{"id":31024,"date":"2023-05-06T21:53:44","date_gmt":"2023-05-06T14:53:44","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=31024"},"modified":"2023-05-06T21:53:44","modified_gmt":"2023-05-06T14:53:44","slug":"truong-hop-nhuoc-co-moi-khoi-phat-sau-nhiem-covid","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/truong-hop-nhuoc-co-moi-khoi-phat-sau-nhiem-covid\/","title":{"rendered":"Nh\u01b0\u1ee3c c\u01a1 (Myasthenia Gravis) kh\u1edfi ph\u00e1t sau nhi\u1ec5m Covid (Case l\u00e2m sa\u0300ng)"},"content":{"rendered":"

Nh\u01b0\u1ee3c c\u01a1 (Myasthenia Gravis) l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd th\u1ea7n kinh c\u01a1 b\u1ea3n, l\u00e0m suy y\u1ebfu kh\u1ea3 n\u0103ng truy\u1ec1n t\u00edn hi\u1ec7u t\u1eeb th\u1ea7n kinh t\u1edbi c\u01a1 b\u1eafp. B\u1ec7nh n\u00e0y \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn kh\u1ea3 n\u0103ng \u0111i\u1ec1u khi\u1ec3n c\u00e1c c\u01a1 b\u1eafp v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c tri\u1ec7u ch\u1ee9ng nh\u01b0 m\u1ec7t m\u1ecfi, suy gi\u1ea3m s\u1ee9c kh\u1ecfe, kh\u00f3 th\u1edf v\u00e0 kh\u00f3 nu\u1ed1t. Nguy\u00ean nh\u00e2n c\u1ee7a nh\u01b0\u01a1\u0323c c\u01a1<\/a> l\u00e0 do h\u1ec7 th\u1ed1ng mi\u1ec5n d\u1ecbch t\u1ea5n c\u00f4ng c\u00e1c th\u1ee5 th\u1ec3 th\u1ea7n kinh tr\u00ean c\u00e1c c\u01a1 b\u1eafp, g\u00e2y ra s\u1ef1 suy gi\u1ea3m ho\u1eb7c m\u1ea5t kh\u1ea3 n\u0103ng truy\u1ec1n t\u00edn hi\u1ec7u. B\u1ec7nh th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n \u1edf ng\u01b0\u1eddi trung ni\u00ean v\u00e0 cao tu\u1ed5i, nh\u01b0ng c\u0169ng c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n \u1edf tr\u1ebb em v\u00e0 thanh ni\u00ean. Ba\u0300i vi\u00ea\u0301t na\u0300y ba\u0301o ca\u0301o m\u00f4\u0323t ca l\u00e2m sa\u0300ng kh\u01a1\u0309i pha\u0301t nh\u01b0\u01a1\u0323c c\u01a1 sau nhi\u00ea\u0303m SARS-CoV-2 ta\u0323i tha\u0300nh ph\u00f4\u0301 H\u00f4\u0300 Chi\u0301 Minh.\u00a0<\/strong><\/p>\n

Ba\u0300i vi\u00ea\u0301t “B\u00e1o c\u00e1o m\u1ed9t tr\u01b0\u1eddng h\u1ee3p nh\u01b0\u1ee3c c\u01a1 m\u1edbi kh\u1edfi ph\u00e1t sau nhi\u1ec5m SARS-CoV-2 t\u1ea1i th\u00e0nh ph\u1ed1 H\u1ed3 Ch\u00ed Minh” 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

Ta\u0301c gia\u0309: Tr\u1ea7n Th\u1ecb B\u00edch Ng\u1ecdc1, \u0110\u00e0o Duy Khoa2<\/em>
\nB\u1ed9 m\u00f4n Th\u1ea7n Kinh, Tr\u01b0\u1eddng \u0110\u1ea1i H\u1ecdc Y Khoa Ph\u1ea1m Ng\u1ecdc Th\u1ea1ch, TP. H\u1ed3 Ch\u00ed Minh1<\/em>
\nKhoa N\u1ed9i Th\u1ea7n Kinh, B\u1ec7nh vi\u1ec7n Vinmec Central Park TP. H\u1ed3 Ch\u00ed Minh2<\/em><\/p>\n

1. T\u00f3m t\u1eaft ca l\u00e2m sa\u0300ng Nh\u01b0\u1ee3c c\u01a1 (Myasthenia Gravis) sau nhi\u00ea\u0303m SARS-CoV-2<\/strong><\/h2>\n

Covid 19 l\u00e0 \u0111\u1ea1i d\u1ecbch to\u00e0n c\u1ea7u v\u00e0 g\u00e2y ra t\u1ed5n th\u01b0\u01a1ng ch\u00ednh tr\u00ean h\u1ec7 h\u00f4 h\u1ea5p. Tuy nhi\u00ean, c\u00e1c bi\u1ec3u hi\u1ec7n v\u1ec1 th\u1ea7n kinh \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn. C\u00f3 kho\u1ea3ng 36% tr\u01b0\u1eddng h\u1ee3p Covid 19 c\u00f3 bi\u1ec3u hi\u1ec7n v\u1ec1 th\u1ea7n kinh v\u1edbi ph\u1ed5 l\u00e2m s\u00e0ng r\u1ea5t r\u1ed9ng, th\u01b0\u1eddng g\u1eb7p nh\u1ea5t l\u00e0 cho\u00e1ng v\u00e1ng v\u00e0 \u0111au \u0111\u1ea7u. C\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u1ed9t qu\u1ef5, vi\u00eam n\u00e3o, vi\u00eam t\u1ee7y, li\u1ec7t Bell, h\u1ed9i ch\u1ee9ng Guillaine \u2013 Barr\u00e9, nh\u01b0\u1ee3c c\u01a1 c\u0169ng \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn. Ch\u00fang t\u00f4i b\u00e1o c\u00e1o m\u1ed9t tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n n\u1eef 61 tu\u1ed5i, kh\u1edfi ph\u00e1t c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a nh\u01b0\u1ee3c c\u01a1 (Myasthenia Gravis) sau khi b\u1ecb Covid-19. Tr\u01b0\u1edbc kh\u1edfi ph\u00e1t tri\u1ec7u ch\u1ee9ng \u0111\u1ea7u ti\u00ean c\u1ee7a nh\u01b0\u1ee3c c\u01a1 6 tu\u1ea7n, b\u1ec7nh nh\u00e2n s\u1ed1t, sau \u0111\u00f3 test PCR coronavirus d\u01b0\u01a1ng t\u00ednh v\u00e0 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb Covid \u1ed5n \u0111\u1ecbnh. Tri\u1ec7u ch\u1ee9ng nh\u01b0\u1ee3c c\u01a1 c\u1ee7a b\u1ec7nh nh\u00e2n bao g\u1ed3m s\u1ee5p mi, nu\u1ed1t kh\u00f3, n\u00f3i kh\u00f3. Test k\u00edch th\u00edch th\u1ea7n kinh l\u1eb7p l\u1ea1i t\u1ea7n s\u1ed1 3Hz d\u01b0\u01a1ng t\u00ednh (\u0111\u00e1p \u1ee9ng gi\u1ea3m tr\u00ean 10%) \u1edf 3 nh\u00f3m c\u01a1: c\u01a1 d\u1ea1ng ng\u00f3n c\u00e1i ng\u1eafn, c\u01a1 thang v\u00e0 c\u01a1 v\u00f2ng m\u1eaft; kh\u00e1ng th\u1ec3 kh\u00e1ng th\u1ee5 th\u1ec3 acetylcholine d\u01b0\u01a1ng t\u00ednh. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb IVIG 2g\/kg, methylprednisolone v\u00e0 pyridostigmine, v\u00e0 sau 3 tu\u1ea7n \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb t\u1ed1t. B\u1ec7nh nh\u01b0\u1ee3c c\u01a1 l\u00e0 m\u1ed9t b\u1ec7nh t\u1ef1 mi\u1ec5n, do t\u1ef1 kh\u00e1ng th\u1ec3 t\u1ea5n c\u00f4ng v\u00e0o kh\u1edbp th\u1ea7n kinh c\u01a1. Covid 19 g\u00e2y ra b\u00e3o cytokin, l\u00e0m x\u00e1o tr\u1ed9n ch\u1ee9c n\u0103ng h\u1ec7 th\u1ed1ng mi\u1ec5n d\u1ecbch v\u00e0 c\u00f3 th\u1ec3 t\u1ea1o ra c\u00e1c kh\u00e1ng th\u1ec3 chuy\u00ean bi\u1ec7t, bao g\u1ed3m c\u00e1c kh\u00e1ng th\u1ec3 ch\u1ed1ng l\u1ea1i kh\u1edbp th\u1ea7n kinh c\u01a1.
\nT\u1eeb kh\u00f3a: B\u1ec7nh nh\u01b0\u1ee3c c\u01a1, SARS-CoV-2, Covid-19.<\/p>\n

