{"id":30977,"date":"2023-05-06T21:55:54","date_gmt":"2023-05-06T14:55:54","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=30977"},"modified":"2023-05-06T21:55:54","modified_gmt":"2023-05-06T14:55:54","slug":"benh-nao-sau-co-hoi-phuc-pres-co-that-mach-nao-co-hoi-phuc-rcvs","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/benh-nao-sau-co-hoi-phuc-pres-co-that-mach-nao-co-hoi-phuc-rcvs\/","title":{"rendered":"H\u1ed9i ch\u1ee9ng b\u1ec7nh n\u00e3o sau c\u00f3 h\u1ed3i ph\u1ee5c PRES v\u00e0 h\u1ed9i ch\u1ee9ng co th\u1eaft m\u1ea1ch n\u00e3o c\u00f3 h\u1ed3i ph\u1ee5c RCVS"},"content":{"rendered":"

Ba\u0300i vi\u00ea\u0301t H\u1ed9i ch\u1ee9ng b\u1ec7nh n\u00e3o sau c\u00f3 h\u1ed3i ph\u1ee5c (PRES) v\u00e0 h\u1ed9i ch\u1ee9ng co th\u1eaft m\u1ea1ch n\u00e3o c\u00f3 h\u1ed3i ph\u1ee5c (RCVS) tri\u0301ch ngu\u00f4\u0300n t\u01b0\u0300 H\u00f4\u0323i Th\u00e2\u0300n kinh ho\u0323c Vi\u00ea\u0323t Nam. <\/strong><\/em><\/p>\n

T\u00e1c gi\u1ea3: Aneesh B. Singhal<\/strong><\/em>
\nBi\u00ean d\u1ecbch: BS. Nguy\u1ec5n Ng\u1ecdc L\u01b0\u01a1ng<\/strong><\/em>
\nHi\u1ec7u \u0111\u00ednh: BS. Hu\u1ef3nh \u0110\u0103ng L\u1ed9c, BS. Ho\u00e0ng Ti\u1ebfn Tr\u1ecdng Ngh\u0129a\u00a0\u00a0<\/strong><\/em>
\nKhoa N\u1ed9i Th\u1ea7n kinh, B\u1ec7nh vi\u1ec7n Qu\u00e2n y 175<\/em><\/p>\n

1. T\u1ed4NG QUAN<\/strong><\/h2>\n

M\u1ee5c ti\u00eau:<\/strong>\u00a0B\u00e0i vi\u1ebft n\u00e0y m\u00f4 t\u1ea3 nguy\u00ean nh\u00e2n, \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng v\u00e0 h\u00ecnh \u1ea3nh h\u1ecdc, h\u01b0\u1edbng x\u1eed tr\u00ed v\u00e0 ti\u00ean l\u01b0\u1ee3ng c\u1ee7a h\u1ed9i ch\u1ee9ng b\u1ec7nh n\u00e3o sau c\u00f3 h\u1ed3i ph\u1ee5c (PRES) v\u00e0 h\u1ed9i ch\u1ee9ng co th\u1eaft m\u1ea1ch n\u00e3o c\u00f3 h\u1ed3i ph\u1ee5c (RCVS), b\u1ec7nh l\u00fd m\u00e0 sinh l\u00fd b\u1ec7nh c\u01a1 b\u1ea3n \u0111\u1ec1u li\u00ean quan \u0111\u1ebfn r\u1ed1i lo\u1ea1n \u0111i\u1ec1u h\u00f2a c\u00f3 h\u1ed3i ph\u1ee5c c\u1ee7a m\u1ea1ch m\u00e1u n\u00e3o.
\nPh\u00e1t hi\u1ec7n g\u1ea7n \u0111\u00e2y:<\/strong>\u00a0PRES v\u00e0 RCVS l\u00e0 nh\u1eefng thu\u1eadt ng\u1eef d\u00f9ng \u0111\u1ec3 m\u00f4 t\u1ea3 hai t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd v\u1edbi c\u00e1c bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng v\u00e0 h\u00ecnh \u1ea3nh h\u1ecdc t\u01b0\u01a1ng t\u1ef1 nhau. Nh\u1ee9c \u0111\u1ea7u, tri\u1ec7u ch\u1ee9ng th\u1ecb gi\u00e1c, co gi\u1eadt v\u00e0 l\u00fa l\u1eabn x\u1ea3y ra \u1edf c\u1ea3 hai h\u1ed9i ch\u1ee9ng. RCVS th\u01b0\u1eddng kh\u1edfi ph\u00e1t b\u1eb1ng nh\u1eefng c\u01a1n \u0111au \u0111\u1ea7u ki\u1ec3u s\u00e9t \u0111\u00e1nh t\u00e1i ph\u00e1t, trong khi b\u1ec7nh n\u00e3o v\u00e0 co gi\u1eadt l\u00e0 nh\u1eefng bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng \u0111i\u1ec3n h\u00ecnh trong PRES. Trong PRES, h\u00ecnh ch\u1ee5p n\u00e3o cho th\u1ea5y h\u00ecnh \u1ea3nh ph\u00f9 c\u0103n nguy\u00ean m\u1ea1ch c\u00f3 th\u1ec3 h\u1ed3i ph\u1ee5c, th\u01b0\u1eddng \u0111\u1ed1i x\u1ee9ng v\u00e0 n\u1eb1m \u1edf c\u00e1c v\u00f9ng d\u01b0\u1edbi v\u1ecf (ch\u1ee7 y\u1ebfu l\u00e0 v\u00f9ng n\u00e3o ph\u00eda sau). Trong RCVS, h\u00ecnh ch\u1ee5p n\u00e3o th\u01b0\u1eddng b\u00ecnh th\u01b0\u1eddng; ch\u1ee5p \u0111\u1ed9ng m\u1ea1ch n\u00e3o cho th\u1ea5y s\u1ef1 co m\u1ea1ch-gi\u00e3n m\u1ea1ch theo t\u1eebng ph\u00e2n \u0111o\u1ea1n, ch\u1ee7 y\u1ebfu \u1edf c\u00e1c \u0111\u1ed9ng m\u1ea1ch thu\u1ed9c \u0111a gi\u00e1c Willis v\u00e0 c\u00e1c nh\u00e1nh c\u1ee7a ch\u00fang. Ngo\u00e0i c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng t\u01b0\u01a1ng t\u1ef1, c\u00f2n t\u1ed3n t\u1ea1i s\u1ef1 tr\u00f9ng l\u1eafp \u0111\u00e1ng k\u1ec3 tr\u00ean h\u00ecnh \u1ea3nh h\u1ecdc gi\u1eefa hai h\u1ed9i ch\u1ee9ng n\u00e0y. C\u1ea3 PRES v\u00e0 RCVS \u0111\u1ec1u c\u00f3 th\u1ec3 c\u00f3 h\u00ecnh \u1ea3nh nh\u1ed3i m\u00e1u v\u00e0 xu\u1ea5t huy\u1ebft; ngo\u00e0i ra, b\u1ea5t th\u01b0\u1eddng m\u1ea1ch m\u00e1u v\u1eabn th\u01b0\u1eddng x\u1ea3y ra trong PRES v\u00e0 ng\u01b0\u1ee3c l\u1ea1i th\u00ec t\u1ed5n th\u01b0\u01a1ng ph\u00f9 c\u0103n nguy\u00ean m\u1ea1ch v\u1eabn c\u00f3 th\u1ec3 g\u1eb7p trong RCVS. C\u00e1c y\u1ebfu t\u1ed1 k\u00edch g\u1ee3i th\u01b0\u1eddng g\u1eb7p (v\u00ed d\u1ee5 s\u1ea3n gi\u1eadt, thu\u1ed1c co m\u1ea1ch v\u00e0 h\u00f3a tr\u1ecb li\u1ec7u) c\u0169ng \u0111\u00e3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh. B\u1ea5t th\u01b0\u1eddng tr\u01b0\u01a1ng l\u1ef1c m\u1ea1ch m\u00e1u n\u00e3o v\u00e0 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng n\u1ed9i m\u00f4 c\u00f3 th\u1ec3 gi\u1ea3i th\u00edch cho c\u1ea3 hai h\u1ed9i ch\u1ee9ng. Qu\u1ea3n l\u00fd c\u00e1c h\u1ed9i ch\u1ee9ng n\u00e0y bao g\u1ed3m lo\u1ea1i b\u1ecf c\u00e1c y\u1ebfu t\u1ed1 k\u00edch g\u1ee3i \u0111\u00e3 x\u00e1c \u0111\u1ecbnh, \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng \u0111au \u0111\u1ea7u ho\u1eb7c co gi\u1eadt v\u00e0 ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p trung b\u00ecnh. C\u1ea3 hai h\u1ed9i ch\u1ee9ng \u0111\u1ec1u t\u1ef1 gi\u1edbi h\u1ea1n, v\u1edbi s\u1ef1 ph\u1ee5c h\u1ed3i l\u00e2m s\u00e0ng x\u1ea3y ra trong v\u00e0i ng\u00e0y \u0111\u1ebfn v\u00e0i tu\u1ea7n. T\u1ef7 l\u1ec7 c\u00f2n t\u1ed3n t\u1ea1i tri\u1ec7u ch\u1ee9ng ho\u1eb7c t\u1eed vong l\u00e0 kh\u00f4ng ph\u1ed5 bi\u1ebfn..
\nT\u00f3m t\u1eaft:<\/strong>\u00a0PRES v\u00e0 RCVS \u0111\u00e3 \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 l\u00e0 hai h\u1ed9i ch\u1ee9ng c\u00f3 s\u1ef1 ch\u1ed3ng ch\u00e9o \u0111\u00e1ng k\u1ec3 v\u1ec1 l\u00e2m s\u00e0ng v\u00e0 h\u00ecnh \u1ea3nh h\u1ecdc. Nh\u1eefng ti\u1ebfn b\u1ed9 trong hi\u1ec3u bi\u1ebft c\u1ee7a ch\u00fang ta v\u1ec1 sinh l\u00fd b\u1ec7nh v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 ti\u00ean l\u01b0\u1ee3ng x\u1ea5u \u0111\u01b0\u1ee3c k\u1ef3 v\u1ecdng s\u1ebd t\u1ed1i \u01b0u h\u00f3a vi\u1ec7c qu\u1ea3n l\u00fd c\u00e1c h\u1ed9i ch\u1ee9ng kh\u00f4ng hi\u1ebfm g\u1eb7p n\u00e0y.<\/p>\n

2. GI\u1edaI THI\u1ec6U V\u00ca\u0300 PRES VA\u0300 RCVS<\/strong><\/h2>\n

B\u1ec7nh nh\u00e2n c\u00f3 c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng v\u00e0 h\u00ecnh \u1ea3nh h\u1ecdc ph\u00f9 h\u1ee3p v\u1edbi h\u1ed9i ch\u1ee9ng b\u1ec7nh n\u00e3o ph\u00eda sau c\u00f3 h\u1ed3i ph\u1ee5c (PRES) v\u00e0 h\u1ed9i ch\u1ee9ng co th\u1eaft m\u1ea1ch m\u00e1u n\u00e3o c\u00f3 h\u1ed3i ph\u1ee5c (RCVS) \u0111\u00e3 \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 trong c\u00e1c b\u00e1o c\u00e1o ca ho\u1eb7c lo\u1ea1t ca t\u1eeb nh\u1eefng n\u0103m 1960. M\u00f4 t\u1ea3 c\u00f3 h\u1ec7 th\u1ed1ng \u0111\u1ea7u ti\u00ean v\u1ec1 PRES l\u00e0 v\u00e0o n\u0103m 1996 l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a vi\u1ec7c nh\u00f3m chung l\u1ea1i m\u1ed9t s\u1ed1 t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd \u0111\u00e3 \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 tr\u01b0\u1edbc \u0111\u00e2y (v\u00ed d\u1ee5, b\u1ec7nh n\u00e3o t\u0103ng huy\u1ebft \u00e1p v\u00e0 b\u1ec7nh n\u00e3o do t\u0103ng ur\u00ea m\u00e1u, ti\u1ec1n s\u1ea3n gi\u1eadt\/s\u1ea3n gi\u1eadt, v\u00e0 b\u1ec7nh n\u00e3o li\u00ean quan \u0111\u1ebfn h\u00f3a tr\u1ecb v\u00e0 mi\u1ec5n d\u1ecbch) d\u1ef1a tr\u00ean \u0111\u1eb7c \u0111i\u1ec3m chung v\u1ec1 h\u00ecnh \u1ea3nh h\u1ecdc c\u1ee7a ch\u00fang l\u00e0 ph\u00f9 n\u00e3o do m\u1ea1ch m\u00e1u \u01b0u th\u1ebf \u1edf v\u00f9ng n\u00e3o ph\u00eda sau v\u00e0 th\u01b0\u1eddng t\u1ef1 h\u1ed3i ph\u1ee5c. Kh\u00e1i ni\u1ec7m RCVS c\u0169ng \u0111\u01b0\u1ee3c h\u00ecnh th\u00e0nh t\u01b0\u01a1ng t\u1ef1: thu\u1eadt ng\u1eef h\u1ed9i ch\u1ee9ng co th\u1eaft m\u1ea1ch m\u00e1u n\u00e3o \u0111\u01b0\u1ee3c gi\u1edbi thi\u1ec7u c\u00e1ch \u0111\u00e2y g\u1ea7n 2 th\u1eadp k\u1ef7 \u0111\u1ec3 nh\u00f3m chung c\u00e1c t\u00ecnh tr\u1ea1ng b\u1ecb h\u1eb9p v\u00e0 gi\u00e3n \u0111\u1ed9ng m\u1ea1ch n\u00e3o t\u1eebng \u0111o\u1ea1n c\u1ea5p t\u00ednh v\u00e0 c\u00f3 h\u1ed3i ph\u1ee5c, th\u01b0\u1eddng kh\u1edfi ph\u00e1t b\u1eb1ng tri\u1ec7u ch\u1ee9ng \u0111au \u0111\u1ea7u s\u00e9t \u0111\u00e1nh (v\u00ed d\u1ee5 b\u1ec7nh m\u1ea1ch m\u00e1u n\u00e3o sau sinh; co th\u1eaft m\u1ea1ch m\u00e1u n\u00e3o li\u00ean quan \u0111\u1ebfn thu\u1ed1c, h\u00f3a tr\u1ecb v\u00e0 c\u00e1c ch\u1ea5t \u0111i\u1ec1u bi\u1ebfn mi\u1ec5n d\u1ecbch; h\u1ed9i ch\u1ee9ng Call ho\u1eb7c Call-Fleming; vi\u00eam m\u1ea1ch m\u00e1u n\u1eeda \u0111\u1ea7u; gi\u1ea3 vi\u00eam m\u1ea1ch h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng; v\u00e0 b\u1ec7nh m\u1ea1ch m\u00e1u l\u00e0nh t\u00ednh c\u1ee7a h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng). Trong v\u00e0i n\u0103m qua, m\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u \u0111o\u00e0n h\u1ec7 ti\u1ebfn c\u1ee9u v\u00e0 h\u1ed3i c\u1ee9u v\u00e0 c\u00e1c b\u00e0i b\u00e1o t\u1ed5ng quan \u0111\u00e3 m\u00f4 t\u1ea3 to\u00e0n di\u1ec7n PRES v\u00e0 RCVS d\u1eabn \u0111\u1ebfn vi\u1ec7c ch\u00fang \u0111\u01b0\u1ee3c th\u1eeba nh\u1eadn nh\u01b0 l\u00e0 h\u1ed9i ch\u1ee9ng r\u1ed1i lo\u1ea1n \u0111i\u1ec1u h\u00f2a m\u1ea1ch m\u00e1u n\u00e3o h\u1ea7u nh\u01b0 lu\u00f4n c\u00f3 th\u1ec3 \u0111\u1ea3o ng\u01b0\u1ee3c v\u00e0 t\u1ef1 gi\u1edbi h\u1ea1n trong di\u1ec5n ti\u1ebfn l\u00e2m s\u00e0ng c\u1ee7a ch\u00fang. Ngo\u00e0i ra, b\u1ec7nh nh\u00e2n c\u00f3 c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a c\u1ea3 hai h\u1ed9i ch\u1ee9ng (h\u1ed9i ch\u1ee9ng trung l\u1eafp gi\u1eefa PRES \/ RCVS) \u0111\u00e3 \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 v\u00e0 nh\u1eefng \u0111i\u1ec3m t\u01b0\u01a1ng \u0111\u1ed3ng gi\u1eefa PRES v\u00e0 RCVS v\u1ec1 bi\u1ec3u hi\u1ec7n c\u00e1c tri\u1ec7u ch\u1ee9ng, bi\u1ebfn ch\u1ee9ng v\u00e0 h\u00ecnh \u1ea3nh h\u1ecdc \u0111\u00e3 \u0111\u01b0\u1ee3c c\u00f4ng nh\u1eadn, d\u1eabn \u0111\u1ebfn kh\u00e1i ni\u1ec7m v\u1ec1 s\u1ef1 tr\u00f9ng l\u1eafp sinh l\u00fd b\u1ec7nh. C\u1ea3 hai h\u1ed9i ch\u1ee9ng n\u00e0y \u0111\u1ec1u th\u01b0\u1eddng g\u1eb7p trong khoa c\u1ea5p c\u1ee9u v\u00e0 c\u01a1 s\u1edf ch\u0103m s\u00f3c \u0111\u1eb7c bi\u1ec7t v\u1ec1 th\u1ea7n kinh c\u0169ng nh\u01b0 tr\u00ean c\u00e1c khoa \u0111i\u1ec1u tr\u1ecb n\u1ed9i tr\u00fa. B\u00e0i vi\u1ebft n\u00e0y \u0111\u00e1nh gi\u00e1 nh\u1eefng \u0111i\u1ec3m gi\u1ed1ng nhau c\u1ee7a PRES v\u00e0 RCVS v\u00e0 s\u1ef1 kh\u00e1c bi\u1ec7t v\u1ec1 y\u1ebfu t\u1ed1 k\u00edch g\u1ee3i, c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m v\u1ec1 l\u00e2m s\u00e0ng, h\u00ecnh \u1ea3nh h\u1ecdc, sinh l\u00fd b\u1ec7nh, qu\u1ea3n l\u00fd v\u00e0 ti\u00ean l\u01b0\u1ee3ng c\u1ee7a ch\u00fang.<\/p>\n

