{"id":29938,"date":"2023-05-06T22:06:50","date_gmt":"2023-05-06T15:06:50","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=29938"},"modified":"2023-05-06T22:06:50","modified_gmt":"2023-05-06T15:06:50","slug":"hoi-chung-o-khuyet","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/hoi-chung-o-khuyet\/","title":{"rendered":"H\u00f4\u0323i ch\u01b0\u0301ng \u00f4\u0309 khuy\u00ea\u0301t"},"content":{"rendered":"

H\u00f4\u0323i ch\u01b0\u0301ng \u00f4\u0309 khuy\u00ea\u0301t\u00a0(lacunar syndomes) l\u00e0 m\u1ed9t bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a \u0111\u1ed9t qu\u1ef5 n\u00e3o \u1ed5 khuy\u1ebft (lacunar infarctions), l\u00e0 m\u1ed9t trong nh\u1eefng nguy\u00ean nh\u00e2n \u0111\u1ed9t qu\u1ef5 n\u00e3o th\u01b0\u1eddng g\u1eb7p nh\u1ea5t \u1edf b\u1ec7nh nh\u00e2n t\u0103ng huy\u1ebft \u00e1p h\u1ec7 th\u1ed1ng m\u1ea1n t\u00ednh. <\/em>C\u00e1c \u1ed5 khuy\u1ebft n\u00e0y th\u01b0\u1eddng h\u00ecnh th\u00e0nh do s\u1ef1 t\u1eafc ngh\u1ebdn c\u00e1c m\u1ea1ch m\u00e1u nh\u1ecf trong n\u00e3o, g\u00e2y ra s\u1ef1 thi\u1ebfu m\u00e1u v\u00e0 t\u1ed5n th\u01b0\u01a1ng c\u00e1c t\u1ebf b\u00e0o n\u00e3o. T\u1ed5ng quan v\u1ec1 H\u1ed9i ch\u1ee9ng \u1ed5 khuy\u1ebft cho th\u1ea5y \u0111\u00e2y l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd th\u01b0\u1eddng g\u1eb7p v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ra nh\u1eefng h\u1eadu qu\u1ea3 nghi\u00eam tr\u1ecdng cho s\u1ee9c kh\u1ecfe c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh. Tuy nhi\u00ean, v\u1edbi vi\u1ec7c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u00fang c\u00e1ch, b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 ph\u1ee5c h\u1ed3i v\u00e0 gi\u1ea3m thi\u1ec3u c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a b\u1ec7nh.<\/p>\n

Ba\u0300i vi\u00ea\u0301t tri\u0301ch ngu\u00f4\u0300n t\u01b0\u0300 H\u00f4\u0323i th\u00e2\u0300n kinh ho\u0323c Vi\u00ea\u0323t Nam<\/a><\/strong><\/em><\/p>\n

Ta\u0301c gia\u0309:<\/strong><\/em><\/p>\n

Nguy\u1ec5n Th\u1ecb H\u01b0\u1eddng1, Nguy\u1ec5n Thanh B\u00ecnh2<\/strong><\/em>
\nB\u1ec7nh vi\u1ec7n \u0110a khoa Qu\u1ed1c t\u1ebf Vinmec Times City1<\/em>
\n\u0110\u1ea1i h\u1ecdc Y H\u00e0 N\u1ed9i2<\/em><\/p>\n

1. \u0110\u1ecbnh ngh\u0129a v\u00e0 l\u1ecbch s\u1eed<\/strong>
\n\u0110\u1ed9t qu\u1ef5 n\u00e3o \u1ed5 khuy\u1ebft \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 nh\u1eefng \u1ed5 t\u1ed5n th\u01b0\u01a1ng nh\u1ecf d\u01b0\u1edbi v\u1ecf c\u00f3 \u0111\u01b0\u1eddng k\u00ednh d\u01b0\u1edbi 15mm do t\u1eafc c\u00e1c ti\u1ec3u \u0111\u1ed9ng m\u1ea1ch ho\u1eb7c \u0111\u1ed9ng m\u1ea1ch xi\u00ean (penetrating arteries) l\u00e0 nh\u1eefng nh\u00e1nh t\u00e1ch tr\u1ef1c ti\u1ebfp t\u1eeb c\u00e1c \u0111\u1ed9ng m\u1ea1ch n\u00e3o l\u1edbn, th\u01b0\u1eddng g\u1eb7p nh\u1ea5t l\u00e0 t\u1eeb \u0111a gi\u00e1c Willis, \u0111\u1ed9ng m\u1ea1ch n\u00e3o gi\u1eefa v\u00e0 \u0111\u1ed9ng m\u1ea1ch n\u1ec1n. C\u00e1c \u0111\u1ed9ng m\u1ea1ch xi\u00ean l\u00e0 nh\u1eefng m\u1ea1ch m\u00e1u c\u00f3 k\u00edch th\u01b0\u1edbc nh\u1ecf h\u01a1n 0.5mm \u0111\u01b0\u1eddng k\u00ednh, k\u00edch th\u01b0\u1edbc c\u1ee7a m\u1ed9t \u1ed5 nh\u1ed3i m\u00e1u t\u1ed1i \u0111a t\u1eeb 0.5 \u2013 15mm t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi m\u1ed9t th\u1ec3 t\u00edch 0.2 \u2013 2ml. C\u1ea7n l\u01b0u \u00fd r\u1eb1ng kh\u00f4ng ph\u1ea3i t\u1ea5t c\u1ea3 c\u00e1c nh\u1ed3i m\u00e1u nh\u1ecf \u1edf s\u00e2u \u0111\u1ec1u l\u00e0 nh\u1ed3i m\u00e1u \u1ed5 khuy\u1ebft. Ch\u1ea9n \u0111o\u00e1n nh\u1ed3i m\u00e1u \u1ed5 khuy\u1ebft \u0111\u00f2i h\u1ecfi ph\u1ea3i lo\u1ea1i tr\u1eeb c\u00e1c nguy\u00ean nh\u00e2n nh\u1ed3i m\u00e1u n\u00e3o kh\u00e1c.
\nThu\u1eadt ng\u1eef \u201clacune\u201d l\u1ea7n \u0111\u1ea7u \u0111\u01b0\u1ee3c Dechambre s\u1eed d\u1ee5ng v\u00e0o n\u0103m 1838 d\u1ef1a tr\u00ean c\u00e1c ph\u00e2n t\u00edch sinh b\u1ec7nh h\u1ecdc c\u1ee7a \u00f4ng v\u1ec1 c\u00e1c t\u1ed5n th\u01b0\u01a1ng d\u01b0\u1edbi v\u1ecf tr\u00ean b\u1ec7nh ph\u1ea9m sinh thi\u1ebft n\u00e3o [1]. \u1ede th\u1eddi \u0111i\u1ec3m \u0111\u00f3, ng\u01b0\u1eddi ta cho r\u1eb1ng nguy\u00ean nh\u00e2n c\u1ee7a nh\u1eefng t\u1ed5n th\u01b0\u01a1ng \u201clacune\u201d ho\u1eb7c l\u00e0 do vi\u00eam, ho\u1eb7c l\u00e0 t\u1ed5n th\u01b0\u01a1ng ch\u1ea3y m\u00e1u tho\u00e1i tri\u1ec3n, ho\u1eb7c ho\u1ea1i t\u1eed sau nh\u1ed3i m\u00e1u. Marie n\u0103m 1901 m\u00f4 t\u1ea3 m\u1ed9t h\u1ed9i ch\u1ee9ng l\u00e2m s\u00e0ng v\u1edbi nhi\u1ec1u \u1ed5 \u201clacune\u201d, bao g\u1ed3m li\u1ec7t n\u1eeda ng\u01b0\u1eddi v\u1edbi kh\u1ea3 n\u0103ng h\u1ed3i ph\u1ee5c t\u1ed1t, r\u1ed1i lo\u1ea1n d\u00e1ng \u0111i b\u01b0\u1edbc nh\u1ecf \u0111\u1eb7c tr\u01b0ng (d\u00e1ng \u0111i b\u01b0\u1edbc nh\u1ecf Dejerine \u2013 marche a petis pas de Dejerine), li\u1ec7t gi\u1ea3 h\u00e0nh v\u00e0 sa s\u00fat tr\u00ed tu\u1ec7. N\u0103m 1960, Fisher nh\u1edd nh\u1eefng ph\u00e2n t\u00edch t\u1ec9 m\u1ec9 v\u1ec1 m\u1ed1i t\u01b0\u01a1ng quan l\u00e2m s\u00e0ng v\u00e0 b\u1ec7nh h\u1ecdc \u0111\u00e3 \u0111\u01b0a ra \u201ch\u1ecdc thuy\u1ebft lacunar\u201d, g\u1ee3i \u00fd r\u1eb1ng \u201clacune\u201d l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a b\u1ec7nh l\u00fd m\u1ea1ch m\u00e1u m\u1ea1n t\u00ednh li\u00ean quan t\u1edbi t\u0103ng huy\u1ebft \u00e1p, v\u1edbi bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng \u0111a d\u1ea1ng v\u00e0 ti\u00ean l\u01b0\u1ee3ng h\u1ed3i ph\u1ee5c t\u1ed1t [2].
\nT\u1eeb \u0111\u1ea7u th\u1ebf k\u1ef7 20, nh\u1eefng quan ni\u1ec7m m\u1edbi v\u1ec1 \u201clacune\u201d \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u01b0a ra v\u00e0 g\u00e2y nhi\u1ec1u tranh c\u00e3i trong vi\u1ec7c s\u1eed d\u1ee5ng thu\u1eadt ng\u1eef c\u0169ng nh\u01b0 x\u00e1c \u0111\u1ecbnh b\u1ec7nh nguy\u00ean v\u00e0 b\u1ec7nh sinh. Ng\u01b0\u1eddi ta th\u1ea5y r\u1eb1ng s\u1ef1 h\u00ecnh th\u00e0nh c\u00e1c khoang nh\u1ecf trong nhu m\u00f4 kh\u00f4ng ph\u1ea3i do ngu\u1ed3n g\u1ed1c thi\u1ebfu m\u00e1u m\u00e0 do s\u1ef1 gi\u00e3n r\u1ed9ng c\u00e1c khoang quanh m\u1ea1ch (etat cribl\u00e9), \u0111\u00f4i khi l\u00e0 di ch\u1ee9ng c\u1ee7a c\u00e1c vi ch\u1ea3y m\u00e1u. Do \u0111\u00f3 trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng ta n\u00ean ph\u00e2n bi\u1ec7t hai thu\u1eadt ng\u1eef sau:
\n\u1ed4 khuy\u1ebft (lacune) ho\u1eb7c nh\u1ed3i m\u00e1u \u1ed5 khuy\u1ebft (lacunar infarction) d\u00f9ng \u0111\u1ec3 ch\u1ec9 c\u00e1c \u1ed5 nh\u1ed3i m\u00e1u nh\u1ecf < 15mm, khu tr\u00fa trong s\u00e2u, c\u00f3 ho\u1eb7c kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng x\u00e1c \u0111\u1ecbnh, l\u00e0 t\u1ed5n th\u01b0\u01a1ng g\u00e2y ra b\u1edfi m\u1ed9t b\u1ec7nh m\u1ea1ch m\u00e1u nh\u1ecf, c\u1ee5c b\u1ed9, \u0111\u1eb7c bi\u1ec7t x\u1ea3y ra \u1edf ng\u01b0\u1eddi c\u00f3 ti\u1ec1n s\u1eed t\u0103ng huy\u1ebft \u00e1p m\u1ea1n t\u00ednh v\u00e0 kh\u00f4ng c\u00f3 c\u00e1c b\u1ec7nh l\u00fd kh\u00e1c c\u00f3 th\u1ec3 g\u00e2y ra t\u1ed5n th\u01b0\u01a1ng n\u00e0y.
\nNh\u1ed3i m\u00e1u nh\u1ecf \u1edf s\u00e2u (pettit infarctus profond): l\u00e2m s\u00e0ng v\u00e0 ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh ch\u1ec9 ra m\u1ed9t t\u1ed5n th\u01b0\u01a1ng c\u00f3 nh\u01b0 tr\u00ean nh\u01b0ng do m\u1ed9t nguy\u00ean nh\u00e2n kh\u00e1c g\u00e2y ra m\u00e0 kh\u00f4ng ph\u1ea3i b\u1ec7nh l\u00fd m\u1ea1ch m\u00e1u nh\u1ecf.<\/p>\n

