\u00f3 th\u1ec3 d\u1eabn t\u1edbi t\u00e0n ph\u1ebf, t\u1eafc ngh\u1ebdn ph\u1ed5i m\u00e3n t\u00ednh, b\u1ec7nh c\u01a1 tim c\u00f3 th\u1ec3 g\u00e2y suy tim \u1ee9 huy\u1ebft.<\/span><\/p>\n

      Kh\u00f4ng c\u00f3 \u0111i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u, ch\u1ec9nh h\u00ecnh bi\u1ebfn d\u1ea1ng d b\u00e0n ch\u00e2n, tri\u1ec7u ch\u1ee9ng x\u1ea5u d\u1ea7n b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111i l\u1ea1i \u0111\u01b0\u1ee3c sau 5 n\u0103m, th\u1eddi gian trung b\u00ecnh c\u1ee7a b\u1ec7nh kho\u1ea3ng 25 n\u0103m.<\/span><\/p>\n

      8. C\u00e1c b\u1ec7nh l\u00fd kh\u00e1c<\/strong><\/h2>\n

      – X\u01a1 c\u1ee9ng r\u1ea3i r\u00e1c: ti\u1ec3u n\u00e3o, cu\u1ed1ng ti\u1ec3u n\u00e3o, th\u00e2n n\u00e3o c\u00f3 nh\u1eefng v\u00f9ng m\u1ea5t myelin \u1edf ch\u1ea5t r\u1eafn. D\u1ea5u hi\u1ec7u ti\u1ec3u n\u00e3o c\u00f3 \u1edf 1\/3 b\u1ec7nh nh\u00e2n khi kh\u00e1m l\u1ea7n \u0111\u1ea7u ti\u00ean, th\u1ea5t \u0111i\u1ec1u d\u00e1ng \u0111i g\u1eb7p 10-15%, th\u1ea5t \u0111i\u1ec1u chi th\u01b0\u1eddng c\u00f3 2 b\u00ean, rung gi\u1eadt nh\u00e3n c\u1ea7u c\u00f3 th\u1ec3 \u0111\u01a1n \u0111\u1ed9c hay \u0111i k\u00e8m c\u00e1c d\u1ea5u hi\u1ec7u ti\u1ec3u n\u00e3o kh\u00e1c, n\u00f3i kh\u00f3 c\u0169ng th\u01b0\u1eddng x\u1ea3y ra. X\u01a1 c\u1ee9ng r\u1ea3i r\u00e1c \u1ea3nh h\u01b0\u1edfng nhi\u1ec1u n\u01a1i trong h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng. Trong b\u1ec7nh s\u1eed c\u00e1c d\u1ea5u hi\u1ec7u th\u1ea7n kinh c\u00f3 th\u1ec3 h\u1ed3i ph\u1ee5c v\u00e0 t\u00e1i ph\u00e1t. X\u00e9t nghi\u1ec7m d\u1ecbch n\u00e3o t\u1ee7y c\u00f3 d\u1ea3i oligoclonal, IgG t\u0103ng, protein t\u0103ng, t\u1ebf b\u00e0o lympho t\u0103ng nh\u1eb9. \u0110i\u1ec7n th\u1ebf g\u1ee3i th\u1ecb gi\u00e1c, th\u00ednh gi\u00e1c, c\u1ea3m gi\u00e1c c\u00f3 th\u1ec3 th\u1ea5y t\u1ed5n th\u01b0\u01a1ng nhi\u1ec1u n\u01a1i. CT, MRI ghi nh\u1eadn v\u00f9ng m\u1ea5t myelin.<\/span><\/p>\n

      – Tho\u00e1i h\u00f3a ti\u1ec3u n\u00e3o do r\u01b0\u1ee3u: x\u1ea3y ra \u1edf ng\u01b0\u1eddi nghi\u1ec7n r\u01b0\u1ee3u m\u1ea1n t\u00ednh, ti\u1ec1n s\u1eed u\u1ed1ng r\u01b0\u1ee3u tr\u00ean 10 n\u0103m, ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng kh\u00f4ng \u0111\u1ea7y \u0111\u1ee7 k\u00e8m nh\u1eefng bi\u1ebfn ch\u1ee9ng do r\u01b0\u1ee3u kh\u00e1c nh\u01b0 b\u1ec7nh gan, s\u1ea3ng r\u01b0\u1ee3u, b\u1ec7nh n\u00e3o Wernicke hay b\u1ec7nh \u0111a d\u00e2y th\u1ea7n kinh. Tho\u00e1i h\u00f3a ti\u1ec3u n\u00e3o khu tr\u00fa ph\u1ea7n tr\u00ean th\u00f9y giun, th\u1ea5t \u0111i\u1ec1u th\u01b0\u1eddng \u00e2m \u1ec9 ti\u1ebfn tri\u1ec3n d\u1ea7n d\u1ea7n, th\u1ea5t \u0111i\u1ec1u d\u00e1ng \u0111i, hai ch\u00e2n c\u0169ng b\u1ecb th\u1ea5t \u0111i\u1ec1u, d\u1ea5u hi\u1ec7u th\u01b0\u1eddng g\u1eb7p k\u00e8m theo l\u00e0 r\u1ed1i lo\u1ea1n c\u1ea3m gi\u00e1c \u1edf b\u00e0n ch\u00e2n, m\u1ea5t ph\u1ea3n x\u1ea1 g\u00f3t do b\u1ec7nh \u0111a d\u00e2y th\u1ea7n kinh. \u00cdt g\u1eb7p h\u01a1n l\u00e0 th\u1ea5t \u0111i\u1ec1u \u1edf tay, rung gi\u1eadt nh\u00e3n c\u1ea7u, n\u00f3i kh\u00f3, gi\u1ea3m tr\u01b0\u01a1ng l\u1ef1c. CT v\u00e0 MRI c\u00f3 th\u1ec3 th\u1ea5y teo ti\u1ec3u n\u00e3o. Kh\u00f4ng \u00a0 \u0111i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u. Tuy nhi\u00ean t\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n \u0111\u1ec1u ph\u1ea3i cho thiamine, b\u1ecf r\u01b0\u1ee3u, nu\u00f4i d\u01b0\u1ee1ng \u0111\u1ea7y \u0111\u1ee7 gi\u00fap \u1ed5n \u0111\u1ecbnh trong nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p.<\/span><\/p>\n