2. \u0110\u1eb7t v\u1ea5n \u0111\u1ec1<\/strong><\/h2>\n

B\u1ec7nh Nh\u01b0\u1ee3c c\u01a1 (Myasthenia Gravis) l\u00e0 m\u1ed9t b\u1ec7nh t\u1ef1 mi\u1ec5n, do c\u00e1c t\u1ef1 kh\u00e1ng th\u1ec3 t\u1ea5n c\u00f4ng v\u00e0o th\u1ee5 th\u1ec3 acetylcholine \u1edf m\u00e0ng sau synapse c\u1ee7a kh\u1edbp th\u1ea7n kinh c\u01a1. Bi\u1ec3u hi\u1ec7n c\u1ee7a nh\u01b0\u1ee3c c\u01a1 bao g\u1ed3m s\u1ee5p mi, song th\u1ecb, nu\u1ed1t kh\u00f3, y\u1ebfu c\u01a1 g\u1ed1c chi v\u00e0 c\u00e1c c\u01a1 h\u00f4 h\u1ea5p. \u0110\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng ch\u00eca kh\u00f3a l\u00e0 y\u1ebfu c\u01a1 dao \u0111\u1ed9ng v\u00e0 kh\u00f4ng \u0111au c\u01a1 t\u1ea1i nh\u1eefng nh\u00f3m c\u01a1 \u0111\u1eb7c bi\u1ec7t (c\u01a1 \u1ed5 m\u1eaft, c\u01a1 h\u1ea7u h\u1ecdng,\u2026) (6).
\nCovid-19 l\u00e0 \u0111\u1ea1i d\u1ecbch to\u00e0n c\u1ea7u, g\u00e2y t\u1ed5n th\u01b0\u01a1ng ch\u00ednh tr\u00ean h\u1ec7 h\u00f4 h\u1ea5p. Tuy nhi\u00ean, c\u00e1c bi\u1ec3u hi\u1ec7n v\u1ec1 th\u1ea7n kinh \u0111\u00e3 b\u1eaft \u0111\u1ea7u \u0111\u01b0\u1ee3c ghi nh\u1eadn. C\u00e1c b\u1ec7nh th\u1ea7n kinh li\u00ean quan Covis-19 c\u00f3 ph\u1ed5 l\u00e2m s\u00e0ng r\u1ea5t r\u1ed9ng, bao g\u1ed3m \u0111\u1ed9t qu\u1ef5, vi\u00eam n\u00e3o, vi\u00eam t\u1ee7y, li\u1ec7t Bell, h\u1ed9i ch\u1ee9ng Guillaine \u2013 Barr\u00e9, nh\u01b0\u1ee3c c\u01a1,\u2026 C\u01a1 ch\u1ebf g\u00e2y t\u1ed5n th\u01b0\u01a1ng h\u1ec7 th\u1ed1ng th\u1ea7n kinh c\u1ee7a SARS-CoV-2 c\u00f2n ch\u01b0a \u0111\u01b0\u1ee3c hi\u1ec3u r\u00f5 ho\u00e0n to\u00e0n, c\u00e1c gi\u1ea3 thuy\u1ebft \u0111\u01b0\u1ee3c \u0111\u01b0a ra bao g\u1ed3m (1), (3), (5):
\n1. S\u1ef1 x\u00e2m nh\u1eadp c\u1ee7a virus v\u00e0o t\u1ebf b\u00e0o th\u1ea7n kinh, lan truy\u1ec1n ng\u01b0\u1ee3c d\u00f2ng qua synapses v\u00e0 g\u00e2y t\u1ed5n th\u01b0\u01a1ng tr\u1ef1c ti\u1ebfp t\u1ebf b\u00e0o th\u1ea7n kinh (th\u00f4ng qua ACE 2 receptor, \u0111\u01b0\u1eddng v\u00e0o t\u1eeb neuron h\u00e0nh kh\u1ee9u).
\n2. \u0110\u00e1p \u1ee9ng vi\u00eam to\u00e0n th\u00e2n, b\u00e3o cytokine, x\u00e1o tr\u1ed9n ch\u1ee9c n\u0103ng h\u1ec7 th\u1ed1ng mi\u1ec5n d\u1ecbch, v\u00e0 t\u1ea1o ra c\u00e1c kh\u00e1ng th\u1ec3 chuy\u00ean bi\u1ec7t.
\nNgo\u00e0i ra, c\u00e1c tri\u1ec7u ch\u1ee9ng h\u1eadu Covid bao g\u1ed3m r\u1ea5t nhi\u1ec1u c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a h\u1ec7 th\u1ed1ng th\u1ea7n kinh nh\u01b0: m\u1ec7t m\u1ecfi, suy gi\u1ea3m nh\u1eadn th\u1ee9c, \u0111au \u0111\u1ea7u, \u0111au c\u01a1, cho\u00e1ng v\u00e1ng, d\u1ecb c\u1ea3m, m\u1ea5t ng\u1ee7,\u2026(1). T\u1ea5t c\u1ea3 c\u00e1c y\u1ebfu t\u1ed1 n\u00e0y \u0111\u00f2i h\u1ecfi c\u00e1c b\u00e1c s\u0129 khi ti\u1ebfp c\u1eadn m\u1ed9t b\u1ec7nh nh\u00e2n \u0111ang b\u1ecb Covid-19 ho\u1eb7c sau khi \u0111\u00e3 kh\u1ecfi b\u1ec7nh, lu\u00f4n ph\u1ea3i th\u0103m kh\u00e1m c\u1ea9n th\u1eadn \u0111\u1ec3 ph\u00e2n bi\u1ec7t c\u00e1c than phi\u1ec1n c\u1ee7a b\u1ec7nh nh\u00e2n l\u00e0 do b\u1ea3n th\u00e2n Covid-19 ho\u1eb7c h\u1ed9i ch\u1ee9ng h\u1eadu Covid g\u00e2y ra hay do b\u1ec7nh l\u00fd th\u1ea7n kinh th\u1ef1c s\u1ef1. Trong t\u00ecnh hu\u1ed1ng c\u00e1c b\u1ec7nh l\u00fd th\u1ea7n kinh m\u1edbi kh\u1edfi ph\u00e1t sau b\u1ecb Covid-19, \u0111\u00f4i khi r\u1ea5t kh\u00f3 kh\u0103n trong ch\u1ea9n \u0111o\u00e1n v\u00e0 th\u1ef1c s\u1ef1 l\u00e0 m\u1ed9t th\u00e1ch th\u1ee9c tr\u00ean l\u00e2m s\u00e0ng.
\nCh\u00fang t\u00f4i b\u00e1o c\u00e1o m\u1ed9t tr\u01b0\u1eddng h\u1ee3p \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n nh\u01b0\u1ee3c c\u01a1 m\u1edbi kh\u1edfi ph\u00e1t sau khi kh\u1ecfi b\u1ec7nh Covid-19 \u0111\u01b0\u1ee3c ghi nh\u1eadn \u0111\u1ea7u ti\u00ean t\u1ea1i Th\u00e0nh ph\u1ed1 H\u1ed3 Ch\u00ed Minh.<\/p>\n

