{"id":8854,"date":"2025-03-21T15:49:43","date_gmt":"2025-03-21T08:49:43","guid":{"rendered":"https:\/\/bvndgiadinh.org.vn\/?p=8854"},"modified":"2025-03-24T07:13:21","modified_gmt":"2025-03-24T00:13:21","slug":"viem-nao-khang-thu-the-nmdaviem-nao-tu-mien-o-tre-em","status":"publish","type":"post","link":"https:\/\/bvndgiadinh.org.vn\/?p=8854","title":{"rendered":"VI\u00caM N\u00c3O KH\u00c1NG TH\u1ee4 TH\u1ec2 NMDA(VI\u00caM N\u00c3O T\u1ef0 MI\u1ec4N) \u1ede TR\u1eba EM"},"content":{"rendered":"\n

M\u1edbi \u0111\u00e2y, khoa Nhi, B\u1ec7nh vi\u1ec7n Nh\u00e2n d\u00e2n Gia \u0110\u1ecbnh ti\u1ebfp nh\u1eadn v\u00e0 \u0111i\u1ec1u tr\u1ecb cho b\u00e9 g\u00e1i 14 tu\u1ed5i \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n vi\u00eam n\u00e3o t\u1ef1 mi\u1ec5n c\u00f3 kh\u00e1ng th\u1ec3 NMDA (N-methyl \u2013D-aspartate) d\u01b0\u01a1ng t\u00ednh. \u0110\u00e2y l\u00e0 m\u1ed9t b\u1ec7nh hi\u1ebfm g\u1eb7p \u1edf tr\u1ebb em v\u00e0 d\u1ec5 b\u1ecb b\u1ecf s\u00f3t ho\u1eb7c ch\u1ea9n \u0111o\u00e1n nh\u1ea7m v\u1edbi c\u00e1c r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n.<\/strong><\/p>\n\n\n\n

V\u00e0o ng\u00e0y 22\/02\/2025, gia \u0111\u00ecnh \u0111\u01b0a b\u00e9 N.M.T, sinh n\u0103m 2011, ng\u1ee5 t\u1ea1i qu\u1eadn B\u00ecnh Th\u1ea1nh, TP.HCM \u0111\u1ebfn khoa Nhi \u0111\u1ec3 c\u00e1c b\u00e1c s\u0129 \u0111i\u1ec1u tr\u1ecb trong t\u00ecnh tr\u1ea1ng xu\u1ea5t hi\u1ec7n \u1ea3o thanh, m\u1ea5t ng\u1ee7, r\u1ed1i lo\u1ea1n nh\u1eadn th\u1ee9c v\u00e0 ng\u00f4n ng\u1eef. 5 ng\u00e0y tr\u01b0\u1edbc khi nh\u1eadp vi\u1ec7n, b\u00e9 T. \u0111\u1ed9t ng\u1ed9t ng\u1ea5t x\u1ec9u trong l\u1edbp, sau \u0111\u00f3, b\u00e9 t\u1ec9nh t\u00e1o v\u00e0 sinh ho\u1ea1t b\u00ecnh th\u01b0\u1eddng. Tuy nhi\u00ean, b\u00e9 c\u00f3 c\u00e1c c\u1eed ch\u1ec9, h\u00e0nh \u0111\u1ed9ng b\u1ea5t th\u01b0\u1eddng nh\u01b0: 1 m\u00ecnh kh\u00f3c, c\u01b0\u1eddi v\u1ec1 \u0111\u00eam, n\u00f3i n\u0103ng kh\u00f4ng ki\u1ec3m so\u00e1t. Khi nghe b\u00e9 T. k\u1ec3 l\u1ea1i l\u00e0 nghe v\u0103ng v\u1eb3ng b\u00ean tai ti\u1ebfng c\u1ee7a ai \u0111\u00f3, m\u1eb9 c\u1ee7a b\u00e9 v\u00f4 c\u00f9ng lo l\u1eafng v\u00e0 ngh\u0129 r\u1eb1ng con m\u00ecnh b\u1ecb \u201cma nh\u1eadp\u201d n\u00ean d\u1ef1 \u0111\u1ecbnh m\u1eddi th\u1ea7y c\u00fang v\u1ec1 nh\u00e0 \u0111\u1ec3 l\u00e0m ph\u00e9p cho b\u00e9. Th\u1ebf nh\u01b0ng, sau khi t\u00ecm hi\u1ec3u th\u00f4ng tin tr\u00ean m\u1ea1ng v\u1ec1 nh\u1eefng bi\u1ec3u hi\u1ec7n kh\u00e1c l\u1ea1 c\u1ee7a b\u00e9 T., gia \u0111\u00ecnh quy\u1ebft \u0111\u1ecbnh \u0111\u01b0a b\u00e9 \u0111\u1ebfn B\u1ec7nh vi\u1ec7n Nh\u00e2n d\u00e2n Gia \u0110\u1ecbnh \u0111\u1ec3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb.<\/p>\n\n\n\n