2. D\u1ecbch t\u1ec5<\/strong>
\n\u0110\u1ed9t qu\u1ef5 n\u00e3o \u1ed5 khuy\u1ebft chi\u1ebfm kho\u1ea3ng 15 \u2013 26% s\u1ed1 tr\u01b0\u1eddng h\u1ee3p nh\u1ed3i m\u00e1u n\u00e3o. Theo d\u1eef li\u1ec7u g\u00e1nh n\u1eb7ng b\u1ec7nh t\u1eadt to\u00e0n c\u1ea7u (GBD) n\u0103m 2016, \u01b0\u1edbc t\u00ednh nguy c\u01a1 \u0111\u1ed9t qu\u1ef5 g\u1ea7n nh\u01b0 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng gi\u1eefa nam v\u00e0 n\u1eef gi\u1edbi, nguy c\u01a1 su\u1ed1t \u0111\u1eddi l\u00e0 18.3% v\u1edbi \u0111\u1ed9t qu\u1ef5 thi\u1ebfu m\u00e1u n\u00e3o c\u1ee5c b\u1ed9 v\u00e0 8.2% v\u1edbi ch\u1ea3y m\u00e1u n\u00e3o [3]. Trong m\u1ed9t nghi\u00ean c\u1ee9u c\u1ed9ng \u0111\u1ed3ng, t\u1ef7 l\u1ec7 nh\u1ed3i m\u00e1u n\u00e3o \u1ed5 khuy\u1ebft trong c\u1ed9ng \u0111\u1ed3ng ng\u01b0\u1eddi da tr\u1eafng l\u00e0 29 tr\u00ean 100.000 d\u00e2n, trong khi t\u1ef7 l\u1ec7 n\u00e0y \u1edf ng\u01b0\u1eddi da \u0111en l\u00e0 52 tr\u00ean 100.000 d\u00e2n [4]. Nh\u01b0 \u0111a s\u1ed1 quy m\u00f4 d\u1ecbch t\u1ec5 c\u1ee7a c\u00e1c nguy\u00ean nh\u00e2n nh\u1ed3i m\u00e1u n\u00e3o kh\u00e1c, t\u1ef7 l\u1ec7 \u0111\u1ed9t qu\u1ef5 n\u00e3o \u1ed5 khuy\u1ebft t\u0103ng l\u00ean theo tu\u1ed5i. T\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n nh\u1ed3i m\u00e1u n\u00e3o \u1ed5 khuy\u1ebft c\u00f3 sa s\u00fat tr\u00ed tu\u1ec7 t\u0103ng g\u1ea5p 4 \u2013 12 l\u1ea7n d\u00e2n s\u1ed1 chung [5]. Sa s\u00fat tr\u00ed tu\u1ec7 sau nh\u1ed3i m\u00e1u \u1ed5 khuy\u1ebft th\u01b0\u1eddng g\u1eb7p m\u1eb7c d\u00f9 c\u00e1c \u1ed5 nh\u1ed3i m\u00e1u n\u00e3o nh\u1ecf c\u00f3 li\u00ean quan t\u1edbi b\u1ec7nh m\u1ea1ch m\u00e1u nh\u1ecf. Ngo\u00e0i ra nh\u1ed3i m\u00e1u n\u00e3o \u1ed5 khuy\u1ebft x\u1ea3y ra \u1edf ng\u01b0\u1eddi c\u00e0ng l\u1edbn tu\u1ed5i th\u00ec c\u00e0ng d\u1ec5 d\u1eabn \u0111\u1ebfn t\u00ecnh tr\u1ea1ng t\u00e0n t\u1eadt l\u00e2u d\u00e0i n\u1eb7ng h\u01a1n.<\/p>\n

3. B\u1ec7nh sinh \u0111\u1ed9t qu\u1ef5 n\u00e3o \u1ed5 khuy\u1ebft<\/strong>
\nH\u1ea7u h\u1ebft \u0111\u1ed9t qu\u1ef5 n\u00e3o \u1ed5 khuy\u1ebft x\u1ea3y ra \u1edf c\u00e1c nh\u00e2n n\u1ec1n, \u0111\u1ed3i th\u1ecb, ch\u1ea5t tr\u1eafng d\u01b0\u1edbi v\u1ecf (bao trong, v\u00e0nh tia), v\u00e0 c\u1ea7u n\u00e3o. V\u1ecb tr\u00ed nh\u1ed3i m\u00e1u thu\u1ed9c di\u1ec7n c\u1ea5p m\u00e1u c\u1ee7a c\u00e1c \u0111\u1ed9ng m\u1ea1ch xi\u00ean, l\u00e0 c\u00e1c nh\u00e1nh \u0111\u1ed9ng m\u1ea1ch \u0111\u1eadu v\u00e2n (nh\u00e1nh c\u1ee7a \u0111\u1ed9ng m\u1ea1ch n\u00e3o gi\u1eefa), \u0111\u1ed9ng m\u1ea1ch qu\u1eb7t ng\u01b0\u1ee3c Heubner (nh\u00e1nh c\u1ee7a \u0111\u1ed9ng m\u1ea1ch n\u00e3o tr\u01b0\u1edbc), \u0111\u1ed9ng m\u1ea1ch m\u1ea1ch m\u1ea1c tr\u01b0\u1edbc (nh\u00e1nh c\u1ee7a \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh trong), c\u00e1c nh\u00e1nh \u0111\u1ed9ng m\u1ea1ch \u0111\u1ed3i th\u1ecb (nh\u00e1nh c\u1ee7a \u0111\u1ed9ng m\u1ea1ch n\u00e3o sau), c\u00e1c nh\u00e1nh xi\u00ean \u1edf c\u1ea7u n\u00e3o c\u1ee7a \u0111\u1ed9ng m\u1ea1ch n\u1ec1n [6] [7]. C\u00e1c nh\u00e1nh n\u00e0y t\u00e1ch ra tr\u1ef1c ti\u1ebfp t\u1eeb c\u00e1c \u0111\u1ed9ng m\u1ea1ch n\u00e3o l\u1edbn, do v\u1eady ch\u00fang \u0111\u1eb7c bi\u1ec7t d\u1ec5 b\u1ecb t\u1ed5n th\u01b0\u01a1ng do t\u00e1c \u0111\u1ed9ng c\u1ee7a t\u0103ng huy\u1ebft \u00e1p. S\u1ef1 n\u1ed1i th\u00f4ng th\u01b0a th\u1edbt v\u00e0 ch\u1ed3ng l\u1ea5n t\u1ed1i thi\u1ec3u trong di\u1ec7n c\u1ea5p m\u00e1u c\u1ee7a c\u00e1c nh\u00e1nh xi\u00ean l\u00fd gi\u1ea3i nguy\u00ean nh\u00e2n \u1ed5 khuy\u1ebft th\u01b0\u1eddng g\u1eb7p v\u1edbi nh\u1ed3i m\u00e1u nh\u1eefng khu v\u1ef1c n\u00e0y. C\u00e1c c\u01a1 ch\u1ebf b\u1ec7nh sinh c\u1ee7a \u0111\u1ed9t qu\u1ef5 n\u00e3o \u1ed5 khuy\u1ebft \u0111\u00e3 \u0111\u01b0\u1ee3c th\u1ed1ng nh\u1ea5t, bao g\u1ed3m:
\nB\u1ec7nh vi m\u1ea1ch t\u0103ng huy\u1ebft \u00e1p (microangiopathy): t\u0103ng huy\u1ebft \u00e1p m\u1ea1n t\u00ednh kh\u00f4ng \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t d\u1eabn \u0111\u1ebfn d\u00e0y th\u00e0nh \u0111\u1ed9ng m\u1ea1ch, g\u00e2y h\u1eb9p l\u00f2ng c\u00e1c nh\u00e1nh \u0111\u1ed9ng m\u1ea1ch xi\u00ean, li\u00ean quan \u0111\u1ebfn tho\u00e1i h\u00f3a m\u1ee1 \u2013 k\u00ednh (lipohyalinosis \u2013 tho\u00e1i h\u00f3a l\u1edbp \u00e1o gi\u1eefa c\u1ee7a th\u00e0nh \u0111\u1ed9ng m\u1ea1ch nh\u1ecf v\u00e0 thay th\u1ebf b\u1eb1ng lipid v\u00e0 collagen), ho\u1ea1i t\u1eed fibrin v\u00e0 lo\u1ea1n s\u1ea3n th\u00e0nh m\u1ea1ch [8] [9] [10].
\nX\u01a1 v\u1eefa m\u1ea1ch nh\u00e1nh (brach atheromatous disease): h\u00ecnh th\u00e0nh c\u00e1c vi x\u01a1 v\u1eefa t\u1ea1i c\u00e1c nh\u00e1nh c\u1ee7a \u0111\u1ed9ng m\u1ea1ch n\u00e3o gi\u1eefa, \u0111a gi\u00e1c Willis, \u0111\u1ed9ng m\u1ea1ch th\u00e2n n\u1ec1n v\u00e0 \u0111\u1ed1t s\u1ed1ng [11]
\nHuy\u1ebft kh\u1ed1i (embolism) ngu\u1ed3n g\u1ed1c t\u1eeb h\u1eb9p m\u1ea1ch c\u1ea3nh do x\u01a1 v\u1eefa ho\u1eb7c t\u1eeb tim [12] [13] [14].
\nR\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng n\u1ed9i m\u00f4 v\u00e0 t\u1ed5n th\u01b0\u01a1ng h\u00e0ng r\u00e0o m\u00e1u n\u00e3o: gi\u1ea3 thuy\u1ebft cho r\u1eb1ng s\u1ef1 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng n\u1ed9i m\u00f4 \u0111\u1ed9ng m\u1ea1ch v\u00e0 mao m\u1ea1ch h\u00e0ng r\u00e0o m\u00e1u n\u00e3o d\u1eabn \u0111\u1ebfn ph\u00f9 quanh m\u1ea1ch, t\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o th\u00e0nh m\u1ea1ch v\u00e0 th\u1ea7n kinh \u0111\u1ec7m, h\u00ecnh th\u00e0nh b\u1ec7nh m\u1ea1ch m\u00e1u nh\u1ecf, nh\u1ed3i m\u00e1u n\u00e3o \u1ed5 khuy\u1ebft v\u00e0 t\u1ed5n th\u01b0\u01a1ng ch\u1ea5t tr\u1eafng [15] [16].<\/p>\n