3. B\u00e1o c\u00e1o ca l\u00e2m s\u00e0ng<\/strong><\/h2>\n

Ch\u00fang t\u00f4i tr\u00ecnh b\u00e0y m\u1ed9t tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n n\u1eef 61 tu\u1ed5i, kh\u00f4ng c\u00f3 ti\u1ec1n s\u1eed y khoa \u0111\u00e1ng ch\u00fa \u00fd tr\u01b0\u1edbc \u0111\u00e2y, \u0111\u1ebfn kh\u00e1m v\u1edbi ch\u00fang t\u00f4i v\u00ec ho kh\u1ea1c k\u00e9m, kh\u00f3 nu\u1ed1t. C\u00e1ch 7 tu\u1ea7n tr\u01b0\u1edbc kh\u1edfi ph\u00e1t tri\u1ec7u ch\u1ee9ng \u0111\u1ea7u ti\u00ean c\u1ee7a nh\u01b0\u1ee3c c\u01a1 (Myasthenia Gravis), b\u1ec7nh nh\u00e2n s\u1ed1t, t\u1ef1 test nhanh kh\u00e1ng nguy\u00ean Covid t\u1ea1i nh\u00e0 d\u01b0\u01a1ng t\u00ednh, kh\u00f4ng \u0111i\u1ec1u tr\u1ecb. 7 ng\u00e0y sau b\u1ec7nh nh\u00e2n m\u1ec7t, kh\u00f3 th\u1edf, v\u00e0o b\u1ec7nh vi\u1ec7n \u0111i\u1ec1u tr\u1ecb Covid, test PCR Coronavirus d\u01b0\u01a1ng t\u00ednh, \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n Covid m\u1ee9c \u0111\u1ed9 trung b\u00ecnh, th\u1edf O2 qua mask v\u00e0 \u0111i\u1ec1u tr\u1ecb theo ph\u00e1c \u0111\u1ed3 Covid m\u1ee9c \u0111\u1ed9 trung b\u00ecnh. T\u00ecnh tr\u1ea1ng \u1ed5n d\u1ea7n, \u0111\u01b0\u1ee3c xu\u1ea5t vi\u1ec7n v\u00e0o ng\u00e0y th\u1ee9 15 v\u1edbi PCR Coronavirus tr\u01b0\u1edbc xu\u1ea5t vi\u1ec7n c\u00f3 CT 35. Sau xu\u1ea5t vi\u1ec7n b\u1ec7nh nh\u00e2n \u1ed5n \u0111\u1ecbnh, kh\u00f4ng m\u1ec7t, kh\u00f4ng kh\u00f3 th\u1edf, \u0111i l\u1ea1i v\u00e0 \u0103n u\u1ed1ng b\u00ecnh th\u01b0\u1eddng. 1 th\u00e1ng sau xu\u1ea5t vi\u1ec7n, b\u1ec7nh nh\u00e2n ghi nh\u1eadn nu\u1ed1t v\u01b0\u1edbng, kh\u00f4ng h\u1eb1ng \u0111\u1ecbnh nh\u01b0ng kh\u00f4ng s\u1eb7c, \u0103n u\u1ed1ng v\u00e0 n\u00f3i chuy\u1ec7n b\u00ecnh th\u01b0\u1eddng, kh\u00f4ng m\u1ec7t, kh\u00f4ng kh\u00f3 th\u1edf, v\u00e0 kh\u00f4ng \u0111i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u. 2 tu\u1ea7n sau, tri\u1ec7u ch\u1ee9ng ng\u00e0y c\u00e0ng nhi\u1ec1u h\u01a1n, nu\u1ed1t kh\u00f3 h\u01a1n, ho kh\u1ea1c kh\u00f3, n\u00f3i kh\u00f3 v\u00e0 th\u1eddi gian tri\u1ec7u ch\u1ee9ng k\u00e9o d\u00e0i h\u01a1n, \u0111i kh\u00e1m \u1edf m\u1ed9t b\u1ec7nh vi\u1ec7n tuy\u1ebfn tr\u00ean t\u1ea1i Th\u00e0nh ph\u1ed1 H\u1ed3 Ch\u00ed Minh, \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n \u0111\u1ed9t qu\u1ef5 nh\u1eb9 v\u00e0 \u0111i\u1ec1u tr\u1ecb ngo\u1ea1i tr\u00fa. T\u00ecnh tr\u1ea1ng kh\u00f4ng c\u1ea3i thi\u1ec7n, n\u00ean h\u00f4m sau b\u1ec7nh nh\u00e2n v\u00e0o m\u1ed9t b\u1ec7nh vi\u1ec7n tuy\u1ebfn tr\u00ean kh\u00e1c t\u1ea1i Th\u00e0nh ph\u1ed1 H\u1ed3 Ch\u00ed Minh, \u0111\u01b0\u1ee3c nh\u1eadp vi\u1ec7n. Ch\u1ea9n \u0111o\u00e1n l\u00fac nh\u1eadp vi\u1ec7n: nu\u1ed1t kh\u00f3 do t\u00e2m l\u00fd (ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t: b\u1ec7nh ti\u1ebfp h\u1ee3p th\u1ea7n kinh-c\u01a1), \u0111\u01b0\u1ee3c ch\u1ee5p MRI n\u00e3o, \u0111o \u0111i\u1ec7n c\u01a1, k\u1ebft qu\u1ea3 b\u00ecnh th\u01b0\u1eddng (h\u00ecnh 3a). B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c xu\u1ea5t vi\u1ec7n sau 4 ng\u00e0y v\u1edbi ch\u1ea9n \u0111o\u00e1n xu\u1ea5t vi\u1ec7n: R\u1ed1i lo\u1ea1n lo \u00e2u-h\u1ed9i ch\u1ee9ng h\u1eadu Covid. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb ch\u1ed1ng lo \u00e2u, nh\u01b0ng tri\u1ec7u ch\u1ee9ng v\u1eabn kh\u00f4ng gi\u1ea3m.<\/p>\n