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Qua ki\u1ec3m tra, th\u0103m kh\u00e1m c\u1ee7a c\u00e1c b\u00e1c s\u0129 \u1edf khoa Nhi, b\u00e9 T. \u0111\u01b0\u1ee3c ghi nh\u1eadn m\u1ea5t \u0111\u1ecbnh h\u01b0\u1edbng v\u1ec1 th\u1eddi gian, kh\u00f4ng gian v\u00e0 kh\u1ea3 n\u0103ng th\u1ef1c hi\u1ec7n c\u00e1c ph\u00e9p t\u00ednh \u0111\u01a1n gi\u1ea3n, r\u1ed1i lo\u1ea1n ng\u00f4n ng\u1eef k\u00e8m r\u1ed1i lo\u1ea1n gi\u1ea5c ng\u1ee7 v\u00e0 \u1ea3o thanh. C\u00e1c k\u1ebft qu\u1ea3 c\u1eadn l\u00e2m s\u00e0ng kh\u00f4ng ph\u00e1t hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng nhu m\u00f4 n\u00e3o tr\u00ean MRI, nh\u01b0ng c\u00f3 t\u0103ng b\u1ea1ch c\u1ea7u \u0111\u01a1n nh\u00e2n trong d\u1ecbch n\u00e3o t\u1ee7y k\u00e8m kh\u00e1ng th\u1ec3 kh\u00e1ng th\u1ee5 th\u1ec3 NMDA d\u01b0\u01a1ng t\u00ednh – m\u1ed9t ch\u1ec9 d\u1ea5u quan tr\u1ecdng trong x\u00e1c \u0111\u1ecbnh b\u1ec7nh vi\u00eam n\u00e3o t\u1ef1 mi\u1ec5n. B\u00e9 T. \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi Methylprednisolon li\u1ec1u cao v\u00e0 gi\u1ea3m li\u1ec1u d\u1ea7n theo ph\u00e1c \u0111\u1ed3. Sau h\u01a1n 2 tu\u1ea7n \u0111i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c, to\u00e0n di\u1ec7n d\u01b0\u1edbi s\u1ef1 ph\u1ed1i h\u1ee3p li\u00ean chuy\u00ean khoa N\u1ed9i th\u1ea7n kinh v\u00e0 Nhi \u1edf B\u1ec7nh vi\u1ec7n Nh\u00e2n d\u00e2n Gia \u0110\u1ecbnh, t\u00ecnh tr\u1ea1ng b\u1ec7nh c\u1ee7a b\u00e9 T. c\u00f3 ti\u1ebfn tri\u1ec3n t\u1ed1t. Ng\u00e0y 11\/03, b\u00e9 \u0111\u01b0\u1ee3c xu\u1ea5t vi\u1ec7n v\u1ec1 nh\u00e0.<\/p>\n\n\n\n

S\u00e1ng ng\u00e0y 18\/03\/2025, b\u00e9 T. tr\u1edf l\u1ea1i khoa Nhi t\u00e1i kh\u00e1m theo l\u1ecbch h\u1eb9n. L\u00fac n\u00e0y, kh\u1ea3 n\u0103ng nh\u1eadn th\u1ee9c v\u00e0 giao ti\u1ebfp c\u1ee7a b\u00e9 \u0111\u00e3 d\u1ea7n c\u1ea3i thi\u1ec7n. M\u1eb9 c\u1ee7a b\u00e9 cho bi\u1ebft b\u00e9 ng\u1ee7 ngon v\u1ec1 \u0111\u00eam v\u00e0 kh\u00f4ng c\u00f2n n\u00f3i chuy\u1ec7n 1 m\u00ecnh. C\u00e1c bi\u1ec3u hi\u1ec7n n\u00e0y cho th\u1ea5y d\u1ea5u hi\u1ec7u ph\u1ee5c h\u1ed3i \u1edf b\u00e9 T. b\u1eaft \u0111\u1ea7u c\u00f3 k\u1ebft qu\u1ea3 nh\u01b0 ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh vi\u00eam n\u00e3o t\u1ef1 mi\u1ec5n<\/p>\n\n\n\n