3. D\u1ecaCH T\u1ec4 HO\u0323C PRES VA\u0300 RCVS<\/strong><\/h2>\n

Hai th\u1eadp k\u1ef7 qua \u0111\u00e3 ch\u1ee9ng ki\u1ebfn s\u1ef1 b\u00f9ng n\u1ed5 c\u1ee7a c\u00e1c b\u00e1o c\u00e1o \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1 v\u1ec1 PRES v\u00e0 RCVS nh\u1edd v\u00e0o \u0111\u1eb7c \u0111i\u1ec3m \u0111\u1eb7c tr\u01b0ng c\u1ee7a ch\u00fang k\u1ebft h\u1ee3p v\u1edbi vi\u1ec7c ch\u1ea9n \u0111o\u00e1n d\u1ec5 d\u00e0ng h\u01a1n do vi\u1ec7c s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i CT, MRI n\u00e3o, m\u1ea1ch n\u00e3o. Tr\u01b0\u1edbc \u0111\u00e2y \u0111\u01b0\u1ee3c coi l\u00e0 hi\u1ebfm g\u1eb7p, tuy nhi\u00ean PRES v\u00e0 RCVS hi\u1ec7n g\u1eb7p th\u01b0\u1eddng xuy\u00ean trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng, theo ICD-10 c\u00e1c m\u00e3 c\u1ee7a h\u1ed9i ch\u1ee9ng tr\u00ean l\u1ea7n l\u01b0\u1ee3t l\u00e0 (PRES, I67.83; RCVS, I67.841). PRES c\u00f3 th\u1ec3 g\u1eb7p \u1edf m\u1ecdi l\u1ee9a tu\u1ed5i, m\u1eb7c d\u00f9 ph\u1ed5 bi\u1ebfn nh\u1ea5t l\u00e0 ng\u01b0\u1eddi tr\u1ebb ho\u1eb7c trung ni\u00ean v\u00e0 c\u00f3 \u01b0u th\u1ebf l\u00e0 n\u1eef. PRES \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o \u1edf 0,4%-8% ng\u01b0\u1eddi l\u1edbn v\u00e0 2%-25% tr\u1ebb em \u0111\u01b0\u1ee3c gh\u00e9p t\u1ea1ng ho\u1eb7c t\u1ee7y x\u01b0\u01a1ng v\u00e0 l\u00ean \u0111\u1ebfn 25% b\u1ec7nh nh\u00e2n b\u1ecb b\u1ec7nh l\u00fd t\u1ef1 mi\u1ec5n, nhi\u1ec5m tr\u00f9ng ho\u1eb7c b\u1ec7nh th\u1eadn m\u1ea1n giai \u0111o\u1ea1n cu\u1ed1i. \u1ede tr\u1ebb em, PRES \u0111\u01b0\u1ee3c quan s\u00e1t th\u1ea5y \u1edf 0,4% s\u1ed1 ca nh\u1eadp vi\u1ec7n h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c v\u00e0 chi\u1ebfm 0,04% s\u1ed1 ca nh\u1eadp vi\u1ec7n, v\u1edbi t\u1ef7 l\u1ec7 t\u1eed vong l\u00e0 3,2%. C\u00e1c b\u00e1o c\u00e1o v\u1ec1 RCVS bao g\u1ed3m h\u01a1n 1200 b\u1ec7nh nh\u00e2n t\u1eeb c\u00e1c n\u01a1i, ch\u1ee7ng t\u1ed9c v\u00e0 d\u00e2n t\u1ed9c kh\u00e1c nhau ch\u1ec9 trong 15 n\u0103m qua. \u0110\u1ed9 tu\u1ed5i t\u1eeb 4 th\u00e1ng \u0111\u1ebfn 82 tu\u1ed5i, v\u1edbi tu\u1ed5i trung b\u00ecnh l\u00e0 42 \u0111\u1ebfn trong c\u00e1c nghi\u00ean c\u1ee9u \u0111o\u00e0n h\u1ec7 l\u1edbn. T\u1ef7 l\u1ec7 n\u1eef tr\u00ean nam dao \u0111\u1ed9ng t\u1eeb 2: 1 \u0111\u1ebfn 10: 1 trong c\u00e1c nghi\u00ean c\u1ee9u \u0111o\u00e0n h\u1ec7. Tuy nhi\u00ean, \u1edf tr\u1ebb em, nam gi\u1edbi chi\u1ebfm \u01b0u th\u1ebf h\u01a1n. Nam gi\u1edbi b\u1ecb th\u01b0\u1eddng \u1edf \u0111\u1ed9 tu\u1ed5i tr\u1ebb h\u01a1n, b\u1eaft \u0111\u1ea7u ho\u1ea1t \u0111\u1ed9ng t\u00ecnh d\u1ee5c th\u01b0\u1eddng xuy\u00ean h\u01a1n (CASE 5-1) v\u00e0 l\u00e0nh t\u00ednh h\u01a1n n\u1eef gi\u1edbi.<\/p>\n

4. \u0110\u1eb6C \u0110I\u1ec2M L\u00c2M S\u00c0NG CU\u0309A PRES VA\u0300 RCVS<\/strong><\/h2>\n

PRES c\u00f3 th\u1ec3 kh\u1edfi ph\u00e1t c\u1ea5p t\u00ednh ho\u1eb7c b\u00e1n c\u1ea5p ho\u1eb7c c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n tr\u00ean h\u00ecnh \u1ea3nh h\u1ecdc trong qu\u00e1 tr\u00ecnh \u0111\u00e1nh gi\u00e1 \u0111\u1ecbnh k\u1ef3 c\u00e1c kh\u1ed1i u ho\u1eb7c b\u1ec7nh n\u00e3o. H\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n c\u00f3 bi\u1ec3u hi\u1ec7n l\u00fa l\u1eabn ho\u1eb7c b\u1ec7nh n\u00e3o c\u1ea5p t\u00ednh (B\u1ea2NG 5-1). \u0110\u1ed9ng kinh c\u01a1n co c\u1ee9ng co gi\u1eadt to\u00e0n th\u1ec3 ho\u1eb7c c\u01a1n \u0111\u1ed9ng kinh d\u01b0\u1edbi l\u00e2m s\u00e0ng (v\u00ed d\u1ee5, gai s\u00f3ng v\u00f9ng ch\u1ea9m tr\u00ean \u0111i\u1ec7n n\u00e3o \u0111\u1ed3) g\u1eb7p \u1edf kho\u1ea3ng 2\/3 s\u1ed1 b\u1ec7nh nh\u00e2n. PRES n\u00ean \u0111\u01b0\u1ee3c ngh\u0129 \u0111\u1ebfn \u1edf b\u1ea5t k\u1ef3 b\u1ec7nh nh\u00e2n n\u00e0o c\u00f3 r\u1ed1i lo\u1ea1n \u00fd th\u1ee9c kh\u00f4ng gi\u1ea3i th\u00edch \u0111\u01b0\u1ee3c \u0111\u1eb7c bi\u1ec7t \u1edf nh\u1eefng ng\u01b0\u1eddi t\u0103ng huy\u1ebft \u00e1p, suy th\u1eadn, suy gi\u1ea3m mi\u1ec5n d\u1ecbch ho\u1eb7c \u0111ang \u0111i\u1ec1u tr\u1ecb h\u00f3a ch\u1ea5t. T\u0103ng huy\u1ebft \u00e1p n\u1eb7ng th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n, m\u1eb7c d\u00f9 PRES v\u1eabn c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n m\u00e0 kh\u00f4ng c\u00f3 t\u0103ng huy\u1ebft \u00e1p. Nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng b\u1ecb b\u1ec7nh n\u00e3o n\u1eb7ng th\u01b0\u1eddng nh\u1edb l\u1ea1i nh\u1eefng c\u01a1n \u0111au \u0111\u1ea7u v\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng th\u1ecb gi\u00e1c. \u0110au \u0111\u1ea7u c\u00f3 th\u1ec3 \u0111\u1ed9t ng\u1ed9t v\u00e0 d\u1eef d\u1ed9i nh\u01b0ng ph\u1ed5 bi\u1ebfn h\u01a1n l\u00e0 t\u1eeb t\u1eeb, lan t\u1ecfa v\u00e0 t\u1ef1 gi\u1edbi h\u1ea1n. C\u00e1c tri\u1ec7u ch\u1ee9ng th\u1ecb gi\u00e1c bao g\u1ed3m nh\u00ecn m\u1edd, \u00e1m \u0111i\u1ec3m th\u1eadm ch\u00ed m\u00f9 v\u1ecf n\u00e3o. Th\u1ecb l\u1ef1c th\u01b0\u1eddng h\u1ed3i ph\u1ee5c khi \u0111i\u1ec1u tr\u1ecb kh\u1ecfi b\u1ec7nh n\u00e3o. B\u1ec7nh nh\u00e2n hi\u1ebfm c\u00f3 bi\u1ebfn ch\u1ee9ng c\u1ee7a PRES, ch\u1eb3ng h\u1ea1n nh\u01b0 nh\u1ed3i m\u00e1u ho\u1eb7c xu\u1ea5t huy\u1ebft n\u00e3o v\u00f9ng ch\u1ea9m d\u1eabn \u0111\u1ebfn c\u00e1c tri\u1ec7u ch\u1ee9ng th\u1ecb gi\u00e1c kh\u00f4ng th\u1ec3 \u0111\u1ea3o ng\u01b0\u1ee3c ho\u1eb7c c\u00e1c thi\u1ebfu h\u1ee5t th\u1ea7n kinh khu tr\u00fa kh\u00e1c nh\u01b0 li\u1ec7t n\u1eeda ng\u01b0\u1eddi. C\u00e1c bi\u1ec3u hi\u1ec7n c\u1ed9t s\u1ed1ng c\u0169ng \u0111\u00e3 \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 trong m\u1ed9t s\u1ed1 \u00edt tr\u01b0\u1eddng h\u1ee3p, th\u01b0\u1eddng l\u00e0 ph\u00f9 t\u1ee7y s\u1ed1ng c\u1ed5 tr\u00ean MRI (c\u00f3 ho\u1eb7c kh\u00f4ng c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ed9t s\u1ed1ng).
\nC\u00e1c tri\u1ec7u ch\u1ee9ng RCVS tr\u00f9ng l\u1eafp v\u1edbi c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a PRES (nh\u1ee9c \u0111\u1ea7u, co gi\u1eadt, c\u00e1c tri\u1ec7u ch\u1ee9ng th\u1ecb gi\u00e1c, b\u1ec7nh n\u00e3o); tuy nhi\u00ean, s\u1ef1 kh\u00e1c bi\u1ec7t r\u00f5 r\u00e0ng c\u0169ng \u0111\u01b0\u1ee3c ghi nh\u1eadn (B\u1ea2NG 5-1). Nh\u01b0 \u0111\u00e3 n\u00eau r\u00f5 trong CASE 5-1, RCVS th\u01b0\u1eddng kh\u1edfi ph\u00e1t c\u1ea5p t\u00ednh v\u1edbi c\u01a1n \u0111au \u0111\u1ea7u d\u1eef d\u1ed9i \u0111\u1ea1t \u0111\u1ebfn \u0111\u1ec9nh \u0111i\u1ec3m trong v\u00f2ng 1 ph\u00fat (\u0111au \u0111\u1ea7u ki\u1ec3u s\u00e9t \u0111\u00e1nh, t\u01b0\u01a1ng t\u1ef1 nh\u01b0 \u0111au \u0111\u1ea7u c\u1ee7a v\u1ee1 t\u00fai ph\u00ecnh v\u00e0 c\u00e1c t\u00ecnh tr\u1ea1ng nghi\u00eam tr\u1ecdng kh\u00e1c \u0111\u01b0\u1ee3c th\u1ea3o lu\u1eadn trong ph\u1ea7n ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t). \u0110au \u0111\u1ea7u ki\u1ec3u s\u00e9t \u0111\u00e1nh t\u00e1i ph\u00e1t \u1edf kho\u1ea3ng 85% \u0111\u1ebfn 90% b\u1ec7nh nh\u00e2n, v\u1edbi trung b\u00ecnh b\u1ed1n l\u1ea7n t\u00e1i ph\u00e1t trong kho\u1ea3ng t\u1eeb 1 \u0111\u1ebfn 4 tu\u1ea7n, th\u01b0\u1eddng kh\u1edfi ph\u00e1t khi g\u1eafng s\u1ee9c ho\u1eb7c th\u1ef1c hi\u1ec7n nghi\u1ec7m ph\u00e1p Valsalva; tuy nhi\u00ean, c\u01b0\u1eddng \u0111\u1ed9 v\u00e0 t\u1ea7n s\u1ed1 c\u1ee7a ch\u00fang gi\u1ea3m d\u1ea7n theo th\u1eddi gian. M\u1ed9t s\u1ed1 \u00edt b\u1ec7nh nh\u00e2n, th\u01b0\u1eddng l\u00e0 ph\u1ee5 n\u1eef \u0111ang mang thai, cho bi\u1ebft \u0111au \u0111\u1ea7u nh\u1eb9 h\u01a1n v\u00e0 kh\u1edfi ph\u00e1t ki\u1ec3u t\u1eeb t\u1eeb kh\u00f4ng ph\u1ea3i ki\u1ec3u s\u00e9t \u0111\u00e1nh ho\u1eb7c th\u1eadm ch\u00ed kh\u00f4ng c\u00f3 \u0111au \u0111\u1ea7u. Co gi\u1eadt \u1edf RCVS \u00edt x\u1ea3y ra h\u01a1n nhi\u1ec1u so v\u1edbi PRES, th\u01b0\u1eddng l\u00e0 c\u01a1n co c\u1ee9ng co gi\u1eadt to\u00e0n th\u1ec3 v\u00e0 t\u1ef1 gi\u1edbi h\u1ea1n, v\u00e0 kh\u00f4ng t\u00e1i ph\u00e1t sau khi kh\u1ecfi RCVS, ngo\u1ea1i tr\u1eeb m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n hi\u1ebfm hoi b\u1ecb t\u1ed5n th\u01b0\u01a1ng n\u00e3o kh\u00f4ng h\u1ed3i ph\u1ee5c. C\u00e1c tri\u1ec7u ch\u1ee9ng th\u1ecb gi\u00e1c t\u01b0\u01a1ng t\u1ef1 nh\u01b0 c\u00e1c tri\u1ec7u ch\u1ee9ng \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o v\u1edbi PRES: nh\u00ecn m\u1edd, \u00e1m \u0111i\u1ec3m v\u00e0 m\u00f9 v\u1ecf n\u00e3o, \u0111\u00f4i khi c\u00f3 m\u1ed9t s\u1ed1 tri\u1ec7u ch\u1ee9ng c\u1ee7a h\u1ed9i ch\u1ee9ng Balint. L\u00fa l\u1eabn nh\u1eb9 khi kh\u1edfi ph\u00e1t th\u01b0\u1eddng x\u1ea3y ra, th\u01b0\u1eddng k\u1ebft h\u1ee3p v\u1edbi \u0111au \u0111\u1ea7u d\u1eef d\u1ed9i, nh\u01b0ng b\u1ec7nh n\u00e3o n\u1eb7ng ho\u1eb7c k\u00e9o d\u00e0i l\u00e0 kh\u00f4ng ph\u1ed5 bi\u1ebfn. T\u0103ng ph\u1ea3n x\u1ea1 lan t\u1ecfa l\u00e0 m\u1ed9t d\u1ea5u hi\u1ec7u th\u1ef1c th\u1ec3 ph\u1ed5 bi\u1ebfn, c\u00f3 th\u1ec3 ph\u1ea3n \u00e1nh r\u1ed1i lo\u1ea1n \u0111i\u1ec1u h\u00f2a t\u1ef1 \u0111\u1ed9ng v\u00e0 t\u0103ng ho\u1ea1t \u0111\u1ed9ng c\u1ee7a h\u1ec7 serotonergic. Nh\u01b0 v\u1edbi PRES, c\u00e1c thi\u1ebfu h\u1ee5t th\u1ea7n kinh khu tr\u00fa nh\u01b0 m\u1ea5t ng\u00f4n ng\u1eef ho\u1eb7c li\u1ec7t n\u1eeda ng\u01b0\u1eddi c\u00f3 th\u1ec3 g\u1eb7p \u1edf b\u1ec7nh nh\u00e2n thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 ho\u1eb7c xu\u1ea5t huy\u1ebft n\u00e3o do RCVS.<\/p>\n