B\u1ea3ng 1. K\u1ebft qu\u1ea3 c\u00e1c c\u1eadn l\u00e2m s\u00e0ng quan tr\u1ecdng<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
X\u00e9t nghi\u1ec7m<\/strong><\/td>\nK\u1ebft qu\u1ea3<\/strong><\/td>\n\u0110\u01a1n v\u1ecb<\/strong><\/td>\nGi\u00e1 tr\u1ecb b\u00ecnh th\u01b0\u1eddng<\/strong><\/td>\n<\/tr>\n
CK<\/td>\n78.32<\/td>\nU\/L<\/td>\n24-180<\/td>\n<\/tr>\n
Kali<\/td>\n3.6<\/td>\nmmol\/L<\/td>\n3.5-5.1<\/td>\n<\/tr>\n
Cortisol (8AM)<\/td>\n24.93<\/td>\n\u00b5g\/dL<\/td>\nAM: 6.7-22.5, PM: <10<\/td>\n<\/tr>\n
TSH<\/td>\n0.822<\/td>\n\u00b5IU\/mL<\/td>\n0.38-5.33<\/td>\n<\/tr>\n
FT4<\/td>\n14.48<\/td>\npmolL<\/td>\n7.9-14.4<\/td>\n<\/tr>\n
CA 125<\/td>\n15.72<\/td>\nU\/ml<\/td>\n<35<\/td>\n<\/tr>\n
AFP<\/td>\n1.64<\/td>\nng\/ml<\/td>\n<9<\/td>\n<\/tr>\n
CEA<\/td>\n1.98<\/td>\nng\/ml<\/td>\n<3<\/td>\n<\/tr>\n
CA 19.9<\/td>\n<0.8<\/td>\nU\/ml<\/td>\n<35<\/td>\n<\/tr>\n
CA 15.3<\/td>\n3.5<\/td>\nU\/ml<\/td>\n<31.4<\/td>\n<\/tr>\n
Cy fra 21.1<\/td>\n1.65<\/td>\nng\/ml<\/td>\n<3.3<\/td>\n<\/tr>\n
IgA<\/td>\n206.8<\/td>\nmg\/dL<\/td>\n90-450<\/td>\n<\/tr>\n
IgM<\/td>\n116<\/td>\nmg\/dL<\/td>\n70-330<\/td>\n<\/tr>\n
IgG<\/td>\n728.2<\/td>\nmg\/dL<\/td>\n800-1800<\/td>\n<\/tr>\n
vs<\/td>\n19<\/td>\nmm sau 1 gi\u1edd<\/td>\n<\/td>\n<\/tr>\n
ANA<\/td>\n\u00c2m t\u00ednh<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Anti-ds DNA<\/td>\n\u00c2m t\u00ednh<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Globulin-alpha 1<\/td>\n2.29<\/td>\ng\/L<\/td>\n2.1-3.5<\/td>\n<\/tr>\n
Globulin-alpha 2<\/td>\n8.49<\/td>\ng\/L<\/td>\n5.1-8.5<\/td>\n<\/tr>\n
Globulin-beta 1<\/td>\n3.79<\/td>\ng\/L<\/td>\n3.4-5.2<\/td>\n<\/tr>\n
Globulin-beta 2<\/td>\n1.95<\/td>\ng\/L<\/td>\n2.3-4.7<\/td>\n<\/tr>\n
Globulin-gamma<\/td>\n7.03<\/td>\ng\/L<\/td>\n8-13.5<\/td>\n<\/tr>\n
Kh\u00e1ng th\u1ec3 kh\u00e1ng th\u1ee5 th\u1ec3 acetylcholine<\/td>\n1.23<\/td>\nmmol\/L<\/td>\n<0.5<\/td>\n<\/tr>\n
Kh\u00e1ng th\u1ec3 kh\u00e1ng MuSK<\/td>\n<0.18<\/td>\nU\/ml<\/td>\n<0.4<\/td>\n<\/tr>\n
CTscan ng\u1ef1c- b\u1ee5ng-ch\u1eadu<\/td>\nB\u00ecnh th\u01b0\u1eddng, kh\u00f4ng ghi nh\u1eadn thymoma.<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
MRI n\u00e3o<\/td>\nB\u00ecnh th\u01b0\u1eddng, kh\u00f4ng ghi nh\u1eadn t\u1ed5n th\u01b0\u01a1ng th\u00e2n n\u00e3o<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
MRI t\u1ee7y c\u1ed5<\/td>\nB\u00ecnh th\u01b0\u1eddng<\/td>\n<\/td>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Sau \u0111\u00f3 b\u1ec7nh nh\u00e2n \u0111\u1ebfn kh\u00e1m v\u1edbi ch\u00fang t\u00f4i trong t\u00ecnh tr\u1ea1ng m\u1ec7t, kh\u00f3 th\u1edf ph\u1ea3i ng\u1ed3i, r\u1ed1i lo\u1ea1n v\u1eadn ng\u00f4n n\u1eb7ng, nu\u1ed1t s\u1eb7c n\u1eb7ng, s\u1ee5p mi 2 b\u00ean. Kh\u00e1m l\u00e2m s\u00e0ng ghi nh\u1eadn.<\/p>\n

