Nh\u00e0 thu\u1ed1c L\u01b0u V\u0103n Ho\u00e0ng<\/a> – CH\u01af\u01a0NG 2: B\u1eaeT CH\u00c9O N\u00c3O (CROSSED- BRAIN FINDINGS)<\/a><\/strong><\/p>\n

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Ngu\u1ed3n B\u00e1c S\u0129 D\u1ecbch: Tr\u01b0\u01a1ng V\u0103n Tr\u00ed<\/strong><\/p>\n
Ca l\u00e2m s\u00e0ng<\/h2>\n
B\u1ec7nh nh\u00e2n n\u1eef, 36 tu\u1ed5i, v\u00e0o c\u1ea5p c\u1ee9u v\u00ec \u0111\u1ed9t ng\u1ed9t ch\u00f3ng m\u1eb7t. V\u00e0i ng\u00e0y tr\u01b0\u1edbc \u0111\u00f3, b\u1ec7nh nh\u00e2n t\u00ea r\u1ea7n tho\u00e1ng qua \u1edf m\u1eb7t tr\u00e1i, k\u00e9o d\u00e0i v\u00e0i gi\u00e2y \u0111\u1ebfn v\u00e0i ph\u00fat, \u0111\u00f4i khi t\u00ea r\u1ea7n tay ph\u1ea3i v\u1edbi th\u1eddi gian t\u01b0\u01a1ng t\u1ef1 nh\u01b0 \u1edf m\u1eb7t. b\u1ec7nh nh\u00e2n c\u00f3 bi\u1ec3u hi\u1ec7n \u0111au c\u1ed5, cho r\u1eb1ng l\u00e0 do t\u1eadp luy\u1ec7n th\u1ec3 thao. Ng\u00e0y xu\u1ea5t hi\u1ec7n tri\u1ec7u ch\u1ee9ng, b\u1ec7nh nh\u00e2n c\u00f3 bi\u1ec3u hi\u1ec7n kh\u00f3 c\u1ea7m n\u1eafm khi \u0111ang \u0103n, tay tr\u00e1i tr\u1edf n\u00ean v\u1ee5ng v\u1ec1, kh\u00f4ng ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c b\u00e1t ng\u0169 c\u1ed1c c\u1ea7m tr\u00ean tay, \u0111\u00e1nh r\u01a1i b\u00e1t, kh\u00f3 kh\u0103n khi n\u00f3i, m\u1ed9t s\u1ed1 t\u1eeb tr\u1edf n\u00ean l\u1ed9n x\u1ed9n, r\u1eddi r\u1ea1c, v\u00e0 m\u1ea5t th\u0103ng b\u1eb1ng. b\u00e1c s\u0129 c\u1ea5p c\u1ee9u kh\u00e1m v\u00e0 tinh t\u1ebf nh\u1eadn ra b\u1ec7nh nh\u00e2n c\u00f3 s\u1ee5p nh\u1eb9 mi tr\u00e1i, do \u0111\u00f3 nghi ng\u1edd ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch n\u00e3o n\u00ean h\u1ed9i ch\u1ea9n ngo\u1ea1i th\u1ea7n kinh. b\u00e1c s\u0129 ngo\u1ea1i th\u1ea7n kinh kh\u00e1m ph\u00e1t hi\u1ec7n s\u1ee5p nh\u1eb9 mi tr\u00e1i. \u0110\u1ed3ng t\u1eed tr\u00e1i h\u01a1i nh\u1ecf h\u01a1n so v\u1edbi \u0111\u1ed3ng t\u1eed ph\u1ea3i; c\u1ea3 hai \u0111\u1ed3ng t\u1eed \u0111\u00e1p \u1ee9ng \u00e1nh s\u00e1ng tr\u1ef1c ti\u1ebfp v\u00e0 gi\u00e1n ti\u1ebfp. b\u1ec7nh nh\u00e2n c\u00f3 bi\u1ec3u hi\u1ec7n gi\u1ea3m c\u1ea3m gi\u00e1c s\u1edd nh\u1eb9 (light touch) \u1edf n\u1eeda m\u1eb7t tr\u00e1i v\u00e0 tay ch\u00e2n ph\u1ea3i, c\u1ea3m gi\u00e1c b\u1ea3n th\u1ec3 (proprioception) v\u00e0 c\u1ea3m gi\u00e1c t\u01b0 th\u1ebf kh\u1edbp c\u00f2n nguy\u00ean v\u1eb9n. S\u1ee9c c\u01a1 \u1edf tay, ch\u00e2n b\u00ecnh th\u01b0\u1eddng, nh\u01b0ng c\u00f3 r\u1ed1i t\u1ea7m (dysmetria) khi l\u00e0m ng\u00f3n tay ch\u1ec9 m\u0169i (finger-nose-finger) \u1edf tay tr\u00e1i.<\/p>\n