5. \u0110\u1eb6C \u0110I\u1ec2M H\u00ccNH \u1ea2NH H\u1eccC<\/strong><\/h2>\n

C\u00e1c t\u1ed5n th\u01b0\u01a1ng PRES \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 t\u1ed1t nh\u1ea5t tr\u00ean phim MRI T2 FLAIR l\u00e0 c\u00e1c t\u1ed5n th\u01b0\u01a1ng t\u0103ng t\u00edn hi\u1ec7u \u0111\u1ed1i x\u1ee9ng th\u01b0\u1eddng n\u1eb1m \u1edf th\u00f9y ch\u1ea9m v\u00e0 th\u00f9y tr\u00e1n (ch\u1ee7 y\u1ebfu l\u00e0 \u1edf v\u00f9ng v\u1ecf \u2013 d\u01b0\u1edbi v\u1ecf) v\u00e0 b\u00e1n c\u1ea7u ti\u1ec3u n\u00e3o (B\u1ea2NG 5-1). Ba d\u1ea1ng h\u00ecnh \u1ea3nh ph\u1ed5 bi\u1ebfn \u0111\u00e3 \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3: t\u1ed5n th\u01b0\u01a1ng \u0111\u1ec9nh ch\u1ea9m, t\u1ed5n th\u01b0\u01a1ng v\u00f9ng ranh gi\u1edbi s\u00e2u v\u00e0 t\u1ed5n th\u01b0\u01a1ng h\u1ed3i tr\u00e1n tr\u00ean (H\u00ccNH 5-2). \u00cdt ph\u1ed5 bi\u1ebfn h\u01a1n l\u00e0 c\u00e1c t\u1ed5n th\u01b0\u01a1ng li\u00ean quan \u0111\u1ebfn h\u1ea1ch n\u1ec1n v\u00e0 th\u00e2n n\u00e3o. T\u1ed5n th\u01b0\u01a1ng PRES ph\u1ea3n \u00e1nh t\u00ecnh tr\u1ea1ng ph\u00f9 c\u0103n nguy\u00ean m\u1ea1ch c\u00f3 th\u1ec3 \u0111\u1ea3o ng\u01b0\u1ee3c v\u00e0 do \u0111\u00f3 lu\u00f4n c\u00f3 h\u00ecnh \u1ea3nh t\u0103ng t\u00edn hi\u1ec7u ho\u1eb7c \u0111\u1ed3ng t\u00edn hi\u1ec7u tr\u00ean phim ADC, h\u1ea7u nh\u01b0 lu\u00f4n ph\u1ee5c h\u1ed3i trong v\u00f2ng v\u00e0i ng\u00e0y \u0111\u1ebfn v\u00e0i tu\u1ea7n. Tuy nhi\u00ean, c\u00f3 \u0111\u1ebfn m\u1ed9t ph\u1ea7n ba s\u1ed1 b\u1ec7nh nh\u00e2n xu\u1ea5t hi\u1ec7n c\u00e1c t\u1ed5n th\u01b0\u01a1ng kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t v\u1edbi c\u00e1c v\u00f9ng gi\u1ea3m t\u00edn hi\u1ec7u (h\u1ea1n ch\u1ebf khu\u1ebfch t\u00e1n, cho th\u1ea5y ph\u00f9 ki\u1ec3u nhi\u1ec5m \u0111\u1ed9c t\u1ebf b\u00e0o do thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9, th\u01b0\u1eddng kh\u00f4ng h\u1ed3i ph\u1ee5c) trong v\u00f9ng t\u0103ng t\u00edn hi\u1ec7u tr\u00ean ADC. C\u00f3 \u0111\u1ebfn 1\/4 s\u1ed1 b\u1ec7nh nh\u00e2n b\u1ecb xu\u1ea5t huy\u1ebft n\u00e3o th\u00f9y ho\u1eb7c xu\u1ea5t huy\u1ebft d\u01b0\u1edbi nh\u1ec7n. H\u00ecnh \u1ea3nh m\u1ea1ch m\u00e1u n\u00e3o trong PRES cho th\u1ea5y t\u00ecnh tr\u1ea1ng h\u1eb9p v\u00e0 gi\u00e3n \u0111\u1ed9ng m\u1ea1ch t\u1eebng \u0111o\u1ea1n (h\u00ecnh d\u1ea1ng \u201cx\u00fac x\u00edch tr\u00ean d\u00e2y\u201d) gi\u1ed1ng v\u1edbi c\u00e1c b\u1ea5t th\u01b0\u1eddng ch\u1ee5p m\u1ea1ch c\u1ee7a RCVS (CASE 5-2 v\u00e0 CASE 5-3) \u1edf kho\u1ea3ng 50% b\u1ec7nh nh\u00e2n. S\u1ef1 co m\u1ea1ch c\u00f3 h\u1ed3i ph\u1ee5c c\u1ee7a c\u00e1c \u0111\u1ed9ng m\u1ea1ch h\u1ec7 th\u1ed1ng kh\u00f4ng \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 trong PRES, kh\u00f4ng gi\u1ed1ng nh\u01b0 trong RCVS, \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 ph\u00eda d\u01b0\u1edbi.
\nH\u00ccNH 5-5 cho th\u1ea5y c\u00e1c lo\u1ea1i t\u1ed5n th\u01b0\u01a1ng v\u00e0 t\u1ea7n su\u1ea5t c\u1ee7a c\u00e1c h\u00ecnh \u1ea3nh t\u1ed5n th\u01b0\u01a1ng trong RCVS. H\u01a1n 70% b\u1ec7nh nh\u00e2n RCVS \u0111\u01b0\u1ee3c ch\u1ee5p MRI n\u00e3o kh\u00f4ng c\u00f3 t\u1ed5n th\u01b0\u01a1ng nhu m\u00f4, m\u1eb7c d\u00f9 c\u00f3 bi\u1ec3u hi\u1ec7n co m\u1ea1ch n\u00e3o lan t\u1ecfa. T\u1ed5n th\u01b0\u01a1ng d\u1ea1ng \u0111\u01b0\u1eddng ho\u1eb7c h\u00ecnh ch\u1ea5m trong khoang r\u00e3nh \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y \u1edf 20% \u0111\u1ebfn 40% b\u1ec7nh nh\u00e2n, ph\u1ea3n \u00e1nh d\u00f2ng ch\u1ea3y ch\u1eadm trong c\u00e1c m\u1ea1ch m\u00e1u b\u1ecb d\u00e3n ra b\u1ea5t th\u01b0\u1eddng. M\u1eb7c d\u00f9 h\u00ecnh \u1ea3nh n\u00e3o ban \u0111\u1ea7u th\u01b0\u1eddng b\u00ecnh th\u01b0\u1eddng, c\u00f3 t\u1edbi 70% b\u1ec7nh nh\u00e2n n\u1ed9i tr\u00fa b\u1ecb xu\u1ea5t huy\u1ebft d\u01b0\u1edbi nh\u1ec7n, xu\u1ea5t huy\u1ebft nhu m\u00f4, nh\u1ed3i m\u00e1u n\u00e3o, ho\u1eb7c ph\u00f9 n\u00e3o c\u0103n nguy\u00ean m\u1ea1ch (PRES) ri\u00eang l\u1ebb ho\u1eb7c k\u1ebft h\u1ee3p trong 2 tu\u1ea7n sau \u0111\u00f3. C\u00e1c t\u1ed5n th\u01b0\u01a1ng xu\u1ea5t huy\u1ebft c\u00f3 xu h\u01b0\u1edbng xu\u1ea5t hi\u1ec7n s\u1edbm h\u01a1n c\u00e1c t\u1ed5n th\u01b0\u01a1ng do thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9. T\u01b0\u01a1ng t\u1ef1 nh\u01b0 PRES, c\u00e1c t\u1ed5n th\u01b0\u01a1ng thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 v\u00e0 ph\u00f9 n\u1ec1 c\u1ee7a RCVS th\u01b0\u1eddng n\u1eb1m \u1edf v\u00f9ng ranh gi\u1edbi ph\u00eda sau v\u00e0 v\u00f9ng v\u1ecf-d\u01b0\u1edbi v\u1ecf c\u1ee7a th\u00f9y \u0111\u00ednh v\u00e0 th\u00f9y tr\u00e1n, hi\u1ebfm khi \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn c\u1ea5u tr\u00fac s\u00e2u, v\u00e0 th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn b\u00e1n c\u1ea7u ti\u1ec3u n\u00e3o. Si\u00eau \u00e2m Doppler xuy\u00ean s\u1ecd c\u00f3 th\u1ec3 cho th\u1ea5y v\u1eadn t\u1ed1c d\u00f2ng m\u00e1u t\u0103ng cao; tuy nhi\u00ean, c\u00f3 \u00edt m\u1ed1i t\u01b0\u01a1ng quan gi\u1eefa v\u1eadn t\u1ed1c d\u00f2ng ch\u1ea3y v\u00e0 s\u1ef1 h\u1eb9p nhi\u1ec1u ch\u1ed7 c\u1ee7a \u0111\u1ed9ng m\u1ea1ch n\u00e3o. MRI th\u00e0nh m\u1ea1ch \u0111\u1ed9 ph\u00e2n gi\u1ea3i cao th\u01b0\u1eddng cho th\u1ea5y \u0111\u1ed9ng m\u1ea1ch k\u00e9m b\u1eaft thu\u1ed1c trong RCVS. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p ch\u1ee5p m\u1ea1ch n\u00e3o trong RCVS (theo \u0111\u1ecbnh ngh\u0129a) l\u00e0 b\u1ea5t th\u01b0\u1eddng, c\u00f3 s\u1ef1 co m\u1ea1ch v\u00e0 gi\u00e3n m\u1ea1ch t\u1eebng \u0111o\u1ea1n (h\u00ecnh d\u1ea1ng \u201cchu\u1ed7i x\u00fac x\u00edch\u201d). C\u00e1c t\u1ed5n th\u01b0\u01a1ng m\u1ea1ch m\u00e1u c\u00f9ng t\u1ed3n t\u1ea1i \u1edf 20% b\u1ec7nh nh\u00e2n, ch\u1eb3ng h\u1ea1n nh\u01b0 b\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch v\u00f9ng c\u1ed5, t\u00fai ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch kh\u00f4ng v\u1ee1, cavernoma, v\u00e0 lo\u1ea1n s\u1ea3n s\u1ee3i. \u0110\u1ed9ng m\u1ea1ch ngo\u00e0i s\u1ecd (\u0111\u1ed9ng m\u1ea1ch c\u1ea3nh ngo\u00e0i s\u1ecd, v\u00f5ng m\u1ea1c, th\u1eadn, m\u1ea1c treo ru\u1ed9t, m\u1ea1ch v\u00e0nh) hi\u1ebfm khi b\u1ecb \u1ea3nh h\u01b0\u1edfng v\u00e0 c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n t\u01b0\u01a1ng t\u1ef1 v\u1edbi ch\u1ee9ng lo\u1ea1n s\u1ea3n s\u1ee3i. C\u00e1c tr\u01b0\u1eddng h\u1ee3p hi\u1ebfm g\u1eb7p m\u1eafc \u0111\u1ed3ng th\u1eddi b\u1ec7nh c\u01a1 tim takotsubo, c\u00f3 l\u1ebd l\u00e0 do co th\u1eaft m\u1ea1ch v\u00e0nh, \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o.
\nT\u00ecnh hu\u1ed1ng 1<\/strong>
\nB\u1ec7nh nh\u00e2n nam, 46 tu\u1ed5i b\u1ecb \u0111au \u0111\u1ea7u d\u1eef d\u1ed9i \u1edf sau g\u00e1y. \u0110au \u0111\u1ea7u t\u1eebng c\u01a1n t\u00e1i \u0111i t\u00e1i l\u1ea1i, v\u00e0 v\u00e0o ng\u00e0y th\u1ee9 3, anh b\u1ecb m\u00f9 v\u1ecf n\u00e3o v\u00e0 li\u1ec7t nh\u1eb9 n\u1eeda ng\u01b0\u1eddi b\u00ean tr\u00e1i. Ti\u1ec1n c\u0103n \u0111au \u0111\u1ea7u migraine kh\u00f4ng ti\u1ec1n tri\u1ec7u, t\u0103ng huy\u1ebft \u00e1p, t\u0103ng lipid m\u00e1u v\u00e0 s\u1eed d\u1ee5ng c\u1ea7n sa. CT m\u1ea1ch m\u00e1u n\u00e3o l\u00fac nh\u1eadp vi\u1ec7n cho th\u1ea5y h\u00ecnh \u1ea3nh h\u1eb9p \u0111a \u1ed5 c\u1ee7a \u0111\u1ed9ng m\u1ea1ch n\u00e3o gi\u1eefa hai b\u00ean (H\u00ccNH 1A), \u0111\u1ed9ng m\u1ea1ch th\u00e2n n\u1ec1n, \u0111\u1ed9ng m\u1ea1ch n\u00e3o sau v\u00e0 \u0111\u1ed9ng m\u1ea1ch ti\u1ec3u n\u00e3o tr\u00ean (H\u00ccNH 1B). Nh\u1eefng b\u1ea5t th\u01b0\u1eddng n\u00e0y c\u0169ng \u0111\u01b0\u1ee3c th\u1ea5y tr\u00ean phim MRA (H\u00ccNH 1C). Phim MRI diffusion (H\u00ccNH 1D) v\u00e0 ADC (H\u00ccNH 1E) cho th\u1ea5y t\u1ed5n th\u01b0\u01a1ng \u0111\u1ed1i x\u1ee9ng \u1edf th\u00f9y ch\u1ea9m hai b\u00ean ph\u00f9 h\u1ee3p v\u1edbi \u0111\u1ed9t qu\u1ef5 do thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9. Ngo\u00e0i ra, MRI n\u00e3o cho th\u1ea5y c\u00e1c \u1ed5 nh\u1ed3i m\u00e1u nh\u1ecf \u1edf hai b\u00ean b\u00e1n c\u1ea7u ti\u1ec3u n\u00e3o v\u00e0 \u1edf th\u00f9y tr\u00e1n b\u00ean ph\u1ea3i. C\u00e1c x\u00e9t nghi\u1ec7m m\u00e1u v\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a hai l\u1ea7n ch\u1ecdc d\u1ecbch n\u00e3o t\u1ee7y cho th\u1ea5y kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng c\u1ee7a vi\u00eam m\u1ea1ch ho\u1eb7c xu\u1ea5t huy\u1ebft d\u01b0\u1edbi nh\u1ec7n. B\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c gi\u1ea3m \u0111au v\u00e0 verapamil. T\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe c\u1ee7a anh \u1ea5y \u0111\u01b0\u1ee3c ph\u1ee5c h\u1ed3i ho\u00e0n to\u00e0n trong kho\u1ea3ng th\u1eddi gian 3 tu\u1ea7n, v\u00e0 MRA sau \u0111\u00f3 cho th\u1ea5y m\u1ea1ch m\u00e1u n\u00e3o \u0111\u00e3 ph\u1ee5c h\u1ed3i (H\u00ccNH 1F).
\nNh\u1eadn x\u00e9t: Tr\u01b0\u1eddng h\u1ee3p n\u00e0y l\u00e0 m\u1ed9t v\u00ed d\u1ee5 \u0111i\u1ec3n h\u00ecnh c\u1ee7a h\u1ed9i ch\u1ee9ng co th\u1eaft m\u1ea1ch m\u00e1u n\u00e3o c\u00f3 h\u1ed3i ph\u1ee5c (RCVS). B\u1ec7nh s\u1eed \u0111au \u0111\u1ea7u ki\u1ec3u s\u00e9t \u0111\u00e1nh t\u00e1i ph\u00e1t trong v\u00e0i ng\u00e0y h\u1ea7u nh\u01b0 l\u00e0 \u0111i\u1ec3n h\u00ecnh c\u1ee7a h\u1ed9i ch\u1ee9ng co th\u1eaft m\u1ea1ch n\u00e3o c\u00f3 h\u1ed3i ph\u1ee5c. C\u00e1c tri\u1ec7u ch\u1ee9ng th\u1ecb gi\u00e1c v\u1ecf n\u00e3o th\u01b0\u1eddng g\u1eb7p v\u00e0 t\u01b0\u01a1ng quan v\u1edbi c\u00e1c t\u1ed5n th\u01b0\u01a1ng thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 \u0111\u1ed1i x\u1ee9ng \u0111i\u1ec3n h\u00ecnh \u1edf v\u00f9ng ranh gi\u1edbi c\u1ee7a \u0111\u1ed9ng m\u1ea1ch n\u00e3o gi\u1eefa v\u00e0 \u0111\u1ed9ng m\u1ea1ch n\u00e3o sau:<\/p>\n