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Simpson test d\u01b0\u01a1ng t\u00ednh, Curtain sign d\u01b0\u01a1ng t\u00ednh, Ice-pack test d\u01b0\u01a1ng t\u00ednh, n\u00e2ng \u0111\u1ea7u r\u1ea5t y\u1ebfu nh\u01b0ng s\u1ee9c c\u01a1 t\u1ee9 chi g\u1ed1c 4\/5, ng\u1ecdn 4\/5+. Kh\u00f4ng ghi nh\u1eadn b\u1ea5t th\u01b0\u1eddng c\u1ea3m gi\u00e1c, ph\u1ea3n x\u1ea1 g\u00e2n c\u01a1 (++) \u0111\u1ed1i x\u1ee9ng, v\u00e0 kh\u00f4ng c\u00f3 d\u1ea5u Hoffman hay d\u1ea5u Babinski (h\u00ecnh 1), (h\u00ecnh 2).
\nB\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c kh\u1ea3o s\u00e1t l\u1ea1i \u0111i\u1ec7n c\u01a1, chu\u1ed7i 10 k\u00edch th\u00edch th\u1ea7n kinh l\u1eb7p l\u1ea1i t\u1ea7n s\u1ed1 3Hz d\u01b0\u01a1ng t\u00ednh, kh\u00e1ng th\u1ec3 kh\u00e1ng th\u1ee5 th\u1ec3 acetylcholin d\u01b0\u01a1ng t\u00ednh, kh\u00e1ng th\u1ec3 kh\u00e1ng MuSK \u00e2m t\u00ednh (h\u00ecnh 3b). K\u1ebft qu\u1ea3 c\u00e1c kh\u1ea3o s\u00e1t kh\u00e1c \u0111\u01b0\u1ee3c li\u1ec7t k\u00ea trong b\u1ea3ng 1. D\u1ef1a tr\u00ean c\u00e1c d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng, c\u1eadn l\u00e2m s\u00e0ng \u0111\u00e3 c\u00f3, ch\u00fang t\u00f4i ch\u1ea9n \u0111o\u00e1n b\u1ec7nh nh\u00e2n b\u1ecb b\u1ec7nh nh\u01b0\u1ee3c c\u01a1, ph\u00e2n \u0111\u1ed9 IIB. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi Methylpredinsolone 32mg\/ng\u00e0y (c\u00e2n n\u1eb7ng 45kg), Pyridostigmine 60mg x 6\/ng\u00e0y v\u00e0 IVIG 2g\/kg trong 5 ng\u00e0y.
\nTri\u1ec7u ch\u1ee9ng c\u1ea3i thi\u1ec7n t\u1ed1t: B\u1edbt s\u1ee5p mi, b\u1edbt r\u1ed1i lo\u1ea1n v\u1eadn ng\u00f4n, b\u1edbt m\u1ec7t kh\u00f3 th\u1edf, nh\u01b0ng c\u00f2n \u0103n s\u1eb7c v\u00e0 \u0111\u01b0\u1ee3c xu\u1ea5t vi\u1ec7n sau khi k\u1ebft th\u00fac \u0111i\u1ec1u tr\u1ecb IVIG. Thu\u1ed1c xu\u1ea5t vi\u1ec7n ti\u1ebfp t\u1ee5c duy tr\u00ec Methylpredinsolone 32mg\/ng\u00e0y, Pyridostigmine 60mg x 6\/ng\u00e0y. 1 tu\u1ea7n sau xu\u1ea5t vi\u1ec7n, b\u1ec7nh nh\u00e2n t\u00e1i kh\u00e1m v\u1edbi c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ea3i thi\u1ec7n r\u00f5: h\u1ebft nu\u1ed1t s\u1eb7c, h\u1ebft n\u00f3i \u0111\u1edb, c\u00f2n s\u1ee5p mi nh\u1eb9 v\u00e0 Simpson test d\u01b0\u01a1ng t\u00ednh (h\u00ecnh 4).<\/p>\n

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

4. B\u00e0n lu\u1eadn v\u00ea\u0300 ca l\u00e2m sa\u0300ng nh\u01b0\u1ee3c c\u01a1 (Myasthenia Gravis) sau nhi\u00ea\u0303m SARS- CoV-2<\/strong><\/h2>\n