      – Th\u1ea5t \u0111i\u1ec1u ti\u1ec3u n\u00e3o m\u00e3n t\u00ednh kh\u1edfi \u0111\u1ea7u \u1edf tu\u1ed5i tr\u01b0\u1edfng th\u00e0nh, \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn d\u00e1ng \u0111i c\u00f2n g\u1eb7p trong thi\u1ec3u n\u0103ng Tuy\u1ebfn gi\u00e1p, h\u1ed9i ch\u1ee9ng c\u1eadn ung th\u01b0, tho\u00e1i h\u00f3a ti\u1ec3u n\u00e3o kh\u00f4ng r\u00f5 nguy\u00ean do v\u00e0 b\u1ea5t th\u01b0\u1eddng \u1edf kh\u1edbp s\u1ecd-c\u1ed9t s\u1ed1ng c\u1ed5 nh\u01b0 d\u1ecb d\u1ea1ng Arnold – Chiari v\u00e0 tho\u00e1i h\u00f3a ti\u1ec3u n\u00e3o do thu\u1ed1c phenytoin.<\/span><\/p>\n

      \u00a0Ngu\u1ed3n tham kh\u1ea3o: Th\u1ea7n kinh h\u1ecdc- \u0110H Y TP H\u1ed3 Ch\u00ed Minh<\/em><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

      T\u00ecm hi\u1ec3u v\u1ec1 c\u00e1c b\u1ec7nh l\u00fd ti\u1ec3u n\u00e3o th\u01b0\u1eddng g\u1eb7p l\u00e0 r\u1ea5t quan tr\u1ecdng trong vi\u1ec7c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh. Ti\u1ec3u n\u00e3o l\u00e0 m\u1ed9t ph\u1ea7n quan tr\u1ecdng c\u1ee7a h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng v\u00e0 c\u00f3 vai tr\u00f2 quan tr\u1ecdng trong vi\u1ec7c \u0111i\u1ec1u ch\u1ec9nh v\u00e0 \u0111i\u1ec1u ph\u1ed1i c\u00e1c ch\u1ee9c n\u0103ng c\u1ee7a c\u01a1 th\u1ec3. T\u00ecm […]<\/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":"\nC\u00e1c b\u1ec7nh l\u00fd ti\u1ec3u n\u00e3o th\u01b0\u1eddng g\u1eb7p - Vinmec<\/title>\n<meta name=\"description\" content=\"Ti\u1ec3u n\u00e3o l\u00e0 m\u1ed9t ph\u1ea7n quan tr\u1ecdng c\u1ee7a h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng v\u00e0 c\u00f3 vai tr\u00f2 quan tr\u1ecdng trong vi\u1ec7c \u0111i\u1ec1u ch\u1ec9nh v\u00e0 \u0111i\u1ec1u ph\u1ed1i c\u00e1c ch\u1ee9c n\u0103ng c\u1ee7a ...\" \/>\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 b\u1ec7nh l\u00fd ti\u1ec3u n\u00e3o th\u01b0\u1eddng g\u1eb7p - Vinmec\" \/>\n<meta property=\"og:description\" content=\"Ti\u1ec3u n\u00e3o l\u00e0 m\u1ed9t ph\u1ea7n quan tr\u1ecdng c\u1ee7a h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng v\u00e0 c\u00f3 vai tr\u00f2 quan tr\u1ecdng trong vi\u1ec7c \u0111i\u1ec1u ch\u1ec9nh v\u00e0 \u0111i\u1ec1u ph\u1ed1i c\u00e1c ch\u1ee9c n\u0103ng c\u1ee7a ...\" \/>\n<meta property=\"og:url\" content=\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/27\/cac-benh-ly-tieu-nao-thuong-gap\/\" \/>\n<meta property=\"og:site_name\" content=\"Vinmec\" \/>\n<meta property=\"article:published_time\" content=\"2023-04-27T10:32:16+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/istockphoto-1051463718-612x612-1-300x209.jpg\" \/>\n<meta name=\"author\" content=\"mitkaka mitkaka\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"mitkaka mitkaka\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"10 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/27\/cac-benh-ly-tieu-nao-thuong-gap\/\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/27\/cac-benh-ly-tieu-nao-thuong-gap\/\",\"name\":\"C\u00e1c b\u1ec7nh l\u00fd ti\u1ec3u n\u00e3o th\u01b0\u1eddng g\u1eb7p - 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