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

H\u00ecnh 1. H\u00ecnh \u1ea3nh h\u1ecdc c\u1ee7a t\u00ecnh hu\u1ed1ng 1<\/p>\n

B\u1ea3ng 1. \u0110\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng, h\u00ecnh \u1ea3nh h\u1ecdc c\u1ee7a PRES v\u00e0 RCVS<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
\u0110\u1eb7c \u0111i\u1ec3m<\/strong><\/td>\nPRES<\/strong><\/td>\nRCVS<\/strong><\/td>\n<\/tr>\n
L\u00e2m s\u00e0ng<\/td>\n<\/tr>\n
B\u1ec7nh n\u00e3o<\/td>\n50-80%<\/td>\n10-15%<\/td>\n<\/tr>\n
C\u01a1n \u0111\u1ed9ng kinh<\/td>\n60-75%<\/td>\n0-20%<\/td>\n<\/tr>\n
Tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh<\/td>\n5-15%<\/td>\nHi\u1ebfm g\u1eb7p<\/td>\n<\/tr>\n
\u0110au \u0111\u1ea7u<\/td>\n50%<\/td>\n90-95%<\/td>\n<\/tr>\n
Tri\u1ec7u ch\u1ee9ng th\u1ecb gi\u00e1c<\/td>\n33%<\/td>\n30-40%<\/td>\n<\/tr>\n
D\u1ea5u th\u1ea7n kinh \u0111\u1ecbnh v\u1ecb<\/td>\n10-15%<\/td>\n9-63%<\/td>\n<\/tr>\n
H\u00ecnh \u1ea3nh h\u1ecdc<\/td>\n<\/tr>\n
Ph\u00f9 n\u00e3o ki\u1ec3u m\u1ea1ch m\u00e1u<\/td>\n100%<\/td>\n15-40%<\/td>\n<\/tr>\n
Nh\u1ed3i m\u00e1u n\u00e3o<\/td>\n15-30%<\/td>\n33%<\/td>\n<\/tr>\n
Xu\u1ea5t huy\u1ebft n\u00e3o<\/td>\n10-25%<\/td>\n15%<\/td>\n<\/tr>\n
Xu\u1ea5t huy\u1ebft d\u01b0\u1edbi nh\u1ec7n<\/td>\n3-8%<\/td>\n40%<\/td>\n<\/tr>\n
Co m\u1ea1ch t\u1eebng \u0111o\u1ea1n<\/td>\n30-70%<\/td>\n100%<\/td>\n<\/tr>\n
T\u1ed5n th\u01b0\u01a1ng m\u1ea1ch m\u00e1u \u0111\u1ed3ng m\u1eafc (t\u00fai ph\u00ecnh, b\u00f3c t\u00e1ch\u2026)<\/td>\nKh\u00f4ng th\u01b0\u1eddng g\u1eb7p<\/td>\n20%<\/td>\n<\/tr>\n
B\u1eaft thu\u1ed1c t\u01b0\u01a1ng ph\u1ea3n<\/td>\n20%<\/td>\nKh\u00f4ng th\u01b0\u1eddng g\u1eb7p<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

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

H\u00ecnh 2. Ba ki\u1ec3u h\u00ecnh \u1ea3nh t\u1ed5n th\u01b0\u01a1ng c\u1ee7a h\u1ed9i ch\u1ee9ng b\u1ec7nh n\u00e3o sau c\u00f3 h\u1ed3i ph\u1ee5c (PRES) \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 tr\u00ean phim MRI FLAIR. T\u1ed5n th\u01b0\u01a1ng th\u00f9y ch\u1ea9m chi\u1ebfm \u01b0u th\u1ebf (A-C). H\u00ecnh (D-F) t\u1ed5n th\u01b0\u01a1ng ch\u1ee7 y\u1ebfu \u1edf v\u00f9ng ranh gi\u1edbi \u0111\u1ed9ng m\u1ea1ch n\u00e3o tr\u01b0\u1edbc, gi\u1eefa, sau tr\u1ea3i d\u00e0i th\u00f9y tr\u00e1n, th\u00f9y \u0111\u1ec9nh v\u00e0 th\u00f9y ch\u1ea9m. H\u00ecnh (G-I) l\u00e0 ki\u1ec3u t\u1ed5n th\u01b0\u01a1ng khu tr\u00fa \u1edf h\u1ed3i tr\u00e1n tr\u00ean m\u00e0 kh\u00f4ng lan r\u1ed9ng ra c\u1ef1c tr\u00e1n. H\u00ecnh \u1ea3nh h\u1ecdc c\u1ee7a t\u00ecnh hu\u1ed1ng 1<\/p>\n

T\u00ecnh hu\u1ed1ng 2<\/strong>
\nB\u1ec7nh nh\u00e2n n\u1eef, 36 tu\u1ed5i b\u1ecb \u0111au \u0111\u1ea7u nhi\u1ec1u li\u00ean quan \u0111\u1ebfn t\u0103ng huy\u1ebft \u00e1p m\u1edbi kh\u1edfi ph\u00e1t 10 ng\u00e0y sau khi sinh song thai b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p m\u1ed5 l\u1ea5y thai. Phim MRI v\u00e0 CT n\u00e3o ban \u0111\u1ea7u th\u00ec b\u00ecnh th\u01b0\u1eddng.Xu\u1ea5t hi\u1ec7n \u0111au \u0111\u1ea7u k\u00e9o d\u00e0i d\u00f9 \u0111\u00e3 d\u00f9ng thu\u1ed1c h\u1ea1 huy\u1ebft \u00e1p; m\u1ed9t c\u01a1n \u0111\u1ed9ng kinh v\u00e0 m\u1ed9t giai \u0111o\u1ea1n m\u1ea5t ng\u00f4n ng\u1eef c\u00f9ng li\u1ec7t n\u1eeda ng\u01b0\u1eddi. Ch\u1ee5p MRI l\u1ea1i v\u00e0o ng\u00e0y th\u1ee9 18 sau sinh (H\u00ccNH 5-3A) cho th\u1ea5y c\u00e1c v\u00f9ng t\u0103ng t\u00edn hi\u1ec7u \u1edf c\u1ea3 hai th\u00f9y ch\u1ea9m ph\u00f9 h\u1ee3p v\u1edbi ph\u00f9 n\u1ec1 ki\u1ec3u m\u1ea1ch m\u00e1u. C\u00e1c \u0111\u1eb7c \u0111i\u1ec3m h\u00ecnh \u1ea3nh l\u00e2m s\u00e0ng n\u00e0y ph\u00f9 h\u1ee3p v\u1edbi h\u1ed9i ch\u1ee9ng b\u1ec7nh n\u00e3o ph\u00eda sau c\u00f3 h\u1ed3i ph\u1ee5c (PRES). Phim MRA c\u1ee7a (H\u00ccNH 5-3B) cho th\u1ea5y h\u1eb9p \u0111a \u1ed5 \u0111o\u1ea1n g\u1ea7n \u0111\u1ed9ng m\u1ea1ch n\u00e3o tr\u01b0\u1edbc, gi\u1eefa v\u00e0 sau. Ph\u00e1t hi\u1ec7n n\u00e0y ph\u00f9 h\u1ee3p v\u1edbi b\u1ec7nh l\u00fd m\u1ea1ch m\u00e1u n\u00e3o sau sinh (m\u1ed9t b\u1ec7nh l\u00fd \u0111\u01b0\u1ee3c bao g\u1ed3m trong thu\u1eadt ng\u1eef chung l\u00e0 h\u1ed9i ch\u1ee9ng co th\u1eaft m\u1ea1ch m\u00e1u n\u00e3o c\u00f3 th\u1ec3 \u0111\u1ea3o ng\u01b0\u1ee3c [RCVS]). MRI thu \u0111\u01b0\u1ee3c v\u00e0o ng\u00e0y 19 sau sinh cho th\u1ea5y c\u00e1c t\u1ed5n th\u01b0\u01a1ng t\u0103ng t\u00edn hi\u1ec7u tr\u00ean phim FLAIR (H\u00ccNH 5-3C) v\u00e0 phim diffusion (H\u00ccNH 5-3D) ph\u00f9 h\u1ee3p v\u1edbi h\u00ecnh \u1ea3nh nh\u1ed3i m\u00e1u n\u00e3o.
\nB\u1ea5t ch\u1ea5p nhi\u1ec1u n\u1ed7 l\u1ef1c \u0111\u1ec3 l\u00e0m gi\u00e3n \u0111\u1ed9ng m\u1ea1ch n\u00e3o b\u1eb1ng c\u00e1ch ti\u00eam thu\u1ed1c d\u00e3n m\u1ea1ch v\u00e0o trong \u0111\u1ed9ng m\u1ea1ch n\u00e3o, b\u1ec7nh nh\u00e2n v\u1eabn ti\u1ebfn tri\u1ec3n n\u1eb7ng th\u00eam. MRA ti\u1ebfp theo (H\u00ccNH 5-3E) cho th\u1ea5y t\u00ecnh tr\u1ea1ng h\u1eb9p \u0111\u1ed9ng m\u1ea1ch n\u00e3o \u0111a \u1ed5 ng\u00e0y c\u00e0ng n\u1eb7ng h\u01a1n, v\u00e0 phim FLAIR cho th\u1ea5y nh\u1ed3i m\u00e1u n\u00e3o hai b\u00ean k\u00e8m theo ph\u00f9 v\u00e0 xu\u1ea5t huy\u1ebft (H\u00ccNH 5-3F). Cu\u1ed1i c\u00f9ng b\u1ec7nh nh\u00e2n \u0111\u00e3 t\u1eed vong. Khi kh\u00e1m nghi\u1ec7m t\u1eed thi, c\u00e1c \u0111\u1ed9ng m\u1ea1ch n\u00e3o kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u vi\u00eam.
\nNh\u1eadn x\u00e9t: Tr\u01b0\u1eddng h\u1ee3p n\u00e0y l\u00e0 m\u1ed9t v\u00ed d\u1ee5 \u0111i\u1ec3n h\u00ecnh c\u1ee7a s\u1ea3n gi\u1eadt sau sinh li\u00ean quan \u0111\u1ebfn b\u1ec7nh l\u00fd m\u1ea1ch m\u00e1u sau sinh (t\u1ee9c l\u00e0 PRES v\u00e0 RCVS), l\u00e0 nh\u1eefng t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd c\u00f3 li\u00ean quan l\u1eabn nhau v\u00e0 l\u00e0 nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p c\u1ee7a nh\u1ed3i m\u00e1u n\u00e3o v\u00e0 xu\u1ea5t huy\u1ebft n\u00e3o sau sinh. Nh\u1eefng h\u1ed9i ch\u1ee9ng n\u00e0y r\u1ea5t kh\u00f3 \u0111\u1ec3 ti\u00ean \u0111o\u00e1n ho\u1eb7c ng\u0103n ng\u1eeba. Ch\u01b0a c\u00f3 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb n\u00e0o \u0111\u01b0\u1ee3c ch\u1ee9ng minh c\u00f3 hi\u1ec7u qu\u1ea3, m\u1eb7c d\u00f9 vi\u1ec7c ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p, b\u1ed5 sung magi\u00ea v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c ch\u1eb9n k\u00eanh canxi \u0111\u01b0\u1ee3c coi l\u00e0 quan tr\u1ecdng. M\u1eb7c d\u00f9 90% b\u1ec7nh nh\u00e2n s\u1ebd t\u1ef1 gi\u1edbi h\u1ea1n v\u00e0 h\u1ed3i ph\u1ee5c trong v\u00e0i ng\u00e0y \u0111\u1ebfn v\u00e0i tu\u1ea7n, m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n (nh\u01b0 trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y) s\u1ebd ti\u1ebfn tri\u1ec3n, th\u01b0\u1eddng d\u1eabn \u0111\u1ebfn t\u1eed vong. Tr\u01b0\u1eddng h\u1ee3p n\u00e0y l\u00e0m n\u1ed5i b\u1eadt nguy c\u01a1 ti\u1ec1m \u1ea9n \u0111\u1ed1i v\u1edbi t\u1ed5n th\u01b0\u01a1ng do co m\u1ea1ch v\u00e0 t\u00e1i t\u01b0\u1edbi m\u00e1u khi ch\u1ee5p m\u1ea1ch x\u00e2m l\u1ea5n v\u00e0 li\u1ec7u ph\u00e1p gi\u00e3n m\u1ea1ch n\u1ed9i m\u1ea1ch.<\/p>\n

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H\u00ecnh 3. H\u00ecnh \u1ea3nh h\u1ecdc c\u1ee7a t\u00ecnh hu\u1ed1ng 2<\/p>\n