Tr\u01b0\u1eddng h\u1ee3p l\u00e2m s\u00e0ng c\u1ee7a ch\u00fang t\u00f4i xu\u1ea5t hi\u1ec7n tri\u1ec7u ch\u1ee9ng \u0111\u1ea7u ti\u00ean c\u1ee7a nh\u01b0\u1ee3c c\u01a1 sau khi \u0111\u01b0\u1ee3c xu\u1ea5t vi\u1ec7n t\u1eeb b\u1ec7nh vi\u1ec7n \u0111i\u1ec1u tr\u1ecb Covid 1 th\u00e1ng, v\u1edbi bi\u1ec3u hi\u1ec7n ban \u0111\u1ea7u l\u00e0 nu\u1ed1t v\u01b0\u1edbng. \u0110\u00e2y l\u00e0 m\u1ed9t tri\u1ec7u ch\u1ee9ng kh\u00f4ng chuy\u00ean bi\u1ec7t, c\u00f3 th\u1ec3 do nhi\u1ec1u nguy\u00ean nh\u00e2n kh\u00e1c nhau, t\u1eeb b\u1ec7nh l\u00fd v\u00f9ng h\u1ea7u h\u1ecdng, cho \u0111\u1ebfn c\u00e1c b\u1ec7nh l\u00fd v\u1ec1 th\u1ea7n kinh,\u2026
\nH\u1ed9i ch\u1ee9ng h\u1eadu Covid c\u00f3 r\u1ea5t nhi\u1ec1u tri\u1ec7u ch\u1ee9ng, \u0111i\u1ec3n h\u00ecnh th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n sau 4 tu\u1ea7n t\u1eeb l\u00fac nhi\u1ec5m SARS-CoV-2, g\u1ed3m c\u00f3 3 nh\u00f3m: c\u00e1c tri\u1ec7u ch\u1ee9ng ti\u1ebfp di\u1ec5n ho\u1eb7c m\u1edbi kh\u1edfi ph\u00e1t, t\u1ed5n th\u01b0\u01a1ng \u0111a c\u01a1 quan do Covid-19, v\u00e0 c\u00e1c h\u1eadu qu\u1ea3 do nh\u1eadp vi\u1ec7n ho\u1eb7c do t\u00ecnh tr\u1ea1ng n\u1eb7ng c\u1ee7a Covid-19. Trong nh\u00f3m c\u00e1c tri\u1ec7u ch\u1ee9ng ti\u1ebfp di\u1ec5n ho\u1eb7c m\u1edbi kh\u1edfi ph\u00e1t, c\u00f3 r\u1ea5t nhi\u1ec1u tri\u1ec7u ch\u1ee9ng li\u00ean quan \u0111\u1ebfn chuy\u00ean khoa th\u1ea7n kinh v\u00e0 kh\u00f4ng \u0111\u1eb7c hi\u1ec7u: m\u1ec7t m\u1ecfi, gi\u1ea3m th\u1ec3 l\u1ef1c, kh\u00f3 suy ngh\u0129 kh\u00f3 t\u1eadp trung, \u0111au \u0111\u1ea7u, \u0111au c\u01a1, m\u1ea5t ng\u1ee7, cho\u00e1ng v\u00e1ng, d\u1ecb c\u1ea3m,\u2026(1). Do \u0111\u00f3, khi ti\u1ebfp c\u1eadn b\u1ec7nh nh\u00e2n c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng n\u00e0y, c\u00e2u h\u1ecfi \u0111\u1ea7u ti\u00ean c\u1ea7n ph\u1ea3i \u0111\u1eb7t ra l\u00e0: \u0111\u00e2y ch\u1ec9 l\u00e0 tri\u1ec7u ch\u1ee9ng c\u1ee7a h\u1ed9i ch\u1ee9ng h\u1eadu Covid, hay l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd th\u1ea7n kinh m\u1edbi kh\u1edfi ph\u00e1t sau nhi\u1ec5m Covid: h\u1ed9i ch\u1ee9ng Guillaine-Barr\u00e9, b\u1ec7nh c\u01a1, huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch n\u00e3o,\u2026\u0110\u00e2y l\u00e0 v\u1ea5n \u0111\u1ec1 th\u1ef1c t\u1ebf m\u00e0 c\u00e1c b\u00e1c s\u0129 chuy\u00ean khoa th\u1ea7n kinh ph\u1ea3i \u0111\u1ed1i m\u1eb7t trong qu\u00e1 tr\u00ecnh th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng, \u0111\u1ec3 tr\u00e1nh b\u1ecf s\u00f3t ch\u1ea9n \u0111o\u00e1n, v\u00e0 \u0111\u00f4i khi th\u1ef1c s\u1ef1 l\u00e0 m\u1ed9t th\u00e1ch th\u1ee9c.
\nCa l\u00e2m s\u00e0ng c\u1ee7a ch\u00fang t\u00f4i kh\u1edfi ph\u00e1t tri\u1ec7u ch\u1ee9ng \u0111\u1ea7u ti\u00ean l\u00e0 nu\u1ed1t v\u01b0\u1edbng, sau \u0111\u00f3 l\u00e0 n\u00f3i kh\u00f3, nu\u1ed1t s\u1eb7c, ho kh\u1ea1c k\u00e9m. B\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111\u1ebfn kh\u00e1m t\u1ea1i hai b\u1ec7nh vi\u1ec7n l\u1edbn t\u1ea1i Th\u00e0nh ph\u1ed1 H\u1ed3 Ch\u00ed Minh, v\u1edbi ch\u1ea9n \u0111o\u00e1n c\u1ee7a b\u1ec7nh vi\u1ec7n th\u1ee9 nh\u1ea5t l\u00e0 \u0111\u1ed9t qu\u1ef5 nh\u1eb9, v\u00e0 l\u1ea7n th\u1ee9 hai \u0111\u01b0\u1ee3c nh\u1eadp vi\u1ec7n v\u00e0o b\u1ec7nh vi\u1ec7n kh\u00e1c. Trong qu\u00e1 tr\u00ecnh n\u1eb1m vi\u1ec7n n\u00e0y, b\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111o \u0111i\u1ec7n c\u01a1, l\u00e0m c\u00e1c c\u1eadn l\u00e2m s\u00e0ng t\u1ea7m so\u00e1t b\u1ec7nh th\u1ef1c th\u1ec3 \u0111\u1ec1u cho k\u1ebft qu\u1ea3 \u00e2m t\u00ednh, v\u00e0 ch\u1ea9n \u0111o\u00e1n xu\u1ea5t vi\u1ec7n l\u00e0 r\u1ed1i lo\u1ea1n lo \u00e2u \u2013 h\u1ed9i ch\u1ee9ng h\u1eadu Covid. \u0110i\u1ec1u n\u00e0y cho th\u1ea5y trong giai \u0111o\u1ea1n s\u1edbm c\u1ee7a b\u1ec7nh, vi\u1ec7c ph\u00e2n bi\u1ec7t c\u00e1c tri\u1ec7u ch\u1ee9ng h\u1eadu Covid v\u1edbi m\u1ed9t b\u1ec7nh l\u00fd th\u1ea7n kinh th\u1ef1c th\u1ec3 m\u1edbi kh\u1edfi ph\u00e1t sau b\u1ecb Covid-19 th\u1ef1c s\u1ef1 l\u00e0 m\u1ed9t th\u00e1ch th\u1ee9c. \u0110\u1ec3 tr\u00e1nh b\u1ecf s\u00f3t ch\u1ea9n \u0111o\u00e1n, b\u00e1c s\u0129 l\u00e2m s\u00e0ng c\u1ea7n ph\u1ea3i c\u00f3 s\u1ef1 ki\u00ean tr\u00ec theo \u0111u\u1ed5i ch\u1ea9n \u0111o\u00e1n, k\u0129 n\u0103ng kh\u00e1m l\u00e2m s\u00e0ng th\u1eadt t\u1ed1t, n\u1eafm