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

H\u00ecnh 1. Gi\u1ea3i ph\u1eabu c\u00e1c \u0111\u1ed9ng m\u1ea1ch n\u00e3o v\u00e0 nh\u00e1nh xi\u00ean c\u1ee7a ch\u00fang<\/p>\n

Y\u1ebfu t\u1ed1 nguy c\u01a1 c\u1ee7a \u0111\u1ed9t qu\u1ef5 n\u00e3o \u1ed5 khuy\u1ebft li\u00ean quan \u0111\u1ebfn b\u1ec7nh m\u1ea1ch m\u00e1u m\u1ea1n t\u00ednh do t\u0103ng huy\u1ebft \u00e1p h\u1ec7 th\u1ed1ng (t\u0103ng huy\u1ebft \u00e1p v\u00e0 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng). Gi\u1edbi t\u00ednh nam, tu\u1ed5i cao, h\u00fat thu\u1ed1c l\u00e1, TIA ho\u1eb7c nh\u1ed3i m\u00e1u n\u00e3o \u1ed5 khuy\u1ebft tr\u01b0\u1edbc \u0111\u00f3 v\u00e0 b\u1ec7nh m\u1ea1ch v\u00e0nh c\u0169ng l\u00e0 nh\u1eefng y\u1ebfu t\u1ed1 nguy c\u01a1. Ngo\u00e0i ra y\u1ebfu t\u1ed1 gen c\u0169ng \u0111\u01b0\u1ee3c xem x\u00e9t. M\u1ed9t nghi\u00ean c\u1ee9u t\u1ed5ng quan n\u0103m 2021 \u0111\u00e3 ch\u1ec9 ra 12 locus c\u00f3 li\u00ean quan \u0111\u1ebfn \u0111\u1ed9t qu\u1ef5 n\u00e3o \u1ed5 khuy\u1ebft [17]. B\u1ec7nh l\u00fd m\u1ea1ch m\u00e1u nh\u1ecf di truy\u1ec1n c\u0169ng c\u00f3 bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng nh\u1ed3i m\u00e1u \u1ed5 khuy\u1ebft bao g\u1ed3m: b\u1ec7nh m\u1ea1ch m\u00e1u n\u00e3o d\u1ea1ng b\u1ed9t, CADASIL (b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch di truy\u1ec1n tr\u1ed9i nhi\u1ec5m s\u1eafc th\u1ec3 k\u00e8m nh\u1ed3i m\u00e1u d\u01b0\u1edbi v\u1ecf v\u00e0 b\u1ec7nh n\u00e3o ch\u1ea5t tr\u1eafng), CARASIL (b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch di truy\u1ec1n l\u1eb7n nhi\u1ec5m s\u1eafc th\u1ec3 k\u00e8m nh\u1ed3i m\u00e1u d\u01b0\u1edbi v\u1ecf v\u00e0 b\u1ec7nh n\u00e3o ch\u1ea5t tr\u1eafng).<\/p>\n