T\u00ecnh hu\u1ed1ng 3<\/strong>
\nB\u1ec7nh nh\u00e2n n\u1eef, 49 tu\u1ed5i b\u1ecb \u0111au \u0111\u1ea7u d\u1eef d\u1ed9i \u0111\u1ea1t \u0111\u1ec9nh trong v\u00e0i gi\u00e2y. Nh\u1eefng c\u01a1n \u0111au \u0111\u1ea7u t\u01b0\u01a1ng t\u1ef1 t\u00e1i ph\u00e1t hai l\u1ea7n trong 2 ng\u00e0y ti\u1ebfp theo v\u00e0 k\u00e8m gi\u1ea3m th\u1ecb l\u1ef1c trung t\u00e2m trong c\u01a1n. V\u00e0o ng\u00e0y th\u1ee9 4 sau khi b\u1eaft \u0111\u1ea7u c\u00f3 tri\u1ec7u ch\u1ee9ng, c\u00f4 \u1ea5y b\u1ecb m\u1ed9t c\u01a1n \u0111\u1ed9ng kinh to\u00e0n th\u1ec3.
\nBN b\u1ecb t\u0103ng huy\u1ebft \u00e1p (230\/130 mm Hg), v\u00e0 kh\u00e1m th\u1ea7n kinh ghi nh\u1eadn t\u0103ng ph\u1ea3n x\u1ea1 g\u00e2n c\u01a1. X\u00e9t nghi\u1ec7m n\u01b0\u1edbc ti\u1ec3u v\u00e0 \u0111\u1ed9c ch\u1ea5t kh\u00f4ng ghi nh\u1eadn b\u1ea5t th\u01b0\u1eddng \u0111\u00e1ng ch\u00fa \u00fd. MRI s\u1ecd n\u00e3o ghi nh\u1eadn ph\u00f9 do m\u1ea1ch m\u00e1u \u1edf v\u00f9ng ch\u1ea9m hai b\u00ean (H\u00ccNH 5-4A), ph\u00f9 h\u1ee3p v\u1edbi h\u1ed9i ch\u1ee9ng b\u1ec7nh n\u00e3o ph\u00eda sau c\u00f3 h\u1ed3i ph\u1ee5c (PRES). Ch\u1ee5p CTA cho th\u1ea5y h\u1eb9p t\u1eebng \u0111o\u1ea1n \u1edf nhi\u1ec1u \u0111\u1ed9ng m\u1ea1ch n\u1ed9i s\u1ecd (H\u00ccNH 5-4B), \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn sau khi ch\u1ee5p DSA (H\u00ccNH 5-4C), ph\u00f9 h\u1ee3p v\u1edbi h\u1ed9i ch\u1ee9ng co th\u1eaft m\u1ea1ch m\u00e1u n\u00e3o c\u00f3 h\u1ed3i ph\u1ee5c (RCVS).
\nM\u1eb7c d\u00f9 b\u1ec7nh nh\u00e2n ph\u1ee7 nh\u1eadn vi\u1ec7c s\u1eed d\u1ee5ng v\u1edbi c\u00e1c ch\u1ea5t g\u00e2y co m\u1ea1ch, nh\u01b0ng h\u1ecfi k\u1ef9 th\u00eam cho th\u1ea5y r\u1eb1ng c\u00f4 \u1ea5y \u0111\u00e3 s\u1eed d\u1ee5ng 0,45 kg (1 lb) cam th\u1ea3o m\u1ed7i ng\u00e0y trong 4 th\u00e1ng. Cam th\u1ea3o c\u00f3 t\u00e1c d\u1ee5ng co m\u1ea1ch n\u00ean ph\u1ea3i ng\u01b0ng ngay. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n b\u1eb1ng thu\u1ed1c ch\u1eb9n k\u00eanh canxi \u0111\u01b0\u1eddng u\u1ed1ng. \u0110au \u0111\u1ea7u c\u1ee7a c\u00f4 \u1ea5y \u0111\u00e3 h\u1ed3i ph\u1ee5c v\u00e0 ch\u1ee5p CT\/ CTA theo d\u00f5i sau 3 th\u00e1ng cho th\u1ea5y t\u00ecnh tr\u1ea1ng ph\u00f9 v\u00e0 co m\u1ea1ch t\u1eebng \u0111o\u1ea1n \u0111\u00e3 \u0111\u01b0\u1ee3c gi\u1ea3i quy\u1ebft (H\u00ccNH 5-4D).
\nNh\u1eadn x\u00e9t: Tr\u01b0\u1eddng h\u1ee3p n\u00e0y l\u00e0 m\u1ed9t v\u00ed d\u1ee5 kinh \u0111i\u1ec3n c\u1ee7a PRES v\u1edbi RCVS. L\u01b0u \u00fd vi\u1ec7c h\u1ecfi k\u1ef9 b\u1ec7nh s\u1eed v\u00e0 ti\u1ec1n c\u0103n l\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ec3 ph\u00e1t hi\u1ec7n ra c\u00e1c ch\u1ea5t g\u00e2y co m\u1ea1ch.<\/p>\n

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H\u00ecnh 4. H\u00ecnh \u1ea3nh h\u1ecdc c\u1ee7a t\u00ecnh hu\u1ed1ng 3<\/p>\n

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H\u00ecnh 5. MRI s\u1ecd n\u00e3o trong RCVS<\/p>\n

6. CH\u1ea8N \u0110O\u00c1N PH\u00c2N BI\u1ec6T<\/strong><\/h2>\n

Ch\u1ea9n \u0111o\u00e1n PRES d\u1ef1a tr\u00ean c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng k\u1ebft h\u1ee3p v\u1edbi h\u00ecnh \u1ea3nh ph\u00f9 n\u00e3o do m\u1ea1ch m\u00e1u. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t v\u1ec1 h\u00ecnh \u1ea3nh h\u1ecdc bao g\u1ed3m nhi\u1ec5m tr\u00f9ng th\u1ea7n kinh trung \u01b0\u01a1ng, b\u1ec7nh n\u00e3o ch\u1ea5t tr\u1eafng \u0111a \u1ed5 ti\u1ebfn tri\u1ec3n, c\u00e1c b\u1ec7nh h\u1ee7y myelin, c\u00e1c kh\u1ed1i u n\u00e3o nh\u01b0 u nguy\u00ean b\u00e0o th\u1ea7n kinh \u0111\u1ec7m ho\u1eb7c lymphoma, vi\u00eam n\u00e3o t\u1ef1 mi\u1ec5n ho\u1eb7c c\u1eadn ung, vi\u00eam m\u1ea1ch ho\u1eb7c b\u1ec7nh n\u00e3o do nhi\u1ec5m \u0111\u1ed9c (v\u00ed d\u1ee5 heroin). Nh\u1eefng b\u1ec7nh l\u00fd n\u00e0y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c lo\u1ea1i tr\u1eeb d\u1ef1a tr\u00ean ti\u1ec1n c\u0103n v\u00e0 \u0111\u00e1nh gi\u00e1 c\u1ea9n th\u1eadn c\u00e1c t\u1ed5n th\u01b0\u01a1ng tr\u00ean MRI, ch\u1ee5p \u1ea3nh n\u00e3o theo d\u00f5i \u0111\u1ec3 x\u00e1c nh\u1eadn kh\u1ea3 n\u0103ng h\u1ed3i ph\u1ee5c c\u1ee7a t\u1ed5n th\u01b0\u01a1ng ho\u1eb7c ch\u1ecdc d\u1ecbch n\u00e3o t\u1ee7y \u0111\u1ec3 lo\u1ea1i tr\u1eeb m\u1ed9t s\u1ed1 nguy\u00ean nh\u00e2n \u1edf tr\u00ean.
\n\u0110\u1ed1i v\u1edbi RCVS, ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n n\u00ean \u0111i t\u1eeb \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng n\u1ed5i b\u1eadt (\u0111au \u0111\u1ea7u ki\u1ec3u s\u00e9t \u0111\u00e1nh) v\u00e0 \u0111\u1eb7c \u0111i\u1ec3m h\u00ecnh \u1ea3nh h\u1ecdc (b\u1ea5t th\u01b0\u1eddng \u0111\u1ed9ng m\u1ea1ch n\u1ed9i s\u1ecd). \u0110\u1ed1i v\u1edbi \u0111au \u0111\u1ea7u ki\u1ec3u s\u00e9t \u0111\u00e1nh, \u0111i\u1ec1u quan tr\u1ecdng l\u00e0 ph\u1ea3i xem li\u1ec7u b\u1ec7nh nh\u00e2n c\u00f3 m\u1ed9t hay nhi\u1ec1u c\u01a1n \u0111au \u0111\u1ea7u t\u00e1i ph\u00e1t trong m\u1ed9t kho\u1ea3ng th\u1eddi gian ng\u1eafn hay kh\u00f4ng. \u0110au \u0111\u1ea7u s\u00e9t \u0111\u00e1nh \u0111\u01a1n \u0111\u1ed9c c\u00f3 th\u1ec3 l\u00e0 th\u1ee9 ph\u00e1t sau c\u00e1c t\u00ecnh tr\u1ea1ng nh\u01b0 xu\u1ea5t huy\u1ebft d\u01b0\u1edbi nh\u1ec7n do v\u1ee1 t\u00fai ph\u00ecnh, u tuy\u1ebfn y\u00ean, b\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch c\u1ed5, vi\u00eam m\u00e0ng n\u00e3o v\u00e0 huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch n\u1ed9i s\u1ecd. Do \u0111\u00f3, h\u00ecnh \u1ea3nh s\u1ecd n\u00e3o v\u00e0 m\u1ea1ch m\u00e1u n\u00e3o ngay l\u1eadp t\u1ee9c \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u0111\u1ec3 lo\u1ea1i tr\u1eeb c\u00e1c nguy\u00ean nh\u00e2n th\u1ee9 ph\u00e1t n\u00e0y. Ch\u1ecdc d\u1ecbch n\u00e3o t\u1ee7y sau \u0111\u00f3 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c xem x\u00e9t \u0111\u1ec3 lo\u1ea1i tr\u1eeb vi\u00eam m\u00e0ng n\u00e3o ho\u1eb7c xu\u1ea5t huy\u1ebft d\u01b0\u1edbi nh\u1ec7n. N\u1ebfu k\u1ebft qu\u1ea3 \u0111\u00e1nh gi\u00e1 \u00e2m t\u00ednh, ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t thu h\u1eb9p l\u1ea1i th\u00e0nh \u0111au \u0111\u1ea7u s\u00e9t \u0111\u00e1nh nguy\u00ean ph\u00e1t (v\u00f4 c\u0103n).
\nNhi\u1ec1u b\u1ec7nh nh\u00e2n b\u1ecb \u0111au \u0111\u1ea7u s\u00e9t \u0111\u00e1nh nguy\u00ean ph\u00e1t c\u0169ng c\u00f3 nh\u1eefng b\u1ea5t th\u01b0\u1eddng tr\u00ean phim m\u1ea1ch m\u00e1u gi\u1ed1ng v\u1edbi RCVS. \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00e1c, nh\u1eefng b\u1ea5t th\u01b0\u1eddng tr\u00ean phim m\u1ea1ch m\u00e1u c\u00f3 th\u1ec3 kh\u00f4ng c\u00f3 tr\u00ean h\u00ecnh \u1ea3nh ban \u0111\u1ea7u nh\u01b0ng tr\u1edf n\u00ean r\u00f5 r\u00e0ng sau \u0111\u00f3. Do \u0111\u00f3, \u0111au \u0111\u1ea7u s\u00e9t \u0111\u00e1nh nguy\u00ean ph\u00e1t \u0111\u01b0\u1ee3c cho l\u00e0 m\u1ed9t ph\u1ea7n c\u1ee7a RCVS. \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 nhi\u1ec1u c\u01a1n \u0111au \u0111\u1ea7u ki\u1ec3u s\u00e9t \u0111\u00e1nh t\u00e1i ph\u00e1t trong nhi\u1ec1u ng\u00e0y, x\u00e1c su\u1ea5t RCVS g\u1ea7n nh\u01b0 l\u00e0 100%. Ch\u1ee5p \u1ea3nh n\u00e3o v\u1eabn \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u0111\u1ec3 kh\u1ea3o s\u00e1t c\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a RCVS, ch\u1eb3ng h\u1ea1n nh\u01b0 xu\u1ea5t huy\u1ebft d\u01b0\u1edbi nh\u1ec7n, xu\u1ea5t huy\u1ebft n\u00e3o th\u00f9y, ho\u1eb7c nh\u1ed3i m\u00e1u n\u00e3o.
\nCh\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t c\u1ee7a m\u1ed9t b\u1ec7nh l\u00fd \u0111\u1ed9ng m\u1ea1ch n\u1ed9i s\u1ecd c\u00f3 b\u1eb1ng ch\u1ee9ng r\u00f5 r\u00e0ng v\u1ec1 b\u1ea5t th\u01b0\u1eddng \u0111\u1ed9ng m\u1ea1ch tr\u00ean phim m\u1ea1ch m\u00e1u bao g\u1ed3m RCVS, vi\u00eam m\u1ea1ch th\u1ea7n kinh trung \u01b0\u01a1ng nguy\u00ean ph\u00e1t, b\u1ec7nh moyamoya, x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch n\u1ed9i s\u1ecd v\u00e0 vi\u00eam m\u1ea1ch nhi\u1ec5m tr\u00f9ng, v\u00e0 m\u1ed9t s\u1ed1 b\u1ec7nh kh\u00e1c. Tr\u01b0\u1edbc khi c\u00f3 kh\u00e1i ni\u1ec7m v\u1ec1 RCVS, nhi\u1ec1u b\u1ec7nh nh\u00e2n \u0111\u00e3 b\u1ecb ch\u1ea9n \u0111o\u00e1n nh\u1ea7m l\u00e0 vi\u00eam m\u1ea1ch th\u1ea7n kinh trung \u01b0\u01a1ng nguy\u00ean ph\u00e1t v\u00e0 ch\u1ecbu r\u1ee7i ro khi sinh thi\u1ebft n\u00e3o v\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch su\u1ed1t \u0111\u1eddi. C\u00e1c nghi\u00ean c\u1ee9u so s\u00e1nh g\u1ea7n \u0111\u00e2y \u0111\u00e3 ch\u1ec9 ra r\u1eb1ng RCVS c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ph\u00e2n bi\u1ec7t v\u1edbi vi\u00eam m\u1ea1ch th\u1ea7n kinh trung \u01b0\u01a1ng nguy\u00ean ph\u00e1t v\u1edbi \u0111\u1ed9 ch\u00ednh x\u00e1c g\u1ea7n 100% d\u1ef1a tr\u00ean \u0111\u1eb7c \u0111i\u1ec3m \u0111au \u0111\u1ea7u (ki\u1ec3u s\u00e9t \u0111\u00e1nh t\u00e1i ph\u00e1t trong RCVS so v\u1edbi t\u1eeb t\u1eeb trong vi\u00eam m\u1ea1ch nguy\u00ean ph\u00e1t c\u1ee7a th\u1ea7n kinh trung \u01b0\u01a1ng), c\u00e1c ki\u1ec3u t\u1ed5n th\u01b0\u01a1ng MRI (nh\u1ed3i m\u00e1u v\u00f9ng ranh gi\u1edbi \u0111\u1ed1i x\u1ee9ng \u1edf c\u00e1c v\u00f9ng v\u1ecf-d\u01b0\u1edbi v\u1ecf trong RCVS so v\u1edbi nh\u1ed3i m\u00e1u r\u1ea3i r\u00e1c \u1edf v\u00f9ng s\u00e2u trong vi\u00eam m\u1ea1ch) v\u00e0 h\u00ecnh \u1ea3nh ch\u1ee5p m\u1ea1ch n\u00e3o (v\u00ed d\u1ee5: h\u1eb9p v\u00e0 d\u00e3n d\u1ea7n trong RCVS so v\u1edbi h\u00ecnh d\u1ea1ng kh\u00f4ng \u0111\u1ec1u trong vi\u00eam m\u1ea1ch nguy\u00ean ph\u00e1t c\u1ee7a th\u1ea7n kinh trung \u01b0\u01a1ng). Vi\u1ec7c ph\u00e2n bi\u1ec7t s\u1edbm l\u00e0 r\u1ea5t quan tr\u1ecdng v\u00ec li\u1ec7u ph\u00e1p glucocorticoid (\u0111i\u1ec1u tr\u1ecb vi\u00eam m\u1ea1ch th\u1ea7n kinh trung \u01b0\u01a1ng nguy\u00ean ph\u00e1t) c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn k\u1ebft c\u1ee5c x\u1ea5u h\u01a1n \u1edf RCVS. \u0110i\u1ec3m RCVS2 \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n g\u1ea7n \u0111\u00e2y (H\u00ccNH 5-6) cung c\u1ea5p \u0111\u1ed9 nh\u1ea1y cao v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u t\u1eeb 99% \u0111\u1ebfn 100% \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n RCVS \u1edf ng\u01b0\u1eddi l\u1edbn m\u1eafc b\u1ec7nh l\u00fd \u0111\u1ed9ng m\u1ea1ch n\u1ed9i s\u1ecd d\u1ef1a tr\u00ean h\u00ecnh \u1ea3nh h\u1ecdc v\u00e0 l\u00e2m s\u00e0ng. Do \u0111\u00f3, ch\u1ea9n \u0111o\u00e1n s\u1edbm c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n ngay t\u1ea1i gi\u01b0\u1eddng b\u1ec7nh m\u00e0 kh\u00f4ng c\u1ea7n l\u00e0m th\u00eam c\u00e1c x\u00e9t nghi\u1ec7m kh\u00e1c nh\u01b0 ch\u1ee5p phim theo d\u00f5i \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh b\u1ec7nh l\u00fd \u0111\u1ed9ng m\u1ea1ch c\u00f3 h\u1ed3i ph\u1ee5c. D\u1ef1a tr\u00ean c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m \u0111\u00e3 th\u1ea3o lu\u1eadn, b\u00e1c s\u0129 l\u00e2m s\u00e0ng s\u1ebd c\u00f3 th\u1ec3 ch\u1ea9n \u0111o\u00e1n RCVS m\u1ed9t c\u00e1ch d\u1ec5 d\u00e0ng v\u00e0 ch\u00ednh x\u00e1c ngay sau khi nh\u1eadp vi\u1ec7n. Ki\u1ec3m tra d\u1ecbch n\u00e3o t\u1ee7y, ch\u1ee5p MRI 3T c\u00f3 ti\u00eam thu\u1ed1c t\u01b0\u01a1ng ph\u1ea3n, x\u00e9t nghi\u1ec7m marker (v\u00ed d\u1ee5, endothelin 1, vi h\u1ea1t tu\u1ea7n ho\u00e0n) v\u00e0 c\u00e1c x\u00e9t nghi\u1ec7m x\u00e2m l\u1ea5n ti\u1ec1m \u1ea9n nhi\u1ec1u r\u1ee7i ro nh\u01b0 truy\u1ec1n thu\u1ed1c gi\u00e3n m\u1ea1ch n\u1ed9i m\u1ea1ch v\u00e0 sinh thi\u1ebft n\u00e3o c\u00f3 c\u00f4ng d\u1ee5ng ch\u1ea9n \u0111o\u00e1n h\u1ea1n ch\u1ebf. C\u1ea7n t\u1eadp trung v\u00e0o vi\u1ec7c x\u00e1c \u0111\u1ecbnh c\u00e1c y\u1ebfu t\u1ed1 k\u00edch g\u1ee3i g\u00e2y co m\u1ea1ch ti\u1ec1m \u1ea9n (B\u1ea2NG 5-2) b\u1eb1ng c\u00e1ch khai th\u00e1c b\u1ec7nh s\u1eed v\u00e0 l\u00e0m c\u00e1c x\u00e9t nghi\u1ec7m nh\u01b0 n\u1ed3ng \u0111\u1ed9 canxi v\u00e0 magi\u00ea, ki\u1ec3m tra ch\u1ea5t \u0111\u1ed9c \u0111\u1ec3 t\u00ecm c\u00e1c ch\u1ea5t ma t\u00fay v\u00e0 n\u1ed3ng \u0111\u1ed9 axit vanillylmandelic trong n\u01b0\u1edbc ti\u1ec3u v\u00e0 axit 5-hydroxy-indoleacetic n\u1ebfu c\u00e1c tri\u1ec7u ch\u1ee9ng g\u1ee3i \u00fd c\u00e1c kh\u1ed1i u ho\u1ea1t m\u1ea1ch nh\u01b0 u pheochromocytomas ho\u1eb7c kh\u1ed1i u carcinoid.<\/p>\n