v\u1eefng di\u1ec5n ti\u1ebfn l\u00e2m s\u00e0ng c\u1ee7a b\u1ec7nh, v\u00e0 \u0111\u1eb7c bi\u1ec7t ph\u1ea3i hi\u1ec3u r\u00f5 \u0111\u1ed9 nh\u1ea1y c\u0169ng nh\u01b0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u c\u1ee7a t\u1eebng lo\u1ea1i c\u1eadn l\u00e2m s\u00e0ng, t\u1eeb \u0111\u00f3 s\u1ebd gi\u00fap \u0111\u01b0a ra ch\u1ea9n \u0111o\u00e1n t\u1ed1t nh\u1ea5t. Trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng th\u1ea7n kinh, c\u00e1c b\u00e1c s\u0129 chuy\u00ean khoa th\u1ea7n kinh ph\u1ea3i \u0111\u1ed1i m\u1eb7t v\u1edbi c\u00e1c tri\u1ec7u ch\u1ee9ng g\u1ee3i \u00fd t\u1ed5n th\u01b0\u01a1ng th\u1ef1c th\u1ec3 ho\u1eb7c c\u01a1 n\u0103ng (r\u1ed1i lo\u1ea1n d\u1ea1ng c\u01a1 th\u1ec3, r\u1ed1i lo\u1ea1n gi\u1ea3 v\u1edd, r\u1ed1i lo\u1ea1n lo \u00e2u,\u2026), trong \u0111\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng nh\u01b0 nu\u1ed1t s\u1eb7c, r\u1ed1i lo\u1ea1n v\u1eadn ng\u00f4n th\u01b0\u1eddng l\u00e0 tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3.
\nB\u1ec7nh nh\u00e2n \u0111\u1ebfn v\u1edbi ch\u00fang t\u00f4i \u1edf giai \u0111o\u1ea1n tri\u1ec7u ch\u1ee9ng \u0111\u00e3 kh\u00e1 \u0111i\u1ec3n h\u00ecnh, bao g\u1ed3m s\u1ee5p mi, r\u1ed1i lo\u1ea1n v\u1eadn ng\u00f4n, kh\u00f3 th\u1edf, c\u00e1c test l\u00e2m s\u00e0ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n nh\u01b0\u1ee3c c\u01a1 (Simpson test, Ice pack test, Curtain sign) \u0111\u1ec1u d\u01b0\u01a1ng t\u00ednh. Do \u0111\u00f3 ch\u00fang t\u00f4i \u0111\u00e3 quy\u1ebft \u0111\u1ecbnh kh\u1ea3o s\u00e1t l\u1ea1i c\u00e1c c\u1eadn l\u00e2m s\u00e0ng ch\u1ea9n \u0111o\u00e1n nh\u01b0\u1ee3c c\u01a1: \u0111i\u1ec7n c\u01a1 (test k\u00edch th\u00edch th\u1ea7n kinh l\u1eb7p l\u1ea1i), kh\u00e1ng th\u1ec3 kh\u00e1ng th\u1ee5 th\u1ec3 acetylcholine,\u2026\u0111\u1ec1u cho k\u1ebft qu\u1ea3 ph\u00f9 h\u1ee3p v\u1edbi ch\u1ea9n \u0111o\u00e1n nh\u01b0\u1ee3c c\u01a1 (b\u1ea3ng 1).
\nC\u01a1 ch\u1ebf g\u00e2y b\u1ec7nh nh\u01b0\u1ee3c c\u01a1 m\u1edbi kh\u1edfi ph\u00e1t sau nhi\u1ec5m SARS-CoV-2 ch\u01b0a \u0111\u01b0\u1ee3c hi\u1ec3u r\u00f5. B\u1ec7nh nh\u01b0\u1ee3c c\u01a1 l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd t\u1ef1 mi\u1ec5n, do s\u1ea3n sinh c\u00e1c t\u1ef1 kh\u00e1ng th\u1ec3 ch\u1ed1ng l\u1ea1i kh\u1edbp th\u1ea7n kinh c\u01a1. M\u1ed9t s\u1ed1 gi\u1ea3 thuy\u1ebft cho r\u1eb1ng, SARS-CoV-2 c\u00f3 c\u00e1c ph\u00e2n t\u1eed t\u01b0\u01a1ng t\u1ef1 v\u1edbi th\u1ee5 th\u1ec3 acetylcholine, t\u1eeb \u0111\u00f3 k\u00edch th\u00edch s\u1ea3n sinh c\u00e1c kh\u00e1ng th\u1ec3 ch\u1ed1ng l\u1ea1i th\u1ee5 th\u1ec3 acetylcholine v\u00e0 g\u00e2y ra b\u1ec7nh nh\u01b0\u1ee3c c\u01a1, nh\u01b0ng \u0111\u1ebfn nay v\u1eabn ch\u01b0a x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c c\u00e1c ph\u00e2n t\u1eed n\u00e0y tr\u00ean SARS-CoV-2. M\u1ed9t c\u00e2u h\u1ecfi kh\u00e1c c\u0169ng \u0111\u01b0\u1ee3c \u0111\u1eb7t ra: b\u1ec7nh nh\u01b0\u1ee3c c\u01a1 m\u1edbi kh\u1edfi ph\u00e1t n\u00e0y ch\u1ec9 l\u00e0 m\u1ed9t s\u1ef1 ki\u1ec7n ng\u1eabu nhi\u00ean, hay th\u1ef1c s\u1ef1 l\u00e0 h\u1eadu qu\u1ea3 sau nhi\u1ec5m SARS-CoV-2? \u0110\u00e2y l\u00e0 c\u00e2u h\u1ecfi kh\u00f3, v\u00e0 \u0111\u1ebfn nay v\u1eabn ch\u01b0a c\u00f3 c\u00e2u tr\u1ea3 l\u1eddi ch\u00ednh x\u00e1c, v\u00ec s\u1ed1 l\u01b0\u1ee3ng ca b\u00e1o c\u00e1o tr\u00ean th\u1ebf gi\u1edbi c\u00f2n r\u1ea5t \u00edt v\u00e0 ch\u01b0a \u0111\u1ee7 d\u1eef li\u1ec7u (2), (3), (4), (5).
\nB\u1edfi v\u00ec s\u1ed1 ca b\u00e1o c\u00e1o tr\u00ean th\u1ebf gi\u1edbi c\u00f2n r\u1ea5t \u00edt, ch\u00fang t\u00f4i v\u1eabn ch\u01b0a x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c li\u1ec7u r\u1eb1ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t n\u00e0o trong \u0111i\u1ec1u tr\u1ecb v\u00e0 d\u1ef1 h\u1eadu l\u00e2u d\u00e0i trong nh\u00f3m b\u1ec7nh nh\u01b0\u1ee3c c\u01a1 kh\u1edfi ph\u00e1t sau nhi\u1ec5m SARS-CoV-2 hay kh\u00f4ng? Tuy nhi\u00ean, ca c\u1ee7a ch\u00fang t\u00f4i, v\u00e0 c\u00e1c b\u00e1o c\u00e1o ca kh\u00e1c tr\u00ean th\u1ebf gi\u1edbi cho th\u1ea5y nh\u00f3m n\u00e0y v\u1eabn \u0111\u00e1p \u1ee9ng v\u1edbi c\u00e1c \u0111i\u1ec1u tr\u1ecb nh\u01b0\u1ee3c c\u01a1 kinh \u0111i\u1ec3n: kh\u00e1ng men acetylcholine esterase, steroids, IVIG ho\u1eb7c thay huy\u1ebft t\u01b0\u01a1ng (2), (4), (5).<\/p>\n