4. \u0110\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng c\u00e1c h\u1ed9i ch\u1ee9ng \u1ed5 khuy\u1ebft th\u01b0\u1eddng g\u1eb7p<\/strong>
\n\u0110a s\u1ed1 c\u00e1c \u0111\u1ed9t qu\u1ef5 n\u00e3o \u1ed5 khuy\u1ebft l\u00e0 kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng. H\u1ed9i ch\u1ee9ng \u1ed5 khuy\u1ebft l\u00e0 bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a c\u00e1c t\u1ed5n th\u01b0\u01a1ng t\u1ea1i nh\u1eefng v\u1ecb tr\u00ed nh\u1ea5t \u0111\u1ecbnh k\u1ec3 tr\u00ean. Cho \u0111\u1ebfn nay, c\u00f3 h\u01a1n 20 h\u1ed9i ch\u1ee9ng \u1ed5 khuy\u1ebft \u0111\u00e3 \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 trong y v\u0103n, tuy nhi\u00ean n\u0103m h\u1ed9i ch\u1ee9ng \u1ed5 khuy\u1ebft sau \u0111\u00e2y \u0111\u00e3 \u0111\u01b0\u1ee3c c\u00f4ng nh\u1eadn r\u1ed9ng r\u00e3i (c\u00e1c h\u1ed9i ch\u1ee9ng \u1ed5 khuy\u1ebft c\u1ed5 \u0111i\u1ec3n):
\n\u2013 Li\u1ec7t v\u1eadn \u0111\u1ed9ng n\u1eeda ng\u01b0\u1eddi \u0111\u01a1n thu\u1ea7n (Pure motor hemiparesis)
\n\u2013 \u0110\u1ed9t qu\u1ef5 n\u00e3o c\u1ea3m gi\u00e1c \u0111\u01a1n thu\u1ea7n (Pure sensory stroke)
\n\u2013 \u0110\u1ed9t qu\u1ef5 n\u00e3o v\u1eadn \u0111\u1ed9ng \u2013 c\u1ea3m gi\u00e1c (Sensorimotor stroke)
\n\u2013 Li\u1ec7t n\u1eeda ng\u01b0\u1eddi th\u1ea5t \u0111i\u1ec1u (Ataxic hemiparesis)
\n\u2013 H\u1ed9i ch\u1ee9ng n\u00f3i kh\u00f3 \u2013 b\u00e0n tay v\u1ee5ng v\u1ec1 (Dysarthria \u2013 clumsy hand syndrome)
\nDo t\u1ed5n th\u01b0\u01a1ng v\u1ecb tr\u00ed d\u01b0\u1edbi v\u1ecf, nh\u00ecn chung trong h\u1ed9i ch\u1ee9ng \u1ed5 khuy\u1ebft s\u1ebd c\u00f3 s\u1ef1 v\u1eafng m\u1eb7t c\u00e1c tri\u1ec7u ch\u1ee9ng bi\u1ec3u hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng v\u1ecf n\u00e3o nh\u01b0 th\u1ea5t ng\u00f4n, b\u00e1n manh, r\u1ed1i lo\u1ea1n nh\u1eadn th\u1ee9c, m\u1ea5t nh\u1eadn th\u1ee9c n\u1eeda ng\u01b0\u1eddi, \u2026 Ngo\u00e0i ra, nh\u1ed3i m\u00e1u n\u00e3o \u1ed5 khuy\u1ebft l\u00e0 th\u1ec3 nh\u1ed3i m\u00e1u th\u01b0\u1eddng g\u1eb7p nh\u1ea5t xu\u1ea5t hi\u1ec7n t\u00ecnh tr\u1ea1ng thi\u1ebfu h\u1ee5t v\u1eadn \u0111\u1ed9ng n\u1eb7ng h\u01a1n sau nh\u1eadp vi\u1ec7n, tri\u1ec7u ch\u1ee9ng ti\u1ebfn tri\u1ec3n t\u1eeb v\u00e0i gi\u1edd \u0111\u1ebfn v\u00e0i ng\u00e0y do t\u00ednh ch\u1ea5t t\u1eafc m\u1ea1ch t\u1eebng n\u1ea5c (stepwise). B\u1ec7nh nh\u00e2n v\u1edbi b\u1ec7nh m\u1ea1ch m\u00e1u nh\u1ecf t\u0103ng huy\u1ebft \u00e1p c\u00f3 nguy c\u01a1 h\u00ecnh th\u00e0nh nhi\u1ec1u \u1ed5 t\u1ed5n th\u01b0\u01a1ng d\u01b0\u1edbi v\u1ecf d\u1ea1ng \u1ed5 khuy\u1ebft c\u00f3 ho\u1eb7c kh\u00f4ng k\u00e8m theo t\u1ed5n th\u01b0\u01a1ng ch\u1ea5t tr\u1eafng, c\u00f3 th\u1ec3 d\u1eabn t\u1edbi sa s\u00fat tr\u00ed tu\u1ec7 m\u1ea1ch m\u00e1u.
\n4.1. Li\u1ec7t v\u1eadn \u0111\u1ed9ng n\u1eeda ng\u01b0\u1eddi \u0111\u01a1n thu\u1ea7n<\/strong><\/em>
\nLi\u1ec7t v\u1eadn \u0111\u1ed9ng n\u1eeda ng\u01b0\u1eddi \u0111\u01a1n thu\u1ea7n l\u00e0 h\u1ed9i ch\u1ee9ng \u1ed5 khuy\u1ebft th\u01b0\u1eddng g\u1eb7p nh\u1ea5t (45 \u2013 57% c\u00e1c tr\u01b0\u1eddng h\u1ee3p) [18]. N\u00f3 \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi bi\u1ec3u hi\u1ec7n li\u1ec7t v\u1eadn \u0111\u1ed9ng tay, ch\u00e2n, m\u1eb7t m\u1ed9t b\u00ean k\u00e8m theo v\u1eafng m\u1eb7t c\u00e1c tri\u1ec7u ch\u1ee9ng v\u1ecf n\u00e3o (th\u1ea5t ng\u00f4n, b\u00e1n manh, r\u1ed1i lo\u1ea1n nh\u1eadn th\u1ee9c, m\u1ea5t nh\u1eadn th\u1ee9c n\u1eeda ng\u01b0\u1eddi) v\u00e0 thi\u1ebfu h\u1ee5t c\u1ea3m gi\u00e1c. Tri\u1ec7u ch\u1ee9ng li\u1ec7t c\u00f3 th\u1ec3 ho\u00e0n to\u00e0n ho\u1eb7c kh\u00f4ng ho\u00e0n to\u00e0n nh\u01b0ng th\u01b0\u1eddng l\u00e0 \u0111\u1ed3ng \u0111\u1ec1u (50%), tay \u2013 m\u1eb7t (29%), m\u1ed9t chi (18%).
\nT\u1ed5n th\u01b0\u01a1ng hay g\u1eb7p \u1edf bao trong nh\u01b0ng c\u0169ng c\u00f3 th\u1ec3 \u1edf c\u00e1c v\u1ecb tr\u00ed kh\u00e1c tr\u00ean \u0111\u01b0\u1eddng v\u1ecf \u2013 t\u1ee7y. Thi\u1ebfu h\u1ee5t v\u1eadn \u0111\u1ed9ng c\u00f3 th\u1ec3 x\u1ea3y ra \u0111\u01a1n \u0111\u1ed9c ho\u1eb7c sau c\u00e1c c\u01a1n TIA n\u1eeda ng\u01b0\u1eddi. M\u1ed9t lo\u1ea1t ca b\u1ec7nh sau \u0111\u00f3 \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 nh\u01b0 h\u1ed9i ch\u1ee9ng \u201cc\u1ea3nh b\u00e1o bao trong\u201d, d\u1ef1 b\u00e1o nh\u1ed3i m\u00e1u c\u1ea5p bao trong tr\u00ean CT s\u1ecd n\u00e3o. M\u1ed9t s\u1ed1 c\u00f3 th\u1ec3 di\u1ec5n ti\u1ebfn do thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 nh\u00e1nh xi\u00ean do huy\u1ebft kh\u1ed1i x\u01a1 v\u1eefa m\u1ea1ch l\u1edbn (\u0111\u1ed9ng m\u1ea1ch n\u00e3o gi\u1eefa, \u0111\u1ed9ng m\u1ea1ch n\u1ec1n) g\u00e2y tri\u1ec7u ch\u1ee9ng dao \u0111\u1ed9ng v\u1eadn \u0111\u1ed9ng.
\n4.2. \u0110\u1ed9t qu\u1ef5 n\u00e3o c\u1ea3m gi\u00e1c \u0111\u01a1n thu\u1ea7n<\/strong><\/em>
\nChi\u1ebfm kho\u1ea3ng 7 \u2013 18% c\u00e1c tr\u01b0\u1eddng h\u1ee3p h\u1ed9i ch\u1ee9ng \u1ed5 khuy\u1ebft [18]. Thi\u1ebfu h\u1ee5t c\u1ea3m gi\u00e1c v\u1edbi t\u00ea b\u00ec \u1edf tay, ch\u00e2n v\u00e0 m\u1eb7t m\u1ed9t b\u00ean kh\u00f4ng k\u00e8m li\u1ec7t v\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng v\u1ecf n\u00e3o. Tri\u1ec7u ch\u1ee9ng c\u1ea3m gi\u00e1c c\u00f3 th\u1ec3 l\u00e0 c\u1ea3m gi\u00e1c n\u00f4ng, s\u00e2u ho\u1eb7c c\u1ea3 hai, c\u00f3 th\u1ec3 c\u1ee5c b\u1ed9 (c\u1ea7u n\u00e3o) ho\u1eb7c n\u1eeda ng\u01b0\u1eddi (\u0111\u1ed3i th\u1ecb).
\n4.3. Li\u1ec7t n\u1eeda ng\u01b0\u1eddi th\u1ea5t \u0111i\u1ec1u<\/strong><\/em>
\n\u0110\u1eb7c tr\u01b0ng b\u1edfi li\u1ec7t n\u1eeda ng\u01b0\u1eddi k\u00e8m th\u1ea5t \u0111i\u1ec1u chi c\u00f9ng b\u00ean, chi\u1ebfm 3 \u2013 18% c\u00e1c tr\u01b0\u1eddng h\u1ee3p h\u1ed9i ch\u1ee9ng \u1ed5 khuy\u1ebft [18]. Tri\u1ec7u ch\u1ee9ng th\u1ea5t \u0111i\u1ec1u chi do s\u1ef1 x\u00e2m ph\u1ea1m b\u00f3 v\u1ecf \u2013 ti\u1ec3u n\u00e3o g\u00e2y qu\u00e1 t\u1ea7m, m\u1ea5t li\u00ean \u0111\u1ed9ng v\u00e0 gi\u1ea3m tr\u01b0\u01a1ng l\u1ef1c c\u01a1. M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n n\u00f3i kh\u00f3, nystagmus, v\u00e0 r\u1ed1i lo\u1ea1n d\u00e1ng \u0111i l\u1ec7ch v\u1ec1 b\u00ean b\u1ec7nh. Nh\u01b0 c\u00e1c h\u1ed9i ch\u1ee9ng \u1ed5 khuy\u1ebft kh\u00e1c, c\u00e1c tri\u1ec7u ch\u1ee9ng v\u1ecf n\u00e3o kh\u00f4ng c\u00f3 m\u1eb7t.
\n4.4. \u0110\u1ed9t qu\u1ef5 n\u00e3o v\u1eadn \u0111\u1ed9ng c\u1ea3m gi\u00e1c<\/strong><\/em>
\nBi\u1ec3u hi\u1ec7n li\u1ec7t n\u1eeda ng\u01b0\u1eddi k\u00e8m t\u00ea b\u00ec m\u1eb7t, tay, ch\u00e2n c\u00f9ng b\u00ean kh\u00f4ng k\u00e8m tri\u1ec7u ch\u1ee9ng v\u1ecf n\u00e3o, chi\u1ebfm 15 \u2013 20% c\u00e1c tr\u01b0\u1eddng h\u1ee3p h\u1ed9i ch\u1ee9ng \u1ed5 khuy\u1ebft [18]. Nh\u1ed3i m\u00e1u t\u1ea1i v\u1ecb tr\u00ed sau b\u00ean \u0111\u1ed3i th\u1ecb v\u00e0 c\u00e1nh tay sau bao trong. V\u1ec1 l\u00fd thuy\u1ebft, c\u00e1c \u0111\u1ed9ng m\u1ea1ch xi\u00ean t\u1eeb \u0111\u1ed9ng m\u1ea1ch n\u00e3o sau c\u1ea5p m\u00e1u cho \u0111\u1ed3i th\u1ecb trong khi c\u00e1c nh\u00e1nh \u0111\u1eadu v\u00e2n c\u1ee7a \u0111\u1ed9ng m\u1ea1ch n\u00e3o gi\u1eefa c\u1ea5p m\u00e1u cho bao trong, do \u0111\u00f3 v\u1ecb tr\u00ed \u0111\u1ed9ng m\u1ea1ch th\u1ee7 ph\u1ea1m trong nh\u1ed3i m\u00e1u \u1ed5 khuy\u1ebft c\u00f3 thi\u1ebfu h\u1ee5t v\u1eadn \u0111\u1ed9ng c\u1ea3m gi\u00e1c c\u00f2n \u0111ang tranh c\u00e3i.
\n4.5. H\u1ed9i ch\u1ee9ng n\u00f3i kh\u00f3 \u2013 b\u00e0n tay v\u1ee5ng v\u1ec1<\/strong><\/em>
\n\u00cdt g\u1eb7p nh\u1ea5t trong s\u1ed1 c\u00e1c h\u1ed9i ch\u1ee9ng \u1ed5 khuy\u1ebft c\u1ed5 \u0111i\u1ec3n, ch\u1ec9 chi\u1ebfm 2 \u2013 6% [18]. Bi\u1ec3u hi\u1ec7n li\u1ec7t m\u1eb7t, n\u00f3i kh\u00f3 (v\u1eeba \u0111\u1ebfn n\u1eb7ng) v\u00e0 y\u1ebfu nh\u1eb9 tay k\u00e8m v\u1ee5ng v\u1ec1, nh\u1ea5t l\u00e0 \u1edf ng\u1ecdn chi (r\u00f5 nh\u1ea5t khi vi\u1ebft), t\u0103ng ph\u1ea3n x\u1ea1 g\u00e2n x\u01b0\u01a1ng c\u00f9ng b\u00ean v\u00e0 nu\u1ed1t kh\u00f3. Kh\u00f4ng c\u00f3 r\u1ed1i lo\u1ea1n c\u1ea3m gi\u00e1c v\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng v\u1ecf n\u00e3o.<\/p>\n\n\n\n\n\n\n\n\n
H\u1ed9i ch\u1ee9ng \u1ed5 khuy\u1ebft c\u1ed5 \u0111i\u1ec3n<\/strong><\/td>\nV\u1ecb tr\u00ed t\u1ed5n th\u01b0\u01a1ng<\/strong><\/td>\nBi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng<\/strong><\/td>\nGi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n d\u01b0\u01a1ng t\u00ednh<\/strong><\/td>\n<\/tr>\n
Li\u1ec7t v\u1eadn \u0111\u1ed9ng n\u1eeda ng\u01b0\u1eddi \u0111\u01a1n thu\u1ea7n<\/td>\nBao trong, v\u00e0nh tia, n\u1ec1n c\u1ea7u n\u00e3o, h\u00e0nh n\u00e3o<\/td>\nLi\u1ec7t m\u1eb7t, tay, ch\u00e2n 1 b\u00ean, kh\u00f4ng c\u00f3 r\u1ed1i lo\u1ea1n c\u1ea3m gi\u00e1c, n\u00f3i kh\u00f3 c\u00f3 th\u1ec3 g\u1eb7p<\/td>\n52 \u2013 85%<\/td>\n<\/tr>\n
\u0110\u1ed9t qu\u1ef5 n\u00e3o c\u1ea3m gi\u00e1c \u0111\u01a1n thu\u1ea7n<\/td>\n\u0110\u1ed3i th\u1ecb, tr\u1ea7n c\u1ea7u n\u00e3o, v\u00e0nh tia<\/td>\nT\u00ea b\u00ec m\u1eb7t, tay, ch\u00e2n 1 b\u00ean, kh\u00f4ng c\u00f3 li\u1ec7t<\/td>\n95 \u2013 100%<\/td>\n<\/tr>\n
Li\u1ec7t n\u1eeda ng\u01b0\u1eddi th\u1ea5t \u0111i\u1ec1u<\/td>\nBao trong, v\u00e0nh tia, n\u1ec1n c\u1ea7u n\u00e3o, \u0111\u1ed3i th\u1ecb<\/td>\nLi\u1ec7t v\u1eadn \u0111\u1ed9ng v\u00e0 th\u1ea5t \u0111i\u1ec1u 1 b\u00ean<\/td>\n59 \u2013 95%<\/td>\n<\/tr>\n
\u0110\u1ed9t qu\u1ef5 n\u00e3o v\u1eadn \u0111\u1ed9ng c\u1ea3m gi\u00e1c<\/td>\nThalamocapsular, n\u1ec1n c\u1ea7u n\u00e3o ho\u1eb7c h\u00e0nh n\u00e3o b\u00ean<\/td>\nLi\u1ec7t n\u1eeda ng\u01b0\u1eddi k\u00e8m thi\u1ebfu h\u1ee5t c\u1ea3m gi\u00e1c c\u00f9ng b\u00ean<\/td>\n51 \u2013 87%<\/td>\n<\/tr>\n
H\u1ed9i ch\u1ee9ng n\u00f3i kh\u00f3 b\u00e0n tay v\u1ee5ng v\u1ec1<\/td>\nN\u1ec1n c\u1ea7u n\u00e3o, bao tr\u1ecdng, v\u00e0nh tia<\/td>\nLi\u1ec7t m\u1eb7t 1 b\u00ean, n\u00f3i kh\u00f3 v\u1edbi li\u1ec7t nh\u1eb9 tay v\u00e0 v\u1ee5ng v\u1ec1<\/td>\nKho\u1ea3ng 96%<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