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

H\u00ecnh 6. Thang \u0111i\u1ec3m RCVS 2 v\u00e0 ph\u00e2n ph\u1ed1i \u0111i\u1ec3m s\u1ed1 \u1edf m\u1ed9t s\u1ed1 b\u1ec7nh l\u00fd m\u1ea1ch m\u00e1u n\u00e3o<\/p>\n

B\u1ea3ng 2. Nh\u1eefng y\u1ebfu t\u1ed1 k\u00edch g\u1ee3i v\u00e0 b\u1ec7nh l\u00fd li\u00ean quan v\u1edbi RCVS<\/p>\n\n\n\n\n\n\n\n\n
Y\u1ebfu t\u1ed1 k\u00edch g\u1ee3i\/b\u1ec7nh l\u00fd li\u00ean quan<\/strong><\/td>\nV\u00ed d\u1ee5<\/strong><\/td>\n<\/tr>\n
C\u00e1c b\u1ec7nh l\u00fd \u0111au \u0111\u1ea7u<\/td>\n\u0110au \u0111\u1ea7u s\u00e9t \u0111\u00e1nh nguy\u00ean ph\u00e1t, \u0111au \u0111\u1ea7u nguy\u00ean ph\u00e1t do g\u1eafng s\u1ee9c, \u0111au \u0111\u1ea7u nguy\u00ean ph\u00e1t li\u00ean quan \u0111\u1ebfn ho\u1ea1t \u0111\u1ed9ng t\u00ecnh d\u1ee5c, \u0111au \u0111\u1ea7u nguy\u00ean ph\u00e1t do ho, migraine.<\/td>\n<\/tr>\n
Thu\u1ed1c<\/td>\nThu\u1ed1c \u0111i\u1ec1u tr\u1ecb Mgraine, thu\u1ed1c c\u1ea3m l\u1ea1nh, thu\u1ed1c ch\u1ed1ng tr\u1ea7m c\u1ea3m, thu\u1ed1c \u0111\u1ed3ng v\u1eadn adrenergic, c\u00e1c ch\u1ebf ph\u1ea9m m\u00e1u, huy\u1ebft t\u01b0\u01a1ng, IVIg, hormone, h\u00f3a tr\u1ecb li\u1ec7u v\u00e0 li\u1ec7u ph\u00e1p mi\u1ec5n d\u1ecbch, NSAID\u2026<\/td>\n<\/tr>\n
Thu\u1ed1c g\u00e2y nghi\u1ec7n<\/td>\nC\u1ea7n sa, cocaine, thu\u1ed1c l\u1eafc, axit lysergic diethylamide, d\u1eabn xu\u1ea5t amphetamine.<\/td>\n<\/tr>\n
Thai k\u1ef3 v\u00e0 h\u1eadu s\u1ea3n<\/td>\nD\u1eady th\u00ec s\u1edbm, hi\u1ebfm mu\u1ed9n, s\u1ea3n gi\u1eadt v\u00e0 ti\u1ec1n s\u1ea3n gi\u1eadt, s\u1ea3n gi\u1eadt mu\u1ed9n sau sinh<\/td>\n<\/tr>\n
Kh\u00e1c<\/td>\n\u0110\u1ed9 cao, ti\u1ebfp x\u00fac v\u1edbi n\u01b0\u1edbc l\u1ea1nh, b\u00e3o, \u0111au bu\u1ed3n nghi\u00eam tr\u1ecdng, t\u0103ng calci m\u00e1u, ng\u01b0ng nifedipine, ng\u01b0ng caffein, r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a porphyrin, ban xu\u1ea5t huy\u1ebft gi\u1ea3m ti\u1ec3u c\u1ea7u huy\u1ebft kh\u1ed1i, u pheochromocytoma, kh\u1ed1i u carcinoid ph\u1ebf qu\u1ea3n, t\u00fai ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch n\u00e3o kh\u00f4ng v\u1ee1, ch\u1ea5n th\u01b0\u01a1ng \u0111\u1ea7u, t\u1ee5 m\u00e1u d\u01b0\u1edbi m\u00e0ng c\u1ee9ng, huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch n\u1ed9i s\u1ecd, ph\u1eabu thu\u1eadt c\u1eaft n\u1ed9i m\u1ea1c \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh sau, u m\u1ea1c treo, c\u00e1c th\u1ee7 thu\u1eadt ph\u1eabu thu\u1eadt th\u1ea7n kinh, k\u00edch th\u00edch t\u1eeb tr\u01b0\u1eddng xuy\u00ean s\u1ecd l\u1eb7p \u0111i l\u1eb7p l\u1ea1i, b\u1ec7nh lupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

7. B\u1ec6NH SINH<\/strong><\/h2>\n

S\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a c\u00e1c b\u1ea5t th\u01b0\u1eddng v\u1ec1 m\u1ea1ch m\u00e1u n\u00e3o v\u00e0 t\u01b0\u1edbi m\u00e1u n\u00e3o, ph\u00f9 ki\u1ec3u m\u1ea1ch m\u00e1u, c\u00e1c bi\u1ebfn ch\u1ee9ng thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 v\u00e0 xu\u1ea5t huy\u1ebft li\u00ean quan \u0111\u1ebfn s\u1ef1 suy gi\u1ea3m tho\u00e1ng qua qu\u00e1 tr\u00ecnh t\u1ef1 \u0111i\u1ec1u h\u00f2a n\u00e3o \u1edf c\u1ea3 hai h\u1ed9i ch\u1ee9ng. Th\u1eadt v\u1eady, ho\u1ea1t \u0111\u1ed9ng m\u1ea1ch m\u00e1u n\u00e3o b\u1ea5t th\u01b0\u1eddng r\u00f5 r\u1ec7t trong giai \u0111o\u1ea1n c\u1ea5p t\u00ednh c\u1ee7a RCVS so v\u1edbi nh\u00f3m \u0111\u1ed1i ch\u1ee9ng, v\u00e0 gi\u1ea3m t\u01b0\u1edbi m\u00e1u n\u00e3o \u0111\u01b0\u1ee3c ghi nh\u1eadn r\u00f5 trong PRES. M\u1ed1i li\u00ean h\u1ec7 gi\u1eefa \u0111au \u0111\u1ea7u s\u00e9t \u0111\u00e1nh t\u00e1i ph\u00e1t v\u00e0 h\u1eb9p \u0111\u1ed9ng m\u1ea1ch n\u00e3o trong RCVS ch\u01b0a \u0111\u01b0\u1ee3c hi\u1ec3u r\u00f5 nh\u01b0ng c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn h\u1ec7 th\u1ed1ng m\u1ea1ch m\u00e1u cho th\u1ea7n kinh sinh ba ho\u1eb7c h\u1ec7 serotonergic gi\u1eefa th\u00e2n n\u00e3o v\u00e0 m\u1ea1ch m\u00e1u n\u00e3o. T\u01b0\u01a1ng t\u1ef1, s\u1ef1 kh\u00e1c bi\u1ec7t v\u1ec1 ph\u00e2n b\u1ed1 m\u1ea1ch m\u00e1u c\u1ee7a tu\u1ea7n ho\u00e0n tr\u01b0\u1edbc v\u00e0 tu\u1ea7n ho\u00e0n sau c\u00f3 th\u1ec3 gi\u1ea3i th\u00edch s\u1ef1 \u01b0u th\u1ebf c\u1ee7a n\u00e3o sau trong PRES. T\u0103ng huy\u1ebft \u00e1p, c\u00f3 th\u1ec3 xu\u1ea5t ph\u00e1t t\u1eeb m\u1ed9t c\u01a1 ch\u1ebf \u1edf trung \u01b0\u01a1ng, c\u00f3 v\u1ebb nh\u01b0 l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 quan tr\u1ecdng g\u00f3p ph\u1ea7n v\u00e0o s\u1ef1 ph\u00e1 v\u1ee1 h\u00e0ng r\u00e0o m\u00e1u n\u00e3o g\u1eb7p trong c\u1ea3 hai h\u1ed9i ch\u1ee9ng. Vai tr\u00f2 c\u1ee7a r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng n\u1ed9i m\u00f4, endothelin 1, serotonin, cytokine, y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng n\u1ed9i m\u00f4 m\u1ea1ch m\u00e1u (VEGF), m\u1ea5t c\u00e2n b\u1eb1ng hormone sinh d\u1ee5c n\u1eef, stress oxy h\u00f3a, di truy\u1ec1n, vi RNA tu\u1ea7n ho\u00e0n v\u00e0 r\u1ed1i lo\u1ea1n \u0111i\u1ec1u h\u00f2a t\u1ef1 \u0111\u1ed9ng c\u0169ng \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ec9 ra nh\u01b0ng c\u1ea7n ti\u1ebfp t\u1ee5c nghi\u00ean c\u1ee9u th\u00eam. Kh\u00f4ng c\u00f3 nguy c\u01a1 di truy\u1ec1n n\u00e0o \u0111\u01b0\u1ee3c bi\u1ebft \u0111\u1ebfn. C\u1ea7n l\u01b0u \u00fd r\u1eb1ng nhi\u1ec1u y\u1ebfu t\u1ed1 k\u00edch ho\u1ea1t v\u00e0 y\u1ebfu t\u1ed1 nguy c\u01a1 c\u1ee7a PRES v\u00e0 RCVS (B\u1ea2NG 5-2) c\u00f3 c\u01a1 s\u1edf l\u00e0 co m\u1ea1ch; m\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1 li\u00ean quan \u0111\u1ebfn m\u1ed1i quan h\u1ec7 th\u1eddi gian, nh\u01b0ng c\u00f3 th\u1ec3 t\u1ed3n t\u1ea1i c\u00e1c nh\u1eefng sai s\u1ed1 trong b\u00e1o c\u00e1o v\u00e0 thi\u1ebfu c\u00e1c nghi\u00ean c\u1ee9u d\u1ecbch t\u1ec5 h\u1ecdc x\u00e1c nh\u1eadn.
\nNhi\u1ec5m tr\u00f9ng v\u00e0 vai tr\u00f2 c\u1ee7a vi\u00eam c\u0169ng \u0111\u00e3 \u0111\u01b0\u1ee3c lo\u1ea1i tr\u1eeb b\u1eb1ng k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m d\u1ecbch n\u00e3o t\u1ee7y b\u00ecnh th\u01b0\u1eddng v\u00e0 nh\u1eefng nghi\u00ean c\u1ee9u v\u1ec1 b\u1ec7nh h\u1ecdc c\u1ee7a \u0111\u1ed9ng m\u1ea1ch n\u00e3o v\u00e0 nhu m\u00f4 n\u00e3o. B\u1ec7nh l\u00fd n\u00e3o trong PRES cho th\u1ea5y ph\u00f9 n\u1ed9i m\u00f4, ho\u1ea1i t\u1eed m\u1ea1ch fibrinoid, c\u00e1c vi nh\u1ed3i m\u00e1u r\u1ea3i r\u00e1c, gliosis, v\u00e0 l\u1eafng \u0111\u1ecdng hemosiderin; tuy nhi\u00ean, trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p, c\u00e1c t\u1ebf b\u00e0o h\u00ecnh sao ph\u1ea3n \u1ee9ng, microglia v\u00e0 t\u1ebf b\u00e0o lympho T quanh m\u1ea1ch \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o. C\u00e1c nghi\u00ean c\u1ee9u b\u1ec7nh h\u1ecdc trong RCVS c\u00f2n h\u1ea1n ch\u1ebf; tuy nhi\u00ean, kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng v\u1ec1 ch\u1ee9ng vi\u00eam \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y.<\/p>\n