1. T\u1ed5n th\u01b0\u01a1ng \u1edf \u0111\u00e2u?<\/p>\n
a. Th\u1ea7n kinh trung \u01b0\u01a1ng<\/p>\n
b. Th\u1ea7n kinh ngo\u1ea1i bi\u00ean<\/p>\n
2. Nguy\u00ean nh\u00e2n g\u00e2y s\u1ee5p mi \u1edf b\u1ec7nh nh\u00e2n n\u00e0y l\u00e0 g\u00ec?<\/p>\n
a. T\u1ed5n th\u01b0\u01a1ng ch\u00e8n \u00e9p d\u00e2y v\u1eadn nh\u00e3n chung (d\u00e2y III)<\/p>\n
b. T\u1ed5n th\u01b0\u01a1ng vi m\u1ea1ch n\u1ed9i t\u1ea1i (microvascular intrinsic lesion) c\u1ee7a d\u00e2y III<\/p>\n
c. T\u1ed5n th\u01b0\u01a1ng \u0111\u01b0\u1eddng d\u1eabn truy\u1ec1n giao c\u1ea3m xu\u1ed1ng \u1edf th\u00e2n n\u00e3o<\/p>\n
d. T\u1ed5n th\u01b0\u01a1ng \u0111\u00e1m r\u1ed1i giao c\u1ea3m n\u1ed9i s\u1ecd \u1edf \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh trong<\/p>\n
3. C\u1ea5u tr\u00fac n\u00e0o g\u00f3p ph\u1ea7n g\u00e2y ra r\u1ed1i t\u1ea7m \u1edf tay tr\u00e1i?<\/p>\n
a. Nh\u00e2n h\u00ecnh c\u1ea7u ti\u1ec3u n\u00e3o (globose cerebellar nuclei) b\u00ean ph\u1ea3i<\/p>\n
b. Cu\u1ed1ng ti\u1ec3u n\u00e3o d\u01b0\u1edbi ph\u1ea3i<\/p>\n
c. Cu\u1ed1ng ti\u1ec3u n\u00e3o tr\u00ean tr\u00e1i<\/p>\n
d. B\u00f3 gai v\u1ecf n\u00e3o ph\u1ea3i (corticospinal tract)<\/p>\n
Th\u1ea3o lu\u1eadn<\/h2>\n
Hy v\u1ecdng tr\u01b0\u1eddng h\u1ee3p n\u00e0y s\u1ebd n\u00eau b\u1eadt \u0111\u01b0\u1ee3c v\u1ea5n \u0111\u1ec1: c\u00f3 th\u1ec3 \u0111\u1ecbnh v\u1ecb \u0111\u01b0\u1ee3c t\u1ed5n th\u01b0\u01a1ng m\u1ed9t c\u00e1ch nhanh ch\u00f3ng n\u1ebfu c\u00f3 ki\u1ebfn th\u1ee9c c\u01a1 b\u1ea3n v\u1ec1 gi\u1ea3i ph\u1eabu th\u1ea7n kinh v\u00e0 kh\u00e1m th\u1ea7n kinh t\u1ed1t. Trong khi b\u00e1c s\u0129 c\u1ea5p c\u1ee9u b\u1ecb l\u00f4i cu\u1ed1n b\u1edfi d\u1ea5u hi\u1ec7u s\u1ee5p mi c\u1ee7a b\u1ec7nh nh\u00e2n, h\u1ecd l\u1ea1i kh\u00f4ng nh\u1eadn ra \u0111\u01b0\u1ee3c \u0111\u00e2y l\u00e0 lo\u1ea1i s\u1ee5p mi n\u00e0o. Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng quan tr\u1ecdng nh\u1ea5t c\u00f3 th\u1ec3 r\u00fat ra t\u1eeb b\u1ec7nh nh\u00e2n n\u00e0y l\u00e0 v\u1ea5n \u0111\u1ec1 b\u1eaft ch\u00e9o n\u00e3o trong gi\u1ea3i ph\u1eabu th\u1ea7n kinh. b\u1ec7nh nh\u00e2n than phi\u1ec1n t\u00ea r\u1ea7n m\u1eb7t tr\u00e1i, do s\u1ef1 li\u00ean quan c\u1ee7a b\u00f3 gai s\u1ed1ng (spinal tract) c\u00f9ng b\u00ean c\u1ee7a d\u00e2y V (nh\u01b0ng b\u1ec7nh nh\u00e2n kh\u00f4ng r\u1ed1i lo\u1ea1n c\u1ea3m gi\u00e1c t\u01b0 th\u1ebf kh\u1edbp v\u00e0 c\u1ea3m gi\u00e1c b\u1ea3n th\u1ec3 – c\u00f3 \u0111\u01b0\u1eddng d\u1eabn truy\u1ec1n \u0111i theo c\u1ed9t sau (dorsal column) v\u00e0o th\u00e2n n\u00e3o c\u00f9ng v\u1edbi c\u00e1c s\u1ee3i th\u1ea7n kinh kh\u00e1c c\u1ee7a d\u00e2y V, b\u1eaft ch\u00e9o \u0111\u01b0\u1eddng gi\u1eefa ngay sau khi \u0111i v\u00e0o th\u00e2n n\u00e3o v\u00e0 \u0111i l\u00ean theo d\u1ea3i c\u1ea3m gi\u00e1c gi\u1eefa (medial lemniscus) \u0111\u1ec3 \u0111\u1ebfn nh\u00e2n b\u1ee5ng sau trong c\u1ee7a \u0111\u1ed3i th\u1ecb). b\u1ec7nh nh\u00e2n t\u00ea r\u1ea7n n\u1eeda ng\u01b0\u1eddi ph\u1ea3i l\u00e0 c\u00f3 li\u00ean quan \u0111\u1ebfn b\u00f3 gai \u0111\u1ed3i th\u1ecb (spinothalamic tract), b\u00f3 n\u00e0y b\u1eaft ch\u00e9o t\u1eeb ph\u1ea3i sang tr\u00e1i sau khi \u0111i v\u00e0o t\u1ee7y s\u1ed1ng m\u1ed9t \u0111o\u1ea1n ng\u1eafn (h\u00ecnh 1). b\u1ec7nh nh\u00e2n c\u00f3 m\u1ed9t s\u1ed1 d\u1ea5u hi\u1ec7u li\u00ean quan \u0111\u1ebfn b\u1eaft ch\u00e9o n\u00e3o: r\u1ed1i lo\u1ea1n d\u00e2y th\u1ea7n kinh s\u1ecd n\u00e3o \u1edf m\u1ed9t b\u00ean v\u00e0 d\u1ea5u th\u1ea7n kinh khu tr\u00fa \u1edf c\u01a1 th\u1ec3 \u0111\u1ed1i b\u00ean, t\u1ea5t c\u1ea3 bi\u1ec3u hi\u1ec7n n\u00e0y l\u1eadp t\u1ee9c gi\u00fap ch\u00fang ta c\u00f3 th\u1ec3 \u0111\u1ecbnh v\u1ecb t\u1ed5n th\u01b0\u01a1ng l\u00e0 \u1edf th\u00e2n n\u00e3o.<\/p>\n
Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng quan tr\u1ecdng th\u1ee9 hai l\u00e0 s\u1ee5p mi kh\u00f4ng ph\u1ea3i l\u00e0 bi\u1ec3u hi\u1ec7n b\u1ec7nh \u0111\u1eb7c tr\u01b0ng c\u1ee7a ph\u00ecnh m\u1ea1ch n\u00e3o ho\u1eb7c h\u1ed9i ch\u1ee9ng tho\u00e1t v\u1ecb. S\u1ee5p mi b\u1ea3n th\u00e2n n\u00f3 kh\u00f4ng c\u00f3 gi\u00e1 tr\u1ecb l\u1edbn v\u1ec1 \u0111\u1ecbnh v\u1ecb, v\u00ec \u0111\u00f3 c\u00f3 th\u1ec3 l\u00e0 bi\u1ec3u hi\u1ec7n c\u1ee7a r\u1ed1i lo\u1ea1n d\u00e2y th\u1ea7n kinh, r\u1ed1i lo\u1ea1n kh\u1edbp th\u1ea7n kinh c\u01a1 (neuromuscular junction), ho\u1eb7c c\u01a1. S\u1ef1 li\u00ean quan c\u1ee7a \u0111\u1ed3ng t\u1eed \u1edf b\u1ec7nh nh\u00e2n c\u00f3 s\u1ee5p mi l\u00e0 r\u1ea5t quan tr\u1ecdng. \u0110\u1ed3ng t\u1eed th\u01b0\u1eddng c\u00f3 \u0111\u01b0\u1eddng k\u00ednh 4-6mm khi \u1edf tr\u1ea1ng th\u00e1i trung t\u00ednh.<\/p>\n