C\u00e1c h\u1ed9i ch\u1ee9ng \u1ed5 khuy\u1ebft kh\u00e1c v\u1edbi bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng \u0111a d\u1ea1ng, m\u1ed9t s\u1ed1 do t\u1eafc m\u1ea1ch l\u1edbn, c\u00f2n l\u1ea1i do nh\u1ed3i m\u00e1u \u1ed5 khuy\u1ebft, nhi\u1ec1u h\u1ed9i ch\u1ee9ng kh\u00f4ng ch\u1ee9ng minh \u0111\u01b0\u1ee3c do nh\u1ed3i m\u00e1u \u1ed5 khuy\u1ebft nh\u01b0ng c\u0169ng kh\u00f4ng b\u00e1c b\u1ecf \u0111\u01b0\u1ee3c.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
C\u00e1c h\u1ed9i ch\u1ee9ng \u1ed5 khuy\u1ebft kh\u00e1c<\/strong><\/td>\nV\u1ecb tr\u00ed t\u1ed5n th\u01b0\u01a1ng<\/strong><\/td>\n<\/tr>\n
Li\u1ec7t v\u1eadn \u0111\u1ed9ng n\u1eeda ng\u01b0\u1eddi \u0111\u01a1n thu\u1ea7n k\u00e8m th\u1ea5t ng\u00f4n v\u1eadn \u0111\u1ed9ng<\/td>\nG\u1ed1i ho\u1eb7c c\u00e1nh tay tr\u01b0\u1edbc bao trong, c\u1ea1nh ch\u1ea5t tr\u1eafng v\u00f9ng v\u00e0nh tia tr\u01b0\u1edbc<\/td>\n<\/tr>\n
Li\u1ec7t v\u1eadn \u0111\u1ed9ng n\u1eeda ng\u01b0\u1eddi \u0111\u01a1n thu\u1ea7n kh\u00f4ng k\u00e8m li\u1ec7t m\u1eb7t<\/td>\nD\u1ea3i th\u00e1p \u1edf h\u00e0nh n\u00e3o (\u0111\u1ed9ng m\u1ea1ch \u0111\u1ed1t s\u1ed1ng\/nh\u00e1nh c\u1ee7a n\u00f3)<\/td>\n<\/tr>\n
H\u1ed9i ch\u1ee9ng n\u00e3o gi\u1eefa \u2013 \u0111\u1ed3i th\u1ecb (li\u1ec7t d\u00e2y III, li\u1ec7t li\u1ebfc d\u1ecdc (h\u1ed9i ch\u1ee9ng Parinaud), gi\u1ea3m \u0111\u1ed9ng l\u1ef1c)<\/td>\nNh\u1ed3i m\u00e1u h\u00ecnh c\u00e1nh b\u01b0\u1edbm (butterfly shape<\/em>) v\u00f9ng c\u1ea1nh gi\u1eefa trung n\u00e3o, d\u01b0\u1edbi \u0111\u1ed3i, \u0111\u1ed3i th\u1ecb hai b\u00ean (t\u1eafc \u0111\u1ed9ng m\u1ea1ch Percheron, \u0111\u1ed9ng m\u1ea1ch c\u1ea1nh gi\u1eefa \u0111\u1ed3i \u2013 d\u01b0\u1edbi \u0111\u1ed3i, \u0111\u1ed9ng m\u1ea1ch c\u1ea1nh gi\u1eefa trung n\u00e3o)<\/td>\n<\/tr>\n
Sa s\u00fat tr\u00ed tu\u1ec7 \u0111\u1ed3i th\u1ecb (gi\u1ea3m \u0111\u1ed9ng l\u1ef1c, m\u1ea5t tr\u00ed nh\u1edb, h\u1ed9i ch\u1ee9ng Horner)<\/td>\nTrung t\u00e2m \u0111\u1ed3i th\u1ecb v\u00e0 v\u00f9ng d\u01b0\u1edbi \u0111\u1ed3i l\u00e2n c\u1eadn (t\u1eafc \u0111\u1ed9ng m\u1ea1ch c\u1ea1nh gi\u1eefa \u0111\u1ed3i \u2013 d\u01b0\u1edbi \u0111\u1ed3i tr\u01b0\u1edbc)<\/td>\n<\/tr>\n
Li\u1ec7t v\u1eadn \u0111\u1ed9ng n\u1eeda ng\u01b0\u1eddi \u0111\u01a1n thu\u1ea7n k\u00e8m li\u1ec7t li\u1ebfc ngang<\/td>\nNh\u1ed3i m\u00e1u c\u1ea1nh gi\u1eefa v\u00f9ng c\u1ea7u n\u00e3o th\u1ea5p (h\u1ed9i ch\u1ee9ng m\u1ed9t v\u00e0 m\u1ed9t n\u1eeda)<\/td>\n<\/tr>\n
Li\u1ec7t v\u1eadn \u0111\u1ed9ng n\u1eeda ng\u01b0\u1eddi \u0111\u01a1n thu\u1ea7n k\u00e8m li\u1ec7t d\u00e2y III \u0111\u1ed1i b\u00ean (h\u1ed9i ch\u1ee9ng Weber)<\/td>\nC\u1ea1nh \u0111\u01b0\u1eddng gi\u1eefa cu\u1ed1ng n\u00e3o, v\u1ecb tr\u00ed tho\u00e1t ra c\u1ee7a d\u00e2y III<\/td>\n<\/tr>\n
Li\u1ec7t v\u1eadn \u0111\u1ed9ng n\u1eeda ng\u01b0\u1eddi \u0111\u01a1n thu\u1ea7n k\u00e8m li\u1ec7t d\u00e2y VI \u0111\u1ed1i b\u00ean<\/td>\nC\u1ea1nh \u0111\u01b0\u1eddng gi\u1eefa c\u1ea7u n\u00e3o tr\u01b0\u1edbc, v\u1ecb tr\u00ed tho\u00e1t ra c\u1ee7a d\u00e2y VI<\/td>\n<\/tr>\n
Li\u1ec7t v\u1eadn \u0111\u1ed9ng n\u1eeda ng\u01b0\u1eddi \u0111\u01a1n thu\u1ea7n k\u00e8m l\u00fa l\u1eabn<\/td>\nC\u00e1nh tay tr\u01b0\u1edbc v\u00e0 ph\u1ea7n tr\u01b0\u1edbc c\u00e1nh tay sau bao trong b\u00ean ph\u1ea3i<\/td>\n<\/tr>\n
Th\u1ea5t \u0111i\u1ec1u ti\u1ec3u n\u00e3o k\u00e8m li\u1ec7t d\u00e2y III \u0111\u1ed1i b\u00ean (h\u1ed9i ch\u1ee9ng Claude)<\/td>\nD\u1ea3i r\u0103ng \u0111\u1ecf (dentatorubral tract<\/em>\u00a0\u2013 cu\u1ed1ng ti\u1ec3u n\u00e3o tr\u00ean), ngay sau khi b\u1eaft ch\u00e9o<\/td>\n<\/tr>\n
M\u00faa vung n\u1eeda ng\u01b0\u1eddi<\/td>\nTh\u1ec3 Luys (d\u01b0\u1edbi \u0111\u1ed3i) (\u0111\u1ed9ng m\u1ea1ch n\u00e3o sau, \u0111\u1ed9ng m\u1ea1ch th\u00f4ng sau, \u0111\u1ed9ng m\u1ea1ch m\u1ea1ch m\u1ea1c sau)<\/td>\n<\/tr>\n
H\u1ed9i ch\u1ee9ng nh\u00e1nh th\u1ea5p \u0111\u1ed9ng m\u1ea1ch n\u1ec1n \u2013 ch\u00f3ng m\u1eb7t, rung gi\u1eadt nh\u00e3n c\u1ea7u, nh\u00ecn \u0111\u00f4i, li\u1ec7t li\u1ebfc ngang, li\u1ec7t v\u1eadn nh\u00e3n li\u00ean nh\u00e2n, th\u1ea5t ng\u00f4n, th\u1ea5t \u0111i\u1ec1u ti\u1ec3u n\u00e3o, t\u00ea b\u00ec m\u1eb7t theo nh\u00e1nh d\u00e2y V<\/td>\nTr\u1ea7n c\u1ea7u n\u00e3o (nh\u00e1nh d\u01b0\u1edbi c\u1ee7a \u0111\u1ed9ng m\u1ea1ch n\u1ec1n ho\u1eb7c c\u00e1c nh\u00e1nh tr\u00ean c\u1ee7a \u0111\u1ed9ng m\u1ea1ch \u0111\u1ed1t s\u1ed1ng)<\/td>\n<\/tr>\n
H\u1ed9i ch\u1ee9ng h\u00e0nh n\u00e3o b\u00ean<\/td>\n\u0110\u1ed9ng m\u1ea1ch \u0111\u1ed1t s\u1ed1ng, \u0111\u1ed9ng m\u1ea1ch ti\u1ec3u n\u00e3o sau d\u01b0\u1edbi<\/td>\n<\/tr>\n
H\u1ed9i ch\u1ee9ng h\u00e0nh \u2013 c\u1ea7u n\u00e3o b\u00ean \u2013 ch\u00f3ng m\u1eb7t, \u00f9 tai, nystagmus, li\u1ec7t VII, th\u1ea5t \u0111i\u1ec1u ti\u1ec3u n\u00e3o, h\u1ed9i ch\u1ee9ng Horner, ph\u00e2n ly c\u1ea3m gi\u00e1c<\/td>\nC\u00e1c nh\u00e1nh th\u1ea5p c\u1ee7a \u0111\u1ed9ng m\u1ea1ch \u0111\u1ed1t s\u1ed1ng, di\u1ec7n chi ph\u1ed1i nh\u00e2n d\u00e2y VII v\u00e0 VIII<\/td>\n<\/tr>\n
H\u1ed9i ch\u1ee9ng kh\u00f3a trong (li\u1ec7t v\u1eadn \u0111\u1ed9ng hai b\u00ean n\u1eeda ng\u01b0\u1eddi \u0111\u01a1n thu\u1ea7n)<\/td>\n\u1ea2nh h\u01b0\u1edfng d\u1ea3i v\u1ecf t\u1ee7y hai b\u00ean: bao trong, c\u1ea7u n\u00e3o, d\u1ea3i th\u00e1p, cu\u1ed1ng n\u00e3o<\/td>\n<\/tr>\n
Tr\u1ea1ng th\u00e1i \u1ed5 khuy\u1ebft (l\u2019\u00e9tat lacunaire<\/em>) \u2013 h\u1ed9i ch\u1ee9ng gi\u1ea3 h\u00e0nh t\u1ee7y c\u00f3 ho\u1eb7c kh\u00f4ng k\u00e8m theo sa s\u00fat tr\u00ed tu\u1ec7 m\u1ea1ch m\u00e1u<\/td>\nNhi\u1ec1u t\u1ed5n th\u01b0\u01a1ng \u1ed5 khuy\u1ebft<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

5. Ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh \u0111\u1ed9t qu\u1ef5 n\u00e3o \u1ed5 khuy\u1ebft<\/strong>
\n\u0110\u1ed9t qu\u1ef5 n\u00e3o \u1ed5 khuy\u1ebft \u1edf nh\u1eefng v\u1ecb tr\u00ed nh\u1ea5t \u0111\u1ecbnh d\u1eabn \u0111\u1ebfn c\u00e1c h\u1ed9i ch\u1ee9ng \u0111\u1ed9t qu\u1ef5 n\u00e3o \u1ed5 khuy\u1ebft kh\u00e1c nhau. T\u01b0\u01a1ng t\u1ef1 nh\u01b0 v\u1eady, m\u1ed9t \u0111\u1ed9t qu\u1ef5 n\u00e3o kh\u00f4ng ph\u1ea3i \u1ed5 khuy\u1ebft v\u00e0 ch\u1ea3y m\u00e1u n\u00e3o nh\u1ecf c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n nh\u01b0 h\u1ed9i ch\u1ee9ng \u1ed5 khuy\u1ebft, \u0111i\u1ec1u n\u00e0y nh\u1ea5n m\u1ea1nh s\u1ef1 c\u1ea7n thi\u1ebft ph\u1ea3i ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh \u2013 th\u1ea7n kinh th\u00edch h\u1ee3p cho t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n nghi ng\u1edd \u0111\u1ed9t qu\u1ef5 n\u00e3o.
\nNh\u1ed3i m\u00e1u n\u00e3o \u1ed5 khuy\u1ebft \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 l\u00e0 nh\u1eefng t\u1ed5n th\u01b0\u01a1ng d\u01b0\u1edbi v\u1ecf c\u00f3 k\u00edch th\u01b0\u1edbc < 15mm. Tuy nhi\u00ean, m\u1ed9t v\u00e0i nghi\u00ean c\u1ee9u ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh trong giai \u0111o\u1ea1n c\u1ea5p (<10 ng\u00e0y t\u1eeb khi kh\u1edfi ph\u00e1t tri\u1ec7u ch\u1ee9ng) \u0111\u00e3 x\u00e1c \u0111\u1ecbnh gi\u1edbi h\u1ea1n k\u00edch th\u01b0\u1edbc c\u1ee7a \u1ed5 khuy\u1ebft l\u00e0 20mm th\u1eadm ch\u00ed 25mm tr\u00ean xung DWI, v\u00ec theo th\u1eddi gian \u0111a ph\u1ea7n c\u00e1c \u1ed5 t\u1ed5n th\u01b0\u01a1ng s\u1ebd gi\u1ea3m th\u1ec3 t\u00edch. Nh\u01b0 \u0111\u00e3 ph\u00e2n t\u00edch, kh\u00f4ng ph\u1ea3i nh\u1ed3i m\u00e1u n\u00e3o nh\u1ecf n\u00e0o c\u0169ng l\u00e0 nh\u1ed3i m\u00e1u \u1ed5 khuy\u1ebft v\u00e0 vi\u1ec7c ch\u1ea9n \u0111o\u00e1n nh\u1ed3i m\u00e1u \u1ed5 khuy\u1ebft \u0111\u00f2i h\u1ecfi lo\u1ea1i tr\u1eeb c\u00e1c nguy\u00ean nh\u00e2n \u0111\u1ed9t qu\u1ef5 n\u00e3o kh\u00e1c.
\nCLVT s\u1ecd n\u00e3o l\u00e0 l\u1ef1a ch\u1ecdn ban \u0111\u1ea7u cho h\u1ea7u h\u1ebft c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u1ed9t qu\u1ef5 n\u00e3o c\u1ea5p, tuy nhi\u00ean CLVT c\u00f3 \u0111\u1ed9 nh\u1ea1y th\u1ea5p trong ch\u1ea9n \u0111o\u00e1n nh\u1ed3i m\u00e1u \u1ed5 khuy\u1ebft (30 \u2013 44%) [19], th\u1eadm ch\u00ed c\u00f2n c\u00f3 th\u1ec3 th\u1ea5p h\u01a1n trong pha t\u1ed1i c\u1ea5p (< 6 gi\u1edd). CLVT c\u0169ng b\u1ecb h\u1ea1n ch\u1ebf trong vi\u1ec7c x\u00e1c \u0111\u1ecbnh c\u00e1c nh\u1ed3i m\u00e1u c\u1ea5p t\u00ednh h\u1ed1 sau v\u00e0 nh\u1ed3i m\u00e1u v\u00f9ng v\u1ecf n\u00e3o. Do \u0111\u00f3, th\u01b0\u1eddng quan s\u00e1t th\u1ea5y t\u1ed5n th\u01b0\u01a1ng \u1ed5 khuy\u1ebft tr\u00ean CLVT s\u1ecd n\u00e3o \u1edf giai \u0111o\u1ea1n m\u1ea1n t\u00ednh. MRI s\u1ecd n\u00e3o kh\u1eafc ph\u1ee5c \u0111\u01b0\u1ee3c ph\u1ea7n n\u00e0o nh\u1eefng nh\u01b0\u1ee3c \u0111i\u1ec3m tr\u00ean khi x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c ch\u00ednh x\u00e1c v\u1ecb tr\u00ed nh\u1ed3i m\u00e1u m\u1edbi. Tr\u00ean h\u00ecnh \u1ea3nh MRI, \u1ed5 nh\u1ed3i m\u00e1u n\u00e3o \u1ed5 khuy\u1ebft \u0111\u01b0\u1ee3c quan s\u00e1t v\u1edbi t\u00ednh ch\u1ea5t gi\u1ea3m t\u00edn hi\u1ec7u tr\u00ean xung T1W, t\u0103ng t\u00edn hi\u1ec7u tr\u00ean xung T2W, h\u1ea1n ch\u1ebf khu\u1ebfch t\u00e1n tr\u00ean DWI. \u0110\u1ed9 nh\u1ea1y c\u1ee7a MRI l\u00e0 l\u1edbn nh\u1ea5t v\u1edbi th\u1ec3 li\u1ec7t v\u1eadn \u0111\u1ed9ng n\u1eeda ng\u01b0\u1eddi \u0111\u01a1n thu\u1ea7n v\u1edbi vi\u1ec7c ph\u00e1t hi\u1ec7n t\u1edbi 85% s\u1ed1 t\u1ed5n th\u01b0\u01a1ng. MRI th\u01b0\u1eddng th\u1ea5y \u0111\u01b0\u1ee3c c\u00e1c t\u1ed5n th\u01b0\u01a1ng trong v\u00f2ng 8 gi\u1edd k\u1ec3 t\u1eeb khi kh\u1edfi ph\u00e1t tri\u1ec7u ch\u1ee9ng. K\u00edch th\u01b0\u1edbc \u1ed5 t\u1ed5n th\u01b0\u01a1ng c\u1ea5p t\u00ednh tr\u00ean DWI th\u01b0\u1eddng b\u1ecb \u0111\u00e1nh gi\u00e1 cao h\u01a1n k\u00edch th\u01b0\u1edbc th\u1ef1c c\u1ee7a \u1ed5 khuy\u1ebft \u1edf ng\u00e0y th\u1ee9 30 kho\u1ea3ng 40% [20].<\/p>\n

\"\"<\/a>\u00a0\"\"<\/a>\u00a0\"\"<\/a>\u00a0\"\"<\/a><\/p>\n

H\u00ecnh 2. H\u00ecnh \u1ea3nh h\u1ecdc nh\u1ed3i m\u00e1u n\u00e3o \u1ed5 khuy\u1ebft: (A) CLVT sau 24 gi\u1edd t\u1ed5n th\u01b0\u01a1ng gi\u1ea3m t\u1ef7 tr\u1ecdng \u0111\u1ed3i th\u1ecb tr\u00e1i, b\u1ec7nh nh\u00e2n n\u1eef 70 tu\u1ed5i nh\u1ed3i m\u00e1u n\u00e3o \u1ed5 khuy\u1ebft \u0111\u1ed3i th\u1ecb tr\u00e1i; (B) MRI DWI t\u1ed5n th\u01b0\u01a1ng h\u1ea1n ch\u1ebf khu\u1ebfch t\u00e1n \u0111\u1ed3i th\u1ecb ph\u1ea3i, b\u1ec7nh nh\u00e2n nam 70 tu\u1ed5i nh\u1ed3i m\u00e1u n\u00e3o \u1ed5 khuy\u1ebft \u0111\u1ed3i th\u1ecb ph\u1ea3i; (C) (D) MRI t\u1ed5n th\u01b0\u01a1ng h\u1ea1n ch\u1ebf khu\u1ebfch t\u00e1n tr\u00ean DWI v\u00e0 gi\u1ea3m t\u00edn hi\u1ec7u tr\u00ean ADC v\u1ecb tr\u00ed \u0111\u1ed3i th\u1ecb tr\u00e1i, b\u1ec7nh nh\u00e2n nam 85 tu\u1ed5i nh\u1ed3i m\u00e1u n\u00e3o \u1ed5 khuy\u1ebft \u0111\u1ed3i th\u1ecb tr\u00e1i.<\/p>\n