5. K\u1ebft lu\u1eadn<\/strong><\/h2>\n

Ch\u00fang t\u00f4i b\u00e1o c\u00e1o m\u1ed9t tr\u01b0\u1eddng h\u1ee3p \u0111\u1ea7u ti\u00ean b\u1ecb b\u1ec7nh nh\u01b0\u1ee3c c\u01a1 (Myasthenia Gravis) m\u1edbi kh\u1edfi ph\u00e1t sau nhi\u1ec5m SARS-CoV-2 t\u1ea1i Th\u00e0nh ph\u1ed1 H\u1ed3 Ch\u00ed Minh. Ca c\u1ee7a ch\u00fang t\u00f4i c\u00f3 \u0111\u1ea7y \u0111\u1ee7 c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng \u0111i\u1ec3n h\u00ecnh c\u1ee7a b\u1ec7nh nh\u01b0\u1ee3c c\u01a1 (Simpson test, Ice pack test, Curtain sign,..), \u0111i\u1ec7n c\u01a1 v\u00e0 kh\u00e1ng th\u1ec3 kh\u00e1ng th\u1ee5 th\u1ec3 acetylcholine d\u01b0\u01a1ng t\u00ednh.
\nBi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a b\u1ec7nh r\u1ea5t d\u1ec5 nh\u1ea7m l\u1eabn v\u1edbi c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a h\u1ed9i ch\u1ee9ng h\u1eadu Covid, v\u00e0 \u0111\u00f2i h\u1ecfi m\u1ed9t k\u1ef9 n\u0103ng l\u00e2m s\u00e0ng t\u1ed1t, hi\u1ec3u bi\u1ebft k\u1ef9 l\u01b0\u1ee1ng gi\u00e1 tr\u1ecb c\u1ee7a t\u1eebng kh\u1ea3o s\u00e1t c\u1eadn l\u00e2m s\u00e0ng \u0111\u1ec3 tr\u00e1nh b\u1ecf s\u00f3t ch\u1ea9n \u0111o\u00e1n. Nh\u00f3m b\u1ec7nh nh\u00e2n n\u00e0y c\u0169ng cho th\u1ea5y \u0111\u00e1p \u1ee9ng v\u1edbi c\u00e1c \u0111i\u1ec1u tr\u1ecb kinh \u0111i\u1ec3n \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u01b0\u1ee3c c\u01a1 th\u00f4ng th\u01b0\u1eddng.
\nC\u01a1 ch\u1ebf c\u1ee7a b\u1ec7nh \u0111\u01b0\u1ee3c cho l\u00e0, SARS-CoV-2 c\u00f3 c\u00e1c ph\u00e2n t\u1eed t\u01b0\u01a1ng t\u1ef1 v\u1edbi th\u1ee5 th\u1ec3 acetylcholine, t\u1eeb \u0111\u00f3 k\u00edch th\u00edch s\u1ea3n sinh c\u00e1c kh\u00e1ng th\u1ec3 ch\u1ed1ng l\u1ea1i th\u1ee5 th\u1ec3 acetylcholine. Tuy nhi\u00ean \u0111\u1ebfn nay v\u1eabn ch\u01b0a x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c c\u00e1c ph\u00e2n t\u1eeb n\u00e0y t\u1eeb SARS-CoV-2 v\u00e0 c\u1ea7n \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u th\u00eam.<\/p>\n

Ta\u0300i li\u00ea\u0323u tham kha\u0309o<\/h2>\n

1. Ani Nalbandian\u200a, Kartik Sehgal\u200a, Aakriti Gupta\u200a, Mahesh V. Madhavan, Claire McGroder, Jacob S. Stevens\u200a, et al. (2021). Post-acute COVID-19 syndrome. Nature Medicine, VOL 27; 601\u2013615.
\n2. Domenico A Restivo, Diego Centonze, Alessandro Alesina, Rosario Marchese-Ragona. (2020). Myasthenia Gravis Associated With SARS-CoV-2 Infection. Ann Intern Med, 173(12):1027-1028. doi: 10.7326\/L20-0845.
\n3. Inga Koneczny, Ruth Herbst. (2019 Jul 2). Myasthenia Gravis: Pathogenic Effects of Autoantibodies on Neuromuscular Architecture. Cells, 8(7):671.
\n4. Meret Huber, Sophia Rogozinski, Wolfram Puppe, Carsten Framme, G\u00fcnter H\u00f6glinger, Karsten Hufendiek, Florian Wegner. (2020). Postinfectious Onset of Myasthenia Gravis in a COVID-19 Patient. Frontiers in Neurology |, doi: 10.3389\/fneur.2020.576153.
\n5. Shitiz Sriwastava, Medha Tandon, Saurabh Kataria, Maha Daimee, Shumaila Sultan. (2020). New onset of ocular myasthenia gravis in a patient with COVID19: a novel case report and literature review. Journal of Neurology, doi.org\/10.1007\/s00415-020-10263-1.
\n6. Vern C Juel, Janice M Massey. (2007 Nov 6). Myasthenia gravis. Orphanet J Rare Dis, 2:44. doi: 10.1186\/1750-1172-2-44.<\/p>\n","protected":false},"excerpt":{"rendered":"

Nh\u01b0\u1ee3c c\u01a1 (Myasthenia Gravis) l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd th\u1ea7n kinh c\u01a1 b\u1ea3n, l\u00e0m suy y\u1ebfu kh\u1ea3 n\u0103ng truy\u1ec1n t\u00edn hi\u1ec7u t\u1eeb th\u1ea7n kinh t\u1edbi c\u01a1 b\u1eafp. B\u1ec7nh n\u00e0y \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn kh\u1ea3 n\u0103ng \u0111i\u1ec1u khi\u1ec3n c\u00e1c c\u01a1 b\u1eafp v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c tri\u1ec7u ch\u1ee9ng nh\u01b0 m\u1ec7t m\u1ecfi, suy gi\u1ea3m s\u1ee9c kh\u1ecfe, kh\u00f3 th\u1edf […]<\/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":"\nNh\u01b0\u1ee3c c\u01a1 (Myasthenia Gravis) kh\u1edfi ph\u00e1t sau nhi\u1ec5m Covid (Case l\u00e2m sa\u0300ng)<\/title>\n<meta name=\"description\" content=\"Nh\u01b0\u1ee3c c\u01a1 (Myasthenia Gravis) l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd th\u1ea7n kinh c\u01a1 b\u1ea3n, l\u00e0m suy y\u1ebfu kh\u1ea3 n\u0103ng truy\u1ec1n t\u00edn hi\u1ec7u t\u1eeb th\u1ea7n kinh t\u1edbi c\u01a1 b\u1eafp.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, 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