\u0110\u1ed3ng t\u1eed gi\u00e3n<\/strong> \u0111\u01b0\u1ee3c chi ph\u1ed1i b\u1edfi giao c\u1ea3m v\u00e0 co nh\u1ecf \u0111\u01b0\u1ee3c chi ph\u1ed1i b\u1edfi ph\u00f3 giao c\u1ea3m. Do \u0111\u00f3, t\u1ed5n th\u01b0\u01a1ng \u0111\u01b0\u1eddng d\u1eabn truy\u1ec1n ph\u00f3 giao c\u1ea3m (d\u1eabn \u0111\u1ebfn c\u01b0\u1eddng t\u01b0\u01a1ng \u0111\u1ed1i giao c\u1ea3m) s\u1ebd g\u00e2y gi\u00e3n \u0111\u1ed3ng t\u1eed v\u00e0 t\u1ed5n th\u01b0\u01a1ng \u0111\u01b0\u1eddng d\u1eabn truy\u1ec1n giao c\u1ea3m (g\u00e2y c\u01b0\u1eddng t\u01b0\u01a1ng \u0111\u1ed1i ph\u00f3 giao c\u1ea3m) s\u1ebd g\u00e2y co \u0111\u1ed3ng t\u1eed. B\u1ec7nh nh\u00e2n s\u1ee5p mi do t\u1ed5n th\u01b0\u01a1ng d\u00e2y III th\u01b0\u1eddng c\u00f3 bi\u1ec3u hi\u1ec7n s\u1ee5p mi ho\u00e0n to\u00e0n (v\u00ec d\u00e2y III chi ph\u1ed1i c\u01a1 n\u00e2ng mi tr\u00ean (levator palpebrae)<\/strong>, l\u00e0 c\u01a1 n\u00e2ng mi ch\u00ednh c\u1ee7a mi m\u1eaft) v\u00e0 nh\u00e3n c\u1ea7u c\u00f3 th\u1ec3 di chuy\u1ec3n xu\u1ed1ng v\u00e0 ra ngo\u00e0i (do c\u01a1 th\u1eb3ng ngo\u00e0i \u0111\u01b0\u1ee3c d\u00e2y VI v\u00e0 c\u01a1 ch\u00e9o tr\u00ean \u0111\u01b0\u1ee3c d\u00e2y IV chi ph\u1ed1i kh\u00f4ng c\u00f2n ch\u1ecbu l\u1ef1c \u0111\u1ed1i kh\u00e1ng c\u1ee7a c\u00e1c c\u01a1 do d\u00e2y III chi ph\u1ed1i). D\u00e2y III mang c\u00e1c s\u1ee3i ph\u00f3 giao c\u1ea3m \u1edf v\u1ecf ngo\u00e0i c\u1ee7a n\u00f3. Ch\u00e8n \u00e9p d\u00e2y III<\/strong> s\u1ebd s\u1edbm l\u00e0m t\u1ed5n th\u01b0\u01a1ng c\u00e1c s\u1ee3i ph\u00f3 giao c\u1ea3m, g\u00e2y ra gi\u00e3n \u0111\u1ed3ng t\u1eed. T\u1ed5n th\u01b0\u01a1ng vi m\u1ea1ch m\u00e1u (microvascular lesion) c\u00f3 khuynh h\u01b0\u1edbng l\u00e0m t\u1ed5n th\u01b0\u01a1ng l\u00f5i b\u00ean trong c\u1ee7a d\u00e2y III, nh\u01b0ng kh\u00f4ng g\u00e2y t\u1ed5n th\u01b0\u01a1ng c\u00e1c s\u1ee3i ph\u00f3 giao c\u1ea3m v\u00e0 s\u1ebd kh\u00f4ng c\u00f3 t\u00e1c \u0111\u1ed9ng \u0111\u1ebfn k\u00edch th\u01b0\u1edbc \u0111\u1ed3ng t\u1eed. Tuy nhi\u00ean, m\u1ed9t c\u00e1ch th\u1eadn tr\u1ecdng- trong khi \u0111i\u1ec1u n\u00e0y \u0111\u00fang \u1edf s\u00e1ch v\u1edf v\u00e0 c\u1eadn l\u00e2m s\u00e0ng, vi\u1ec7c li\u1ec7t d\u00e2y III kh\u00f4ng ho\u00e0n to\u00e0n v\u00e0 \u0111\u1ed3ng t\u1eed kh\u00f4ng b\u1ecb \u1ea3nh h\u01b0\u1edfng v\u1eabn n\u00ean \u0111\u01b0\u1ee3c gi\u1ea3 thi\u1ebft l\u00e0 t\u1ed5n th\u01b0\u01a1ng ch\u00e8n \u00e9p khi kh\u00e1m x\u00e9t (v\u00e0 tr\u01b0\u1edbc khi c\u00f3 th\u1ec3 lo\u1ea1i tr\u1eeb b\u1eb1ng k\u1ebft qu\u1ea3 c\u1eadn l\u00e2m s\u00e0ng). b\u1ec7nh nh\u00e2n s\u1ee5p mi do t\u1ed5n th\u01b0\u01a1ng \u0111\u01b0\u1eddng d\u1eabn truy\u1ec1n giao c\u1ea3m th\u01b0\u1eddng l\u00e0 s\u1ee5p mi nh\u1eb9 do y\u1ebfu c\u01a1 mi tr\u00ean (c\u01a1 M\u00fcller, l\u00e0 c\u01a1 tr\u01a1n), c\u0169ng nh\u01b0 \u0111\u1ed3ng t\u1eed co nh\u1ecf v\u00e0 c\u00f3 th\u1ec3 gi\u1ea3m ph\u1ea3n x\u1ea1 ti\u1ebft m\u1ed3 h\u00f4i \u1edf m\u1eb7t (h\u1ed9i ch\u1ee9ng Horner).<\/p>\n
Tuy nhi\u00ean, trong khi s\u1ee5p mi v\u00e0 \u0111\u1ed3ng t\u1eed co nh\u1ecf gi\u00fap \u0111\u1ecbnh v\u1ecb t\u1ed5n th\u01b0\u01a1ng \u1edf \u0111\u01b0\u1eddng d\u1eabn truy\u1ec1n giao c\u1ea3m c\u00f9ng b\u00ean (m\u1ed9t trong nh\u1eefng \u00edt \u0111\u01b0\u1eddng d\u1eabn truy\u1ec1n kh\u00f4ng bao gi\u1edd b\u1eaft ch\u00e9o), n\u00f3 l\u1ea1i kh\u00f4ng gi\u00fap \u0111\u1ecbnh v\u1ecb \u0111\u01b0\u1ee3c ch\u00ednh x\u00e1c t\u1ed5n th\u01b0\u01a1ng \u1edf v\u1ecb tr\u00ed n\u00e0o tr\u00ean \u0111\u01b0\u1eddng d\u1eabn truy\u1ec1n giao c\u1ea3m. \u0110\u01b0\u1eddng d\u1eabn truy\u1ec1n giao c\u1ea3m b\u1eaft \u0111\u1ea7u t\u1eeb ph\u00eda sau c\u1ee7a h\u1ea1 \u0111\u1ed3i, \u0111i xu\u1ed1ng qua n\u00e3o gi\u1eefa, c\u1ea7u n\u00e3o v\u00e0 h\u00e0nh t\u1ee7y b\u00ean- l\u00e0 v\u1ecb tr\u00ed g\u1ea7n v\u1edbi b\u00f3 gai s\u1ed1ng c\u1ee7a d\u00e2y V, sau \u0111\u00f3 \u0111i v\u00e0o t\u1ee7y c\u1ed5 tr\u01b0\u1edbc khi tho\u00e1t ra ngo\u00e0i t\u1ee7y c\u1ed5 \u1edf \u0111o\u1ea1n C8-T2 (trung t\u00e2m mi t\u1ee7y c\u1ee7a Budge v\u00e0 Waller), v\u00e0 \u0111i xu\u1ed1ng h\u1ea1ch c\u1ed5 tr\u00ean tr\u01b0\u1edbc khi \u0111i v\u00e0o \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh, cu\u1ed1i c\u00f9ng chia ra theo \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh ngo\u00e0i (c\u00e1c s\u1ee3i d\u00e0nh cho ph\u1ea3n x\u1ea1 ti\u1ebft m\u1ed3 h\u00f4i) v\u00e0 theo \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh trong (c\u00e1c s\u1ee3i d\u00e0nh cho n\u00e2ng mi v\u00e0 gi\u00e3n \u0111\u1ed3ng t\u1eed). C\u00e1c s\u1ee3i \u0111i d\u1ecdc theo \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh trong s\u1ebd \u0111i v\u00e0o xoang hang m\u1ed9t \u0111o\u1ea1n ng\u1eafn, sau \u0111\u00f3 \u0111i d\u1ecdc theo d\u00e2y V, v\u00e0 cu\u1ed1i c\u00f9ng \u0111i \u0111\u1ebfn \u0111\u1ed3ng t\u1eed. b\u1ec7nh nh\u00e2n n\u00f3i tr\u00ean c\u00f3 bi\u1ec3u hi\u1ec7n t\u00ea m\u1eb7t c\u00f9ng b\u00ean, t\u00ea n\u1eeda c\u01a1 th\u1ec3 ph\u00eda \u0111\u1ed1i b\u00ean, d\u1ea5u s\u1ee5p m\u00ed- gi\u00fap \u0111\u1ecbnh v\u1ecb t\u1ed5n th\u01b0\u01a1ng g\u00e2y gi\u00e1n \u0111o\u1ea1n d\u1eabn truy\u1ec1n giao c\u1ea3m \u1edf th\u00e2n n\u00e3o (kh\u00f4ng ph\u1ea3i ph\u00ecnh m\u1ea1ch n\u00e3o ch\u00e8n \u00e9p d\u00e2y III nh\u01b0 b\u00e1c s\u0129 c\u1ea5p c\u1ee9u nghi ng\u1edd). C\u00f3 nh\u1eefng c\u1ea5u tr\u00fac n\u00e0o n\u1eb1m g\u1ea7n \u0111\u01b0\u1eddng d\u1eabn truy\u1ec1n n\u00e0y \u1edf h\u00e0nh t\u1ee7y b\u00ean? Cu\u1ed1ng ti\u1ec3u n\u00e3o d\u01b0\u1edbi, l\u00e0 \u0111\u01b0\u1eddng nh\u1eadn th\u00f4ng tin ch\u00ednh (input pathway) t\u1eeb ph\u1ee9c h\u1ee3p c\u00e1c nh\u00e2n b\u1ea7u d\u1ee5c (olivary complex) \u0111\u1ed1i b\u00ean \u0111\u1ebfn b\u00e1n c\u1ea7u ti\u1ec3u n\u00e3o (h\u00ecnh 2).<\/p>\n
$\"h\u00ecnh$
h\u00ecnh \u1ea3nh minh h\u1ecda<\/figcaption><\/figure>\n
B\u00e1n c\u1ea7u ti\u1ec3u n\u00e3o<\/strong> b\u00ean tr\u00e1i t\u00e1c \u0111\u1ed9ng l\u00ean ph\u1ea7n c\u01a1 th\u1ec3 b\u00ean tr\u00e1i-v\u00e0 ch\u1ecbu tr\u00e1ch nhi\u1ec7m cho th\u1ea5t \u0111i\u1ec1u c\u00f9ng b\u00ean c\u1ee7a b\u1ec7nh nh\u00e2n. Bi\u1ebft nh\u1eefng g\u00ec b\u1ea1n bi\u1ebft, b\u00e2y gi\u1edd h\u00e3y xem l\u1ea1i MRI \u1edf h\u00ecnh 3.<\/p>\n
$\"h\u00ecnh$
h\u00ecnh \u1ea3nh minh h\u1ecda<\/figcaption><\/figure>\n
C\u00f3 m\u1ed9t khu v\u1ef1c nh\u1ecf c\u00f3 t\u00edn hi\u1ec7u khu\u1ebfch t\u00e1n b\u1ecb gi\u1edbi h\u1ea1n (restricted diffusion) \u1edf h\u00e0nh t\u1ee7y b\u00ean. N\u1ebfu kh\u00f4ng ch\u00fa \u00fd \u0111\u1ec3 quan s\u00e1t khu v\u1ef1c n\u00e0y, ch\u00fang ta c\u00f3 th\u1ec3 d\u1ec5 d\u00e0ng b\u1ecf s\u00f3t t\u1ed5n th\u01b0\u01a1ng khi l\u01b0\u1edbt nhanh qua h\u00ecnh \u1ea3nh MRI (trong b\u1ed1i c\u1ea3nh \u0111ang tr\u1ef1c \u0111\u00eam, c\u1ea7n ho\u00e0n th\u00e0nh g\u1ea5p b\u1ec7nh \u00e1n m\u00e0 l\u1ea1i \u0111ang b\u1ecb \u00e1p l\u1ef1c v\u00ec c\u00f3 nhi\u1ec1u cu\u1ed9c g\u1ecdi h\u1ed9i ch\u1ea9n). Nh\u01b0ng h\u00ecnh \u1ea3nh \u0111\u00f3 tr\u00ean MRI \u1edf tr\u00ean l\u00e0 m\u1ed9t d\u1ea5u hi\u1ec7u m\u00e1ch l\u1ebbo (tell-tale sign) d\u1ec5 nh\u1eadn ra, kh\u1eb3ng \u0111\u1ecbnh s\u1ef1 nghi ng\u1edd c\u1ee7a ng\u01b0\u1eddi kh\u00e1m, n\u1ebfu bi\u1ebft \u0111\u1ec3 quan s\u00e1t v\u1ecb tr\u00ed \u0111\u00f3. V\u00e0 qua \u0111\u00f3 c\u0169ng c\u1ea3nh b\u00e1o ng\u01b0\u1eddi b\u00e1c s\u0129 xem x\u00e9t \u00fd ngh\u0129a c\u1ee7a vi\u1ec7c \u0111au c\u1ed5 \u1edf b\u1ec7nh nh\u00e2n n\u00e0y-c\u00f3 th\u1ec3 l\u00e0 tri\u1ec7u ch\u1ee9ng c\u1ee7a b\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch \u0111\u1ed1t s\u1ed1ng g\u1ea7n \u0111\u00e2y.<\/p>\n
Tr\u1ea3 l\u1eddi<\/h2>\n
1. A. Th\u1ea7n kinh trung \u01b0\u01a1ng<\/p>\n
2. C. T\u1ed5n th\u01b0\u01a1ng c\u1ee7a \u0111\u01b0\u1eddng d\u1eabn truy\u1ec1n giao c\u1ea3m-v\u1eadn nh\u00e3n xu\u1ed1ng (oculo-sympathetic pathway) \u1edf th\u00e2n n\u00e3o<\/p>\n
3. B. Cu\u1ed1ng ti\u1ec3u n\u00e3o d\u01b0\u1edbi ph\u1ea3i<\/p>\n
T\u00e0i li\u1ec7u tham kh\u1ea3o<\/h2>\n
Ngu\u1ed3n: Matthew McCoyd et al., The Neurological Examination, Operative Neurosurgery, Volume 17, Issue Supplement_1, August 2019, Pages S3\u2013S16<\/p>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"
Nh\u00e0 thu\u1ed1c L\u01b0u V\u0103n Ho\u00e0ng – CH\u01af\u01a0NG 2: B\u1eaeT CH\u00c9O N\u00c3O (CROSSED- BRAIN FINDINGS) Ngu\u1ed3n B\u00e1c S\u0129 D\u1ecbch: Tr\u01b0\u01a1ng V\u0103n Tr\u00ed Ca l\u00e2m s\u00e0ng B\u1ec7nh nh\u00e2n n\u1eef, 36 tu\u1ed5i, v\u00e0o c\u1ea5p c\u1ee9u v\u00ec \u0111\u1ed9t ng\u1ed9t ch\u00f3ng m\u1eb7t. V\u00e0i ng\u00e0y tr\u01b0\u1edbc \u0111\u00f3, b\u1ec7nh nh\u00e2n t\u00ea r\u1ea7n tho\u00e1ng qua \u1edf m\u1eb7t tr\u00e1i, k\u00e9o d\u00e0i v\u00e0i gi\u00e2y \u0111\u1ebfn […]\n","protected":false},"author":1,"featured_media":32453,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-32452","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/32452","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=32452"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/32452\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/32453"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=32452"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=32452"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=32452"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}