8. \u0110I\u1ec0U TR\u1eca<\/strong><\/h2>\n

Vi\u1ec7c qu\u1ea3n l\u00fd c\u1ea3 RCVS v\u00e0 PRES c\u1ea7n hi\u1ec3u r\u1eb1ng c\u1ea3 hai \u0111\u1ec1u l\u00e0 nh\u1eefng t\u00ecnh tr\u1ea1ng l\u00e0nh t\u00ednh t\u1ef1 gi\u1edbi h\u1ea1n. \u0110i\u1ec1u quan tr\u1ecdng l\u00e0 tr\u00e1nh ch\u1ea9n \u0111o\u00e1n sai v\u00e0 kh\u00f4ng \u0111i\u1ec1u tr\u1ecb theo kinh nghi\u1ec7m trong khi t\u1eadp trung v\u00e0o \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng. Kh\u00f4ng c\u00f3 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ho\u1eb7c chi\u1ebfn l\u01b0\u1ee3c c\u1ee5 th\u1ec3 n\u00e0o \u0111\u01b0\u1ee3c ch\u1ee9ng minh hi\u1ec7u qu\u1ea3 \u0111\u1ec3 gi\u1ea3i quy\u1ebft ph\u00f9 n\u1ec1 do m\u1ea1ch m\u00e1u trong PRES ho\u1eb7c c\u00e1c b\u1ea5t th\u01b0\u1eddng m\u1ea1ch m\u00e1u trong RCVS. T\u01b0\u01a1ng t\u1ef1, kh\u00f4ng c\u00f3 chi\u1ebfn l\u01b0\u1ee3c n\u00e0o \u0111\u01b0\u1ee3c thi\u1ebft l\u1eadp \u0111\u1ec3 ng\u0103n ng\u1eeba c\u00e1c bi\u1ebfn ch\u1ee9ng nh\u01b0 \u0111\u1ed9t qu\u1ef5 do thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 ho\u1eb7c xu\u1ea5t huy\u1ebft ho\u1eb7c t\u00ecnh tr\u1ea1ng co m\u1ea1ch tr\u1edf n\u00ean t\u1ed3i t\u1ec7 h\u01a1n. Vi\u1ec7c lo\u1ea1i b\u1ecf y\u1ebfu t\u1ed1 k\u00edch g\u1ee3i (n\u1ebfu \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh), \u00edt nh\u1ea5t l\u00e0 cho \u0111\u1ebfn khi l\u00e2m s\u00e0ng v\u00e0 h\u00ecnh \u1ea3nh h\u1ecdc ph\u1ee5c h\u1ed3i l\u00e0 h\u1ee3p l\u00fd v\u00e0 quan tr\u1ecdng trong c\u1ea3 hai b\u1ec7nh l\u00fd tr\u00ean.
\n\u1ede nh\u1eefng b\u1ec7nh nh\u00e2n m\u1eafc PRES, vi\u1ec7c ph\u00e2n nh\u00f3m th\u00edch h\u1ee3p \u0111\u1ebfn c\u01a1 s\u1edf ch\u0103m s\u00f3c \u0111\u1eb7c bi\u1ec7t ho\u1eb7c t\u1ea7ng d\u00e0nh cho b\u1ec7nh nh\u00e2n n\u1ed9i tr\u00fa ph\u1ee5 thu\u1ed9c v\u00e0o t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng c\u1ee7a b\u1ec7nh nh\u00e2n (v\u00ed d\u1ee5: co gi\u1eadt, b\u1ec7nh n\u00e3o, s\u1ea3n gi\u1eadt) v\u00e0 m\u1ee9c \u0111\u1ed9 t\u0103ng huy\u1ebft \u00e1p. C\u00e1c chuy\u00ean gia \u0111\u1ed3ng \u00fd r\u1eb1ng n\u00ean \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p nghi\u00eam tr\u1ecdng v\u00e0 tr\u00e1nh nh\u1eefng dao \u0111\u1ed9ng c\u1ee7a huy\u1ebft \u00e1p. V\u00ec m\u1ee5c \u0111\u00edch n\u00e0y, theo d\u00f5i huy\u1ebft \u00e1p \u0111\u1ed9ng m\u1ea1ch v\u00e0 d\u00f9ng thu\u1ed1c h\u1ea1 \u00e1p \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch th\u01b0\u1eddng c\u1ea7n thi\u1ebft. Vi\u1ec7c l\u1ef1a ch\u1ecdn thu\u1ed1c h\u1ea1 huy\u1ebft \u00e1p ch\u01b0a \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u, m\u1eb7c d\u00f9 h\u1ea7u h\u1ebft c\u00e1c b\u00e1c s\u0129 l\u00e2m s\u00e0ng \u1ee7ng h\u1ed9 thu\u1ed1c ch\u1eb9n k\u00eanh canxi v\u00ec t\u00e1c d\u1ee5ng gi\u00e3n m\u1ea1ch c\u1ee7a ch\u00fang. Huy\u1ebft \u00e1p n\u00ean \u0111\u01b0\u1ee3c gi\u1ea3m d\u1ea7n kho\u1ea3ng 25% sau m\u1ed7i 3 \u0111\u1ebfn 4 gi\u1edd. Ch\u0103m s\u00f3c n\u00ean \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ec3 tr\u00e1nh h\u1ea1 huy\u1ebft \u00e1p v\u00e0 l\u00e0m tr\u1ea7m tr\u1ecdng th\u00eam t\u00ecnh tr\u1ea1ng thi\u1ebfu m\u00e1u n\u00e3o, \u0111\u1eb7c bi\u1ec7t khi \u0111\u1ed1i m\u1eb7t v\u1edbi gi\u1ea3m t\u01b0\u1edbi m\u00e1u n\u00e3o v\u00e0 RCVS \u0111\u1ed3ng th\u1eddi.
\n\u1ede nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb ti\u1ec1n s\u1ea3n gi\u1eadt ho\u1eb7c s\u1ea3n gi\u1eadt n\u1eb7ng, c\u1ea7n \u0111\u1ea3m b\u1ea3o k\u1ebft th\u00fac thai k\u1ef3 s\u1edbm v\u00e0 ch\u1ec9 \u0111\u1ecbnh magie sulfat \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb v\u00e0 d\u1ef1 ph\u00f2ng co gi\u1eadt. Nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 \u00fd th\u1ee9c thay \u0111\u1ed5i c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i b\u1eb1ng \u0111i\u1ec7n n\u00e3o \u0111\u1ed3 \u0111\u1ec3 bi\u1ebft tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh d\u01b0\u1edbi l\u00e2m s\u00e0ng v\u00e0 \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p. Co c\u1ee9ng co gi\u1eadt to\u00e0n th\u1ec3 l\u00e0 th\u01b0\u1eddng g\u1eb7p khi kh\u1edfi ph\u00e1t \u0111\u1ed1i v\u1edbi PRES nh\u01b0ng th\u01b0\u1eddng kh\u00f4ng t\u00e1i ph\u00e1t, do \u0111\u00f3, thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh d\u00e0i h\u1ea1n kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o tr\u1eeb khi c\u00e1c c\u01a1n co gi\u1eadt t\u00e1i ph\u00e1t do t\u1ed5n th\u01b0\u01a1ng n\u00e3o kh\u00f4ng h\u1ed3i ph\u1ee5c. H\u1ea7u h\u1ebft c\u00e1c b\u00e1c s\u0129 l\u00e2m s\u00e0ng kh\u00f4ng d\u00f9ng thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh d\u1ef1 ph\u00f2ng cho b\u1ec7nh nh\u00e2n PRES ho\u1eb7c RCVS, ngay c\u1ea3 khi c\u00f3 t\u1ed5n th\u01b0\u01a1ng c\u1ea5u tr\u00fac n\u00e3o, tr\u1eeb khi b\u1ec7nh nh\u00e2n b\u1ecb co gi\u1eadt t\u00e1i ph\u00e1t ho\u1eb7c c\u00e1c ph\u00e1t hi\u1ec7n li\u00ean quan \u0111\u1ebfn \u0111i\u1ec7n n\u00e3o \u0111\u1ed3, trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y, \u0111\u00e1nh gi\u00e1 l\u00e2m s\u00e0ng v\u00e0 \u0111i\u1ec7n n\u00e3o \u0111\u1ed3 theo d\u00f5i \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh th\u1eddi gian \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng ch\u1ed1ng \u0111\u1ed9ng kinh th\u00edch h\u1ee3p.
\nCorticosteroid c\u00f3 th\u1ec3 th\u00fac \u0111\u1ea9y PRES, kh\u00f4ng li\u00ean quan \u0111\u1ebfn m\u1ee9c \u0111\u1ed9 ph\u00f9 n\u1ec1 ki\u1ec3u m\u1ea1ch m\u00e1u, v\u00e0 c\u00f3 th\u1ec3 l\u00e0m tr\u1ea7m tr\u1ecdng th\u00eam t\u00ecnh h\u00ecnh \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u1ed3ng m\u1eafc RCVS, v\u00ec v\u1eady t\u1ed1t nh\u1ea5t n\u00ean tr\u00e1nh d\u00f9ng trong PRES. T\u0103ng \u0111\u01b0\u1eddng huy\u1ebft c\u00f3 li\u00ean quan \u0111\u1ebfn ti\u00ean l\u01b0\u1ee3ng x\u1ea5u h\u01a1n v\u00e0 c\u1ea7n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi. \u0110i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng \u0111au \u0111\u1ea7u v\u00e0 tr\u1ea5n an l\u00e0 nh\u1eefng kh\u00eda c\u1ea1nh quan tr\u1ecdng c\u1ee7a \u0111i\u1ec1u tr\u1ecb. Nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb m\u1ea5t ch\u1ee9c n\u0103ng do \u0111\u1ed9t qu\u1ef5 c\u00f3 th\u1ec3 c\u1ea7n \u0111\u1ebfn li\u1ec7u ph\u00e1p ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng.
\nM\u1eb7c d\u00f9 kh\u1edfi ph\u00e1t kh\u00e1 t\u1ed1i c\u1ea5p v\u1edbi \u0111au \u0111\u1ea7u s\u00e9t \u0111\u00e1nh v\u00e0 co th\u1eaft m\u1ea1ch m\u00e1u n\u00e3o, ph\u1ea7n l\u1edbn b\u1ec7nh nh\u00e2n RCVS kh\u00f4ng c\u00f3 t\u1ed5n th\u01b0\u01a1ng nhu m\u00f4 n\u00e3o ho\u1eb7c thi\u1ebfu h\u1ee5t th\u1ea7n kinh khu tr\u00fa. Nhi\u1ec1u b\u1ec7nh nh\u00e2n \u0111au \u0111\u1ea7u s\u00e9t \u0111\u00e1nh \u0111\u01a1n \u0111\u1ed9c \u0111\u01b0\u1ee3c xu\u1ea5t vi\u1ec7n t\u1ea1i khoa c\u1ea5p c\u1ee9u ch\u1ec9 nh\u1eadp vi\u1ec7n l\u1ea1i v\u00ec \u0111au \u0111\u1ea7u t\u00e1i ph\u00e1t, l\u00fac n\u00e0y ch\u1ee5p m\u1ea1ch m\u00e1u n\u00e3o cho th\u1ea5y co m\u1ea1ch d\u1eabn \u0111\u1ebfn ch\u1ea9n \u0111o\u00e1n RCVS. Qu\u1ea3n l\u00fd b\u1ec7nh nh\u00e2n RCVS ch\u1ee7 y\u1ebfu l\u00e0 theo d\u00f5i tri\u1ec7u ch\u1ee9ng cho \u0111\u1ebfn khi c\u01a1n \u0111au \u0111\u1ea7u \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t v\u00e0 c\u00e1c \u0111\u1ee3t t\u00e1i ph\u00e1t b\u1eaft \u0111\u1ea7u thuy\u00ean gi\u1ea3m; \u0111i\u1ec1u n\u00e0y th\u01b0\u1eddng m\u1ea5t m\u1ed9t v\u00e0i ng\u00e0y. \u0110au \u0111\u1ea7u d\u1eef d\u1ed9i c\u00f3 th\u1ec3 c\u1ea7n d\u00f9ng thu\u1ed1c ch\u1ed1ng vi\u00eam kh\u00f4ng steroid nh\u01b0 indomethacin ho\u1eb7c ibuprofen v\u00e0 th\u1eadm ch\u00ed \u0111i\u1ec1u tr\u1ecb b\u1eb1ng opioid. B\u1ec7nh nh\u00e2n RCVS v\u1edbi thi\u1ebfu h\u1ee5t th\u1ea7n kinh khu tr\u00fa v\u00e0 co m\u1ea1ch n\u1eb7ng ho\u1eb7c b\u1ea5t th\u01b0\u1eddng h\u00ecnh \u1ea3nh n\u00e3o n\u00ean \u0111\u01b0\u1ee3c nh\u1eadp vi\u1ec7n trong th\u1eddi gian d\u00e0i h\u01a1n. Nguy c\u01a1 cao nh\u1ea5t c\u1ee7a c\u00e1c bi\u1ebfn ch\u1ee9ng xu\u1ea5t huy\u1ebft l\u00e0 trong tu\u1ea7n \u0111\u1ea7u ti\u00ean v\u00e0 c\u00e1c bi\u1ebfn ch\u1ee9ng thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 th\u01b0\u1eddng \u1edf tu\u1ea7n th\u1ee9 hai. Vi\u1ec7c ph\u00e2n lo\u1ea1i th\u00edch h\u1ee3p v\u00e0o t\u1ea7ng d\u00e0nh cho b\u1ec7nh nh\u00e2n n\u1ed9i tr\u00fa thay v\u00ec \u0111\u01a1n v\u1ecb ch\u0103m s\u00f3c \u0111\u1eb7c bi\u1ec7t \u0111\u00f2i h\u1ecfi ph\u1ea3i c\u00f3 s\u1ef1 quy\u1ebft \u0111\u1ecbnh v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng, \u0111\u00e1nh gi\u00e1 kh\u1ea3 n\u0103ng \u0111o huy\u1ebft \u00e1p v\u00e0 li\u1ec7u c\u00f3 c\u00e1c y\u1ebfu t\u1ed1 d\u1ef1 b\u00e1o ti\u00ean l\u01b0\u1ee3ng k\u00e9m nh\u01b0 s\u1eed d\u1ee5ng glucocorticoid ho\u1eb7c thu\u1ed1c co m\u1ea1ch serotonergic hay kh\u00f4ng. Si\u00eau \u00e2m Doppler xuy\u00ean s\u1ecd h\u00e0ng ng\u00e0y r\u1ea5t h\u1eefu \u00edch \u0111\u1ec3 theo d\u00f5i v\u1eadn t\u1ed1c d\u00f2ng m\u00e1u n\u1ed9i s\u1ecd m\u1eb7c d\u00f9 \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u c\u1ee7a ch\u00fang b\u1ecb h\u1ea1n ch\u1ebf v\u00e0 v\u1eadn t\u1ed1c d\u00f2ng ch\u1ea3y b\u00ecnh th\u01b0\u1eddng c\u00f3 th\u1ec3 kh\u00f4ng t\u01b0\u01a1ng quan v\u1edbi c\u00e1c b\u1ea5t th\u01b0\u1eddng khi ch\u1ee5p m\u1ea1ch. C\u00e1c nguy\u00ean t\u1eafc qu\u1ea3n l\u00fd huy\u1ebft \u00e1p v\u00e0 co gi\u1eadt trong RCVS t\u01b0\u01a1ng t\u1ef1 nh\u01b0 c\u00e1c nguy\u00ean t\u1eafc \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 \u1edf tr\u00ean \u0111\u1ed1i v\u1edbi PRES. \u0110i\u1ec1u quan tr\u1ecdng l\u00e0 ph\u1ea3i t\u00edch c\u1ef1c h\u01a1n trong vi\u1ec7c ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p \u1edf b\u1ec7nh nh\u00e2n \u0111\u1ed3ng m\u1eafc RCVS v\u00e0 PRES. Thu\u1ed1c ch\u1eb9n k\u00eanh canxi (v\u00ed d\u1ee5: nimodipine, verapamil) n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t v\u00ec \u0111\u01b0\u1ee3c cho l\u00e0 c\u00f3 t\u00e1c d\u1ee5ng gi\u00e3n m\u1ea1ch, nh\u01b0ng kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn th\u1eddi gian co m\u1ea1ch. Tuy nhi\u00ean, ch\u00fang c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m c\u01b0\u1eddng \u0111\u1ed9 \u0111au \u0111\u1ea7u v\u00e0 h\u1ea7u h\u1ebft c\u00e1c b\u00e1c s\u0129 l\u00e2m s\u00e0ng s\u1eed d\u1ee5ng c\u00e1c lo\u1ea1i thu\u1ed1c n\u00e0y cho \u0111\u1ebfn khi gi\u1ea3i quy\u1ebft \u0111\u01b0\u1ee3c c\u01a1n \u0111au \u0111\u1ea7u ho\u1eb7c c\u00e1c b\u1ea5t th\u01b0\u1eddng v\u1ec1 ch\u1ee5p m\u1ea1ch.
\nNh\u1eefng sai l\u1ea7m ph\u1ed5 bi\u1ebfn trong \u0111i\u1ec1u tr\u1ecb RCVS bao g\u1ed3m s\u1eed d\u1ee5ng triptan, ergots, ho\u1eb7c c\u00e1c lo\u1ea1i thu\u1ed1c co m\u1ea1ch d\u00f9ng trong \u0111i\u1ec1u tr\u1ecb Migraine; d\u00f9ng glucocorticoid ho\u1eb7c ti\u1ebfn h\u00e0nh sinh thi\u1ebft n\u00e3o ho\u1eb7c truy\u1ec1n thu\u1ed1c gi\u00e3n m\u1ea1ch \u0111\u1ec3 lo\u1ea1i tr\u1eeb c\u00e1c b\u1ec7nh l\u00fd \u0111\u1ed9ng m\u1ea1ch kh\u00f4ng ph\u1ea3i RCVS nh\u01b0 vi\u00eam m\u1ea1ch. C\u1ea7n l\u01b0u \u00fd r\u1eb1ng truy\u1ec1n thu\u1ed1c gi\u00e3n m\u1ea1ch c\u00f3 t\u00e1c d\u1ee5ng ng\u1eafn h\u1ea1n v\u00e0 c\u00f3 th\u1ec3 g\u00e2y t\u1ed5n th\u01b0\u01a1ng do t\u00e1i t\u01b0\u1edbi m\u00e1u. M\u1eb7c d\u00f9 c\u00e1c b\u00e1o c\u00e1o ca cho th\u1ea5y hi\u1ec7u qu\u1ea3, nh\u01b0ng kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng r\u00f5 r\u00e0ng v\u1ec1 l\u1ee3i \u00edch; do \u0111\u00f3, th\u1ee7 thu\u1eadt x\u00e2m l\u1ea5n n\u00e0y kh\u00f4ng th\u1ec3 \u0111\u01b0\u1ee3c ch\u1ea5p nh\u1eadn cho c\u00e1c m\u1ee5c \u0111\u00edch ch\u1ea9n \u0111o\u00e1n th\u01b0\u1eddng quy v\u00e0 n\u00ean \u0111\u01b0\u1ee3c d\u00e0nh nh\u01b0 li\u1ec7u ph\u00e1p c\u1ee9u c\u00e1nh cho t\u00ecnh tr\u1ea1ng x\u1ea5u \u0111i r\u00f5 r\u1ec7t tr\u00ean l\u00e2m s\u00e0ng.<\/p>\n