6. \u0110i\u1ec1u tr\u1ecb \u0111\u1ed9t qu\u1ef5 n\u00e3o \u1ed5 khuy\u1ebft<\/strong>
\nB\u1ec7nh nh\u00e2n \u0111\u1ed9t qu\u1ef5 n\u00e3o c\u1ea5p \u0111\u1ebfn s\u1edbm n\u00ean \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 \u0111\u1ec3 tr\u1edf th\u00e0nh \u1ee9ng c\u1eed vi\u00ean cho c\u00e1c li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb t\u00e1i th\u00f4ng, bao g\u1ed3m ti\u00eau s\u1ee3i huy\u1ebft \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch v\u00e0 l\u1ea5y huy\u1ebft kh\u1ed1i c\u01a1 h\u1ecdc. Aspirin v\u00e0 c\u00e1c thu\u1ed1c kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u kh\u00e1c kh\u00f4ng n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong v\u00f2ng 24 gi\u1edd \u0111\u1ea7u sau ti\u00eau s\u1ee3i huy\u1ebft. Ti\u00eau s\u1ee3i huy\u1ebft c\u00f3 li\u00ean quan \u0111\u1ebfn kho\u1ea3ng 6% c\u00e1c ch\u1ea3y m\u00e1u n\u00e3o c\u00f3 tri\u1ec7u ch\u1ee9ng, vi\u1ec7c s\u1eed d\u1ee5ng n\u00ean \u0111\u01b0\u1ee3c th\u1ea3o lu\u1eadn k\u1ef9 v\u1edbi gia \u0111\u00ecnh b\u1ec7nh nh\u00e2n. M\u1eb7t kh\u00e1c, n\u1ebfu kh\u00f4ng c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, thu\u1ed1c kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u n\u00ean \u0111\u01b0\u1ee3c kh\u1edfi \u0111\u1ed9ng c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t khi ch\u1ea9n \u0111o\u00e1n TIA ho\u1eb7c nh\u1ed3i m\u00e1u n\u00e3o, th\u1eadm ch\u00ed tr\u01b0\u1edbc khi c\u01a1 ch\u1ebf ch\u00ednh x\u00e1c c\u1ee7a nh\u1ed3i m\u00e1u \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh.
\nTrong d\u1ef1 ph\u00f2ng th\u1ee9 ph\u00e1t \u0111\u1ed9t qu\u1ef5 n\u00e3o, b\u1ec7nh nh\u00e2n n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa t\u00edch c\u1ef1c v\u00e0 ki\u1ec3m so\u00e1t y\u1ebfu t\u1ed1 nguy c\u01a1, bao g\u1ed3m ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p, li\u1ec7u ph\u00e1p kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u v\u00e0 statin, v\u00e0 \u0111i\u1ec1u ch\u1ec9nh l\u1ed1i s\u1ed1ng. Can thi\u1ec7p n\u00e0y ph\u00f9 h\u1ee3p cho c\u1ea3 b\u1ec7nh nh\u00e2n bi\u1ec3u hi\u1ec7n \u0111\u1ed9t qu\u1ef5 n\u00e3o\/TIA v\u00e0 c\u1ea3 b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 ti\u1ec1n s\u1eed \u0111\u1ed9t qu\u1ef5 nh\u01b0ng c\u00f3 nh\u1ed3i m\u00e1u n\u00e3o \u1ed5 khuy\u1ebft tr\u00ean h\u00ecnh \u1ea3nh h\u1ecdc (nh\u1ed3i m\u00e1u n\u00e3o th\u1ea7m l\u1eb7ng). Tuy nhi\u00ean, l\u1ee3i \u00edch v\u00e0 nguy c\u01a1 c\u1ee7a li\u1ec7u ph\u00e1p kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u ch\u01b0a \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u \u0111\u1ea7y \u0111\u1ee7 \u1edf c\u00e1c b\u1ec7nh nh\u00e2n nh\u1ed3i m\u00e1u \u1ed5 khuy\u1ebft th\u1ea7m l\u1eb7ng.
\nHi\u1ec7u qu\u1ea3 c\u1ee7a aspirin v\u00e0 c\u00e1c li\u1ec7u ph\u00e1p kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u kh\u00e1c trong d\u1ef1 ph\u00f2ng \u0111\u1ed9t qu\u1ef5 n\u00e3o th\u1ee9 ph\u00e1t v\u00e0 t\u1eed vong \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh \u1edf c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u1ed9t qu\u1ef5 n\u00e3o kh\u00f4ng do huy\u1ebft kh\u1ed1i t\u1eeb tim n\u00f3i chung. M\u1ed9t ph\u00e2n t\u00edch g\u1ed9p n\u0103m 2015 \u0111\u00e1nh gi\u00e1 c\u00e1c li\u1ec7u ph\u00e1p kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u so v\u1edbi placebo v\u00e0 b\u00e1o c\u00e1o k\u1ebft qu\u1ea3, trong d\u01b0\u1edbi nh\u00f3m nh\u1ed3i m\u00e1u n\u00e3o \u1ed5 khuy\u1ebft, \u0111i\u1ec1u tr\u1ecb li\u1ec7u ph\u00e1p kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u \u0111\u01a1n li\u00ean quan \u0111\u1ebfn vi\u1ec7c gi\u1ea3m \u0111\u00e1ng k\u1ec3 nguy c\u01a1 nh\u1ed3i m\u00e1u n\u00e3o t\u00e1i ph\u00e1t (RR 0.48, 95% CI 0.30 \u2013 0.78) [21]. K\u1ebft qu\u1ea3 t\u1eeb th\u1eed nghi\u1ec7m SPS3 g\u1ee3i \u00fd vi\u1ec7c s\u1eed d\u1ee5ng kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u k\u00e9p (ph\u1ed1i h\u1ee3p aspirin v\u00e0 clopidogrel) trong th\u1eddi gian d\u00e0i c\u00f3 th\u1ec3 c\u00f3 h\u1ea1i cho b\u1ec7nh nh\u00e2n \u0111\u1ed9t qu\u1ef5 n\u00e3o \u1ed5 khuy\u1ebft do l\u00e0m t\u0103ng nguy c\u01a1 xu\u1ea5t huy\u1ebft v\u00e0 t\u1eed vong nh\u01b0ng kh\u00f4ng l\u00e0m gi\u1ea3m t\u1ef7 l\u1ec7 nh\u1ed3i m\u00e1u t\u00e1i ph\u00e1t [22].<\/p>\n

 <\/p>\n

T\u00c0I LI\u1ec6U THAM KH\u1ea2O
\n1. Dechambre A. M\u00e9moire sur la curabilit\u00e9 du ramollissement c\u00e9r\u00e9bral. Gaz Med Paris 1838; 6:305.
\n2. FISHER CM. LACUNES: SMALL, DEEP CEREBRAL INFARCTS. Neurology 1965; 15:774.
\n3. Gorelick PB. The global burden of stroke: persistent and disabling. Lancet Neurol 2019; 18(5):417-418.
\n4. Petty GW, Brown RD, Whisnant JP, Sicks JD, O\u2019Fallon WM, Wiebers DO. Ischemic stroke subtypes: a population-based study of incidence and risk factors. Stroke 1999; 30(12):2513-6
\n5. Loeb C, Gandolfo C, Croce R, Conti M. Dementia associated with lacunar infarction. Stroke 1992; 23(9):1225-9.
\n6. Fisher CM. Capsular infarcts: the underlying vascular lesions. Arch Neurol 1979; 36:65.
\n7. Feekes JA, Hsu SW, Chaloupka JC, Cassell MD. Tertiary microvascular territories define lacunar infarcts in the basal ganglia. Ann Neurol 2005; 58:18.
\n8. Fisher CM. Lacunar strokes and infarcts: a review. Neurology 1982; 32:871.
\n9. Blevins BL, Vinters HV, Love S, et al. Brain arteriolosclerosis. Acta Neuropathol 2021; 141:1.
\n10. Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol 2010; 9:689.
\n11. Caplan LR. Intracranial branch atheromatous disease: a neglected, understudied, and underused concept. Neurology 1989; 39:1246.
\n12. Macdonald RL, Kowalczuk A, Johns L. Emboli enter penetrating arteries of monkey brain in relation to their size. Stroke 1995; 26:1247.
\n13. Hart RG, Foster JW, Luther MF, Kanter MC. Stroke in infective endocarditis. Stroke 1990; 21:695.
\n14. Cacciatore A, Russo LS Jr. Lacunar infarction as an embolic complication of cardiac and arch angiography. Stroke 1991; 22:1603.
\n15. Wardlaw JM, Sandercock PA, Dennis MS, Starr J. Is breakdown of the blood-brain barrier responsible for lacunar stroke, leukoaraiosis, and dementia? Stroke 2003; 34:806.
\n16. Wardlaw JM. What causes lacunar stroke? J Neurol Neurosurg Psychiatry 2005; 76:617.
\n17. Traylor M, Persyn E, Tomppo L, et al. Genetic basis of lacunar stroke: a pooled analysis of individual patient data and genome-wide association studies. Lancet Neurol 2021; 20:351.
\n18. Chamorro A, Sacco RL, Mohr JP, et al. Clinical-computed tomographic correlations of lacunar infarction in the Stroke Data Bank. Stroke 1991; 22:175.
\n19. Hommel M, Besson G, Le Bas JF, et al. Prospective study of lacunar infarction using magnetic resonance imaging. Stroke 1990; 21:546.
\n20. Koch S, McClendon MS, Bhatia R. Imaging evolution of acute lacunar infarction: leukoariosis or lacune? Neurology 2011; 77:1091.
\n21. Kwok CS, Shoamanesh A, Copley HC, et al. Efficacy of antiplatelet therapy in secondary prevention following lacunar stroke: pooled analysis of randomized trials. Stroke 2015; 46:1014.
\n22. SPS3 Investigators, Benavente OR, Hart RG, et al. Effects of clopidogrel added to aspirin in patients with recent lacunar stroke. N Engl J Med 2012; 367:817.<\/p>\n","protected":false},"excerpt":{"rendered":"