9. TI\u00caN L\u01af\u1ee2NG<\/strong><\/h2>\n

K\u1ebft c\u1ee5c c\u1ee7a c\u1ea3 RCVS v\u00e0 PRES th\u01b0\u1eddng l\u00e0 t\u1ed1t, v\u1edbi kh\u1ea3 n\u0103ng ph\u1ee5c h\u1ed3i c\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng v\u00e0 b\u1ea5t th\u01b0\u1eddng h\u00ecnh \u1ea3nh trong v\u00f2ng v\u00e0i ng\u00e0y \u0111\u1ebfn v\u00e0i tu\u1ea7n \u1edf kho\u1ea3ng 80% \u0111\u1ebfn 90% b\u1ec7nh nh\u00e2n m\u1eafc PRES v\u00e0 h\u01a1n 90% b\u1ec7nh nh\u00e2n RCVS. Ch\u1ee5p n\u00e3o v\u00e0 m\u1ea1ch m\u00e1u n\u00e3o th\u01b0\u1eddng \u0111\u01b0\u1ee3c theo d\u00f5i \u0111\u1ec3 x\u00e1c nh\u1eadn s\u1ef1 ph\u1ee5c h\u1ed3i c\u1ee7a c\u00e1c b\u1ea5t th\u01b0\u1eddng nhu m\u00f4 n\u00e3o ho\u1eb7c m\u1ea1ch m\u00e1u v\u00e0 ch\u1ea9n \u0111o\u00e1n lo\u1ea1i tr\u1eeb c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c; tuy nhi\u00ean, vai tr\u00f2 c\u1ee7a vi\u1ec7c l\u00e0m n\u00e0y \u0111ang tr\u1edf n\u00ean h\u1ea1n ch\u1ebf v\u1edbi b\u1ec7nh s\u1eed t\u1ef1 gi\u1edbi h\u1ea1n v\u00e0 vi\u1ec7c c\u1ea3i thi\u1ec7n \u0111\u1ed9 ch\u00ednh x\u00e1c c\u1ee7a ch\u1ea9n \u0111o\u00e1n s\u1edbm.
\nV\u1edbi PRES, th\u1eddi gian trung b\u00ecnh \u0111\u1ec3 h\u1ed3i ph\u1ee5c v\u1ec1 l\u00e2m s\u00e0ng l\u00e0 d\u01b0\u1edbi 1 tu\u1ea7n; v\u1ec1 h\u00ecnh \u1ea3nh h\u1ecdc c\u00f3 th\u1ec3 l\u00e2u h\u01a1n. Suy gi\u1ea3m nh\u1eadn th\u1ee9c l\u00e2u d\u00e0i v\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng th\u1ea7n kinh nh\u01b0 gi\u1ea3m th\u1ecb l\u1ef1c ho\u1eb7c ch\u00f3ng m\u1eb7t \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o \u1edf 10% \u0111\u1ebfn 20% b\u1ec7nh nh\u00e2n; tuy nhi\u00ean, ch\u00fang th\u01b0\u1eddng nh\u1eb9 v\u00e0 kh\u00f4ng g\u00e2y \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng. \u0110\u1ed9ng kinh t\u00e1i ph\u00e1t c\u00f3 th\u1ec3 x\u1ea3y ra do c\u00e1c bi\u1ebfn ch\u1ee9ng nh\u1ed3i m\u00e1u ho\u1eb7c ho\u1eb7c xu\u1ea5t huy\u1ebft. B\u1ec7nh nh\u00e2n PRES xu\u1ea5t huy\u1ebft v\u00e0 PRES \u1edf b\u1ec7nh nh\u00e2n t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft c\u00f3 k\u1ebft c\u1ee5c x\u1ea5u h\u01a1n, th\u1eddi gian h\u1ed3i ph\u1ee5c l\u00e2u h\u01a1n. T\u1eed vong (v\u00ed d\u1ee5, do ph\u00f9 n\u00e3o ti\u1ebfn tri\u1ec3n ho\u1eb7c xu\u1ea5t huy\u1ebft n\u00e3o) \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o \u1edf 5% \u0111\u1ebfn 7% b\u1ec7nh nh\u00e2n; tuy nhi\u00ean, nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y n\u1eb7ng v\u00e0 t\u1eed vong kh\u00f4ng ph\u1ea3i l\u00fac c\u0169ng do PRES tr\u1ef1c ti\u1ebfp. PRES t\u00e1i ph\u00e1t \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o \u1edf 5% \u0111\u1ebfn 10% b\u1ec7nh nh\u00e2n, th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn t\u0103ng huy\u1ebft \u00e1p kh\u00f4ng ki\u1ec3m so\u00e1t ho\u1eb7c c\u00f3 s\u1eed d\u1ee5ng thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch. Lo\u1ea1i b\u1ecf li\u1ec7u ph\u00e1p h\u00f3a tr\u1ecb li\u1ec7u ho\u1eb7c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o trong giai \u0111o\u1ea1n c\u1ea5p t\u00ednh, v\u00e0 c\u00e1c thu\u1ed1c thay th\u1ebf n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t, n\u1ebfu c\u00f3 th\u1ec3, sau khi \u0111i\u1ec1u tr\u1ecb kh\u1ecfi PRES. Ti\u1ec1n s\u1ea3n gi\u1eadt v\u00e0 s\u1ea3n gi\u1eadt c\u00f3 li\u00ean quan \u0111\u1ebfn nguy c\u01a1 cao h\u01a1n v\u1ec1 c\u00e1c k\u1ebft c\u1ee5c tim m\u1ea1ch trong t\u01b0\u01a1ng lai nh\u01b0 t\u0103ng huy\u1ebft \u00e1p, b\u1ec7nh m\u1ea1ch v\u00e0nh v\u00e0 \u0111\u1ed9t qu\u1ef5; tuy nhi\u00ean, nguy c\u01a1 l\u00e2u d\u00e0i c\u1ee7a PRES v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c bi\u1ebft r\u00f5.
\nKho\u1ea3ng m\u1ed9t ph\u1ea7n ba s\u1ed1 b\u1ec7nh nh\u00e2n RCVS ti\u1ebfn tri\u1ec3n thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 ho\u1eb7c xu\u1ea5t huy\u1ebft, nh\u01b0ng 90% t\u1ef1 gi\u1edbi h\u1ea1n v\u00e0o th\u1eddi \u0111i\u1ec3m xu\u1ea5t vi\u1ec7n v\u00e0 95% \u0111\u1ebfn 98% l\u00e0 ph\u1ee5c h\u1ed3i ho\u00e0n to\u00e0n trong v\u00f2ng 3 th\u00e1ng. \u0110au \u0111\u1ea7u ki\u1ec3u s\u00e9t \u0111\u00e1nh th\u01b0\u1eddng t\u00e1i ph\u00e1t, trung b\u00ecnh kho\u1ea3ng 4 c\u01a1n, trong kho\u1ea3ng th\u1eddi gian v\u00e0i ng\u00e0y \u0111\u1ebfn v\u00e0i tu\u1ea7n, sau \u0111\u00f3 gi\u1ea3m d\u1ea7n. S\u1ef1 ph\u1ee5c h\u1ed3i c\u1ee7a ch\u00fang kh\u00f4ng ph\u1ee5 thu\u1ed9c v\u1edbi s\u1ef1 b\u1ea5t th\u01b0\u1eddng c\u1ee7a m\u1ea1ch m\u00e1u n\u00e3o, nh\u1eefng b\u1ea5t th\u01b0\u1eddng m\u1ea1ch m\u00e1u n\u00e3o c\u00f3 th\u1ec3 m\u1ea5t 2 \u0111\u1ebfn 3 th\u00e1ng \u0111\u1ec3 h\u1ed3i ph\u1ee5c. T\u1ef7 l\u1ec7 t\u1eed vong \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o trong 2,5% \u1edf b\u1ec7nh nh\u00e2n n\u1ed9i tr\u00fa, v\u00e0 k\u1ebft c\u1ee5c x\u1ea5u h\u01a1n c\u00f3 li\u00ean quan \u0111\u1ebfn vi\u1ec7c mang thai v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 kh\u00e1c nh\u01b0 \u0111i\u1ec1u tr\u1ecb glucocorticoid. \u0110au \u0111\u1ea7u m\u00e3n t\u00ednh v\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng t\u00e2m th\u1ea7n, ch\u1eb3ng h\u1ea1n nh\u01b0 lo \u00e2u v\u00e0 tr\u1ea7m c\u1ea3m th\u01b0\u1eddng g\u1eb7p v\u00e0 c\u00f3 li\u00ean quan \u0111\u1ebfn ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng th\u1ea5p h\u01a1n. Nh\u01b0 v\u1edbi PRES, vi\u1ec7c lo\u1ea1i b\u1ecf c\u00e1c ch\u1ea5t g\u00e2y co m\u1ea1ch, bao g\u1ed3m thu\u1ed1c \u0111i\u1ec1u tr\u1ecb Migraine v\u00e0 thu\u1ed1c ch\u1ed1ng tr\u1ea7m c\u1ea3m, l\u00e0 h\u1ee3p l\u00fd cho \u0111\u1ebfn khi h\u1ed3i ph\u1ee5c. B\u1ec7nh nh\u00e2n RCVS b\u1ecb tr\u1ea7m c\u1ea3m k\u00e9o d\u00e0i c\u00f3 th\u1ec3 c\u1ea7n s\u1eed d\u1ee5ng thu\u1ed1c ch\u1ed1ng tr\u1ea7m c\u1ea3m thu\u1ed9c h\u1ec7 serotonergic, c\u00f3 v\u1ebb an to\u00e0n v\u00ec nh\u1eefng thu\u1ed1c n\u00e0y kh\u00f4ng c\u00f3 li\u00ean quan v\u1edbi RCVS t\u00e1i ph\u00e1t. L\u01b0u \u00fd r\u1eb1ng v\u1eabn n\u00ean tr\u00e1nh d\u00f9ng triptan v\u00ec ch\u00fang \u0111\u01b0\u1ee3c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh l\u00fd m\u1ea1ch m\u00e1u n\u00e3o.<\/p>\n

10. K\u1ebeT LU\u1eacN<\/strong><\/h2>\n

PRES v\u00e0 RCVS \u0111ang \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n v\u00e0 b\u00e1o c\u00e1o v\u1edbi t\u1ea7n su\u1ea5t ng\u00e0y c\u00e0ng t\u0103ng. C\u00e1c t\u00e0i li\u1ec7u g\u1ea7n \u0111\u00e2y kh\u1eb3ng \u0111\u1ecbnh c\u00f3 s\u1ef1 tr\u00f9ng l\u1eb7p \u0111\u00e1ng k\u1ec3 v\u1ec1 c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng, h\u00ecnh \u1ea3nh v\u00e0 h\u00ecnh ch\u1ee5p m\u1ea1ch m\u00e1u c\u1ee7a ch\u00fang, cho th\u1ea5y ch\u00fang c\u00f3 chung m\u1ed9t sinh l\u00fd b\u1ec7nh d\u1ef1a tr\u00ean s\u1ef1 co th\u1eaft m\u1ea1ch n\u00e3o v\u00e0 s\u1ef1 ph\u00e1 v\u1ee1 h\u00e0ng r\u00e0o m\u00e1u n\u00e3o. C\u1ea3 hai h\u1ed9i ch\u1ee9ng \u0111\u1ec1u t\u1ef1 gi\u1edbi h\u1ea1n v\u00e0 c\u00f3 ti\u00ean l\u01b0\u1ee3ng t\u1ed1t. \u0110\u00e1nh gi\u00e1 c\u1ea9n th\u1eadn c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng v\u00e0 h\u00ecnh \u1ea3nh n\u00e3o th\u01b0\u1eddng cho ph\u00e9p ch\u1ea9n \u0111o\u00e1n s\u1edbm ch\u00ednh x\u00e1c, \u0111i\u1ec1u n\u00e0y r\u1ea5t quan tr\u1ecdng v\u00ec c\u00e1c li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb theo kinh nghi\u1ec7m, bao g\u1ed3m glucocorticoid \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh l\u00fd t\u01b0\u01a1ng t\u1ef1 nh\u01b0 vi\u00eam m\u1ea1ch th\u1ea7n kinh trung \u01b0\u01a1ng nguy\u00ean ph\u00e1t, c\u00f3 th\u1ec3 l\u00e0m tr\u1ea7m tr\u1ecdng th\u00eam PRES v\u00e0 \u0111\u1eb7c bi\u1ec7t l\u00e0 RCVS.<\/p>\n","protected":false},"excerpt":{"rendered":"

Ba\u0300i vi\u00ea\u0301t H\u1ed9i ch\u1ee9ng b\u1ec7nh n\u00e3o sau c\u00f3 h\u1ed3i ph\u1ee5c (PRES) v\u00e0 h\u1ed9i ch\u1ee9ng co th\u1eaft m\u1ea1ch n\u00e3o c\u00f3 h\u1ed3i ph\u1ee5c (RCVS) tri\u0301ch ngu\u00f4\u0300n t\u01b0\u0300 H\u00f4\u0323i Th\u00e2\u0300n kinh ho\u0323c Vi\u00ea\u0323t Nam. T\u00e1c gi\u1ea3: Aneesh B. Singhal Bi\u00ean d\u1ecbch: BS. Nguy\u1ec5n Ng\u1ecdc L\u01b0\u01a1ng Hi\u1ec7u \u0111\u00ednh: BS. Hu\u1ef3nh \u0110\u0103ng L\u1ed9c, BS. Ho\u00e0ng Ti\u1ebfn Tr\u1ecdng Ngh\u0129a\u00a0\u00a0 Khoa N\u1ed9i […]<\/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\u1ed9i ch\u1ee9ng b\u1ec7nh n\u00e3o sau c\u00f3 h\u1ed3i ph\u1ee5c PRES v\u00e0 h\u1ed9i ch\u1ee9ng co th\u1eaft m\u1ea1ch n\u00e3o c\u00f3 h\u1ed3i ph\u1ee5c RCVS<\/title>\n<meta name=\"description\" content=\"RCVS th\u01b0\u1eddng kh\u1edfi ph\u00e1t b\u1eb1ng nh\u1eefng c\u01a1n \u0111au \u0111\u1ea7u ki\u1ec3u s\u00e9t \u0111\u00e1nh t\u00e1i ph\u00e1t, trong khi b\u1ec7nh n\u00e3o v\u00e0 co gi\u1eadt l\u00e0 bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng \u0111i\u1ec3n h\u00ecnh trong PRES.\" \/>\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\" 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