H\u00f4\u0323i ch\u01b0\u0301ng \u00f4\u0309 khuy\u00ea\u0301t\u00a0(lacunar syndomes) l\u00e0 m\u1ed9t bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a \u0111\u1ed9t qu\u1ef5 n\u00e3o \u1ed5 khuy\u1ebft (lacunar infarctions), l\u00e0 m\u1ed9t trong nh\u1eefng nguy\u00ean nh\u00e2n \u0111\u1ed9t qu\u1ef5 n\u00e3o th\u01b0\u1eddng g\u1eb7p nh\u1ea5t \u1edf b\u1ec7nh nh\u00e2n t\u0103ng huy\u1ebft \u00e1p h\u1ec7 th\u1ed1ng m\u1ea1n t\u00ednh. C\u00e1c \u1ed5 khuy\u1ebft n\u00e0y th\u01b0\u1eddng h\u00ecnh th\u00e0nh do s\u1ef1 t\u1eafc ngh\u1ebdn c\u00e1c m\u1ea1ch m\u00e1u […]<\/p>\n","protected":false},"author":42,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[10,33],"tags":[],"yoast_head":"\nH\u00f4\u0323i ch\u01b0\u0301ng \u00f4\u0309 khuy\u00ea\u0301t - Vinmec<\/title>\n<meta name=\"description\" content=\"H\u00f4\u0323i ch\u01b0\u0301ng \u00f4\u0309 khuy\u00ea\u0301t l\u00e0 bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a \u0111\u1ed9t qu\u1ef5 n\u00e3o \u1ed5 khuy\u1ebft, nguy\u00ean nh\u00e2n \u0111\u1ed9t qu\u1ef5 n\u00e3o th\u01b0\u1eddng g\u1eb7p \u1edf t\u0103ng huy\u1ebft \u00e1p h\u1ec7 th\u1ed1ng m\u1ea1n t\u00ednh.\" \/>\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=\"H\u00f4\u0323i ch\u01b0\u0301ng \u00f4\u0309 khuy\u00ea\u0301t - Vinmec\" \/>\n<meta property=\"og:description\" content=\"H\u00f4\u0323i ch\u01b0\u0301ng \u00f4\u0309 khuy\u00ea\u0301t l\u00e0 bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a \u0111\u1ed9t qu\u1ef5 n\u00e3o \u1ed5 khuy\u1ebft, nguy\u00ean nh\u00e2n \u0111\u1ed9t qu\u1ef5 n\u00e3o th\u01b0\u1eddng g\u1eb7p \u1edf t\u0103ng huy\u1ebft \u00e1p h\u1ec7 th\u1ed1ng m\u1ea1n t\u00ednh.\" \/>\n<meta property=\"og:url\" content=\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/hoi-chung-o-khuyet\/\" \/>\n<meta property=\"og:site_name\" content=\"Vinmec\" \/>\n<meta property=\"article:published_time\" content=\"2023-05-06T15:06:50+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/hoithankinhhocvietnam.com.vn\/wp-content\/uploads\/2022\/07\/18.png\" \/>\n<meta name=\"author\" content=\"Minh Nguyen Phuong Hong\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Minh Nguyen Phuong Hong\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"20 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\/05\/06\/hoi-chung-o-khuyet\/\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/hoi-chung-o-khuyet\/\",\"name\":\"H\u00f4\u0323i ch\u01b0\u0301ng \u00f4\u0309 khuy\u00ea\u0301t - Vinmec\",\"isPartOf\":{\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/#website\"},\"datePublished\":\"2023-05-06T15:06:50+00:00\",\"dateModified\":\"2023-05-06T15:06:50+00:00\",\"author\":{\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/03b2d0bc3d50ddac2db2720cc5f983e5\"},\"description\":\"H\u00f4\u0323i ch\u01b0\u0301ng \u00f4\u0309 khuy\u00ea\u0301t l\u00e0 bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a \u0111\u1ed9t qu\u1ef5 n\u00e3o \u1ed5 khuy\u1ebft, nguy\u00ean nh\u00e2n \u0111\u1ed9t qu\u1ef5 n\u00e3o th\u01b0\u1eddng g\u1eb7p \u1edf t\u0103ng huy\u1ebft \u00e1p h\u1ec7 th\u1ed1ng m\u1ea1n t\u00ednh.\",\"breadcrumb\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/hoi-chung-o-khuyet\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/hoi-chung-o-khuyet\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/hoi-chung-o-khuyet\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/noithathoaphat.in\/ctv\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"H\u00f4\u0323i ch\u01b0\u0301ng \u00f4\u0309 khuy\u00ea\u0301t\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/#website\",\"url\":\"https:\/\/noithathoaphat.in\/ctv\/\",\"name\":\"Vinmec\",\"description\":\"H\u1ec7 th\u1ed1ng Y t\u1ebf Vinmec\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/noithathoaphat.in\/ctv\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/03b2d0bc3d50ddac2db2720cc5f983e5\",\"name\":\"Minh Nguyen Phuong Hong\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/image\/\",\"url\":\"http:\/\/0.gravatar.com\/avatar\/6abe0451bc535a2494837653d4fdba14?s=96&d=mm&r=g\",\"contentUrl\":\"http:\/\/0.gravatar.com\/avatar\/6abe0451bc535a2494837653d4fdba14?s=96&d=mm&r=g\",\"caption\":\"Minh Nguyen Phuong Hong\"},\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/author\/helennguyen24062002gmail-com\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"H\u00f4\u0323i ch\u01b0\u0301ng \u00f4\u0309 khuy\u00ea\u0301t - Vinmec","description":"H\u00f4\u0323i ch\u01b0\u0301ng \u00f4\u0309 khuy\u00ea\u0301t l\u00e0 bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a \u0111\u1ed9t qu\u1ef5 n\u00e3o \u1ed5 khuy\u1ebft, nguy\u00ean nh\u00e2n \u0111\u1ed9t qu\u1ef5 n\u00e3o th\u01b0\u1eddng g\u1eb7p \u1edf t\u0103ng huy\u1ebft \u00e1p h\u1ec7 th\u1ed1ng m\u1ea1n t\u00ednh.","robots":{"index":"noindex","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"og_locale":"en_US","og_type":"article","og_title":"H\u00f4\u0323i ch\u01b0\u0301ng \u00f4\u0309 khuy\u00ea\u0301t - Vinmec","og_description":"H\u00f4\u0323i ch\u01b0\u0301ng \u00f4\u0309 khuy\u00ea\u0301t l\u00e0 bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a \u0111\u1ed9t qu\u1ef5 n\u00e3o \u1ed5 khuy\u1ebft, nguy\u00ean nh\u00e2n \u0111\u1ed9t qu\u1ef5 n\u00e3o th\u01b0\u1eddng g\u1eb7p \u1edf t\u0103ng huy\u1ebft \u00e1p h\u1ec7 th\u1ed1ng m\u1ea1n t\u00ednh.","og_url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/hoi-chung-o-khuyet\/","og_site_name":"Vinmec","article_published_time":"2023-05-06T15:06:50+00:00","og_image":[{"url":"http:\/\/hoithankinhhocvietnam.com.vn\/wp-content\/uploads\/2022\/07\/18.png"}],"author":"Minh Nguyen Phuong Hong","twitter_card":"summary_large_image","twitter_misc":{"Written by":"Minh Nguyen Phuong Hong","Est. reading time":"20 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/hoi-chung-o-khuyet\/","url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/hoi-chung-o-khuyet\/","name":"H\u00f4\u0323i ch\u01b0\u0301ng \u00f4\u0309 khuy\u00ea\u0301t - Vinmec","isPartOf":{"@id":"https:\/\/noithathoaphat.in\/ctv\/#website"},"datePublished":"2023-05-06T15:06:50+00:00","dateModified":"2023-05-06T15:06:50+00:00","author":{"@id":"https:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/03b2d0bc3d50ddac2db2720cc5f983e5"},"description":"H\u00f4\u0323i ch\u01b0\u0301ng \u00f4\u0309 khuy\u00ea\u0301t l\u00e0 bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a \u0111\u1ed9t qu\u1ef5 n\u00e3o \u1ed5 khuy\u1ebft, nguy\u00ean nh\u00e2n \u0111\u1ed9t qu\u1ef5 n\u00e3o th\u01b0\u1eddng g\u1eb7p \u1edf t\u0103ng huy\u1ebft \u00e1p h\u1ec7 th\u1ed1ng m\u1ea1n t\u00ednh.","breadcrumb":{"@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/hoi-chung-o-khuyet\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/hoi-chung-o-khuyet\/"]}]},{"@type":"BreadcrumbList","@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/hoi-chung-o-khuyet\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/noithathoaphat.in\/ctv\/"},{"@type":"ListItem","position":2,"name":"H\u00f4\u0323i ch\u01b0\u0301ng \u00f4\u0309 khuy\u00ea\u0301t"}]},{"@type":"WebSite","@id":"https:\/\/noithathoaphat.in\/ctv\/#website","url":"https:\/\/noithathoaphat.in\/ctv\/","name":"Vinmec","description":"H\u1ec7 th\u1ed1ng Y t\u1ebf Vinmec","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/noithathoaphat.in\/ctv\/?s={search_term_string}"},"query-input":"required name=search_term_string"}],"inLanguage":"en-US"},{"@type":"Person","@id":"https:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/03b2d0bc3d50ddac2db2720cc5f983e5","name":"Minh Nguyen Phuong Hong","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/image\/","url":"http:\/\/0.gravatar.com\/avatar\/6abe0451bc535a2494837653d4fdba14?s=96&d=mm&r=g","contentUrl":"http:\/\/0.gravatar.com\/avatar\/6abe0451bc535a2494837653d4fdba14?s=96&d=mm&r=g","caption":"Minh Nguyen Phuong Hong"},"url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/author\/helennguyen24062002gmail-com\/"}]}},"_links":{"self":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/29938"}],"collection":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/users\/42"}],"replies":[{"embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/comments?post=29938"}],"version-history":[{"count":3,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/29938\/revisions"}],"predecessor-version":[{"id":32734,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/29938\/revisions\/32734"}],"wp:attachment":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/media?parent=29938"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/categories?post=29938"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/tags?post=29938"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}