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Vi\u00eam n\u00e3o t\u1ef1 mi\u1ec5n l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd th\u1ea7n kinh nghi\u00eam tr\u1ecdng, hi\u1ebfm g\u1eb7p, x\u1ea3y ra khi h\u1ec7 mi\u1ec5n d\u1ecbch c\u1ee7a c\u01a1 th\u1ec3 t\u1ea5n c\u00f4ng v\u00e0o c\u00e1c t\u1ebf b\u00e0o th\u1ea7n kinh kho\u1ebb m\u1ea1nh g\u00e2y n\u00ean t\u00ecnh tr\u1ea1ng vi\u00eam n\u00e3o. B\u1ec7nh th\u01b0\u1eddng kh\u1edfi ph\u00e1t v\u1edbi c\u00e1c tri\u1ec7u ch\u1ee9ng t\u00e2m th\u1ea7n nh\u01b0: \u1ea3o thanh, \u1ea3o gi\u00e1c, lo \u00e2u ho\u1eb7c thay \u0111\u1ed5i h\u00e0nh vi khi\u1ebfn nhi\u1ec1u ng\u01b0\u1eddi l\u1ea7m t\u01b0\u1edfng \u0111\u00f3 l\u00e0 d\u1ea5u hi\u1ec7u c\u1ee7a b\u1ec7nh t\u00e2m th\u1ea7n ph\u00e2n li\u1ec7t ho\u1eb7c c\u00e1c r\u1ed1i lo\u1ea1n t\u00e2m l\u00fd kh\u00e1c. TS.BS V\u00f5 V\u0103n T\u00e2n, Tr\u01b0\u1edfng khoa N\u1ed9i Th\u1ea7n kinh, B\u1ec7nh vi\u1ec7n Nh\u00e2n d\u00e2n Gia \u0110\u1ecbnh chia s\u1ebb: \u201cVi\u00eam n\u00e3o t\u1ef1 mi\u1ec5n l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd c\u00f3 di\u1ec5n bi\u1ebfn ph\u1ee9c t\u1ea1p v\u00e0 kh\u1ea3 n\u0103ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn t\u00ednh m\u1ea1ng n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi. B\u1ec7nh th\u01b0\u1eddng g\u1eb7p \u1edf n\u1eef gi\u1edbi, tr\u1ebb tu\u1ed5i v\u00e0 d\u1ec5 nh\u1ea7m l\u1eabn v\u1edbi c\u00e1c r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n d\u1eabn \u0111\u1ebfn \u0111i\u1ec1u tr\u1ecb kh\u00f4ng hi\u1ec7u qu\u1ea3, k\u00e9o d\u00e0i th\u1eddi gian \u0111i\u1ec1u tr\u1ecb. Ngo\u00e0i ra, kh\u00f4ng \u00edt tr\u01b0\u1eddng h\u1ee3p b\u1ecb nh\u1ea7m<\/p>\n\n\n\n

t\u01b0\u1edfng n\u00ean s\u1ebd t\u00ecm \u0111\u1ebfn c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1ec7nh n\u00e0y ph\u1ea3n y h\u1ecdc, s\u1ebd l\u00e0m ch\u1eadm tr\u1ec5 ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb sau n\u00e0y\u201d.<\/p>\n\n\n\n

Theo BS.CKI Ph\u1ea1m Th\u1ecb Ho\u00e0ng Oanh, Ph\u00f3 tr\u01b0\u1edfng khoa Nhi, B\u1ec7nh vi\u1ec7n Nh\u00e2n d\u00e2n Gia \u0110\u1ecbnh, c\u00f3 kho\u1ea3ng 30% – 50% tr\u01b0\u1eddng h\u1ee3p vi\u00eam n\u00e3o t\u1ef1 mi\u1ec5n c\u00f3 k\u1ebft qu\u1ea3 MRI s\u1ecd n\u00e3o b\u00ecnh th\u01b0\u1eddng nh\u01b0 tr\u01b0\u1eddng h\u1ee3p c\u1ee7a b\u00e9 T. Do \u0111\u00f3, MRI b\u00ecnh th\u01b0\u1eddng trong 1 tu\u1ea7n \u0111\u1ea7u c\u1ee7a b\u1ec7nh c\u0169ng kh\u00f4ng th\u1ec3 lo\u1ea1i tr\u1eeb ch\u1ea9n \u0111o\u00e1n. Khi tr\u1ebb c\u00f3 c\u00e1c bi\u1ec3u hi\u1ec7n th\u1ea7n kinh kh\u1edfi ph\u00e1t c\u1ea5p t\u00ednh < 3 th\u00e1ng v\u1edbi ti\u1ec1n c\u0103n tr\u01b0\u1edbc \u0111\u00f3 ho\u00e0n to\u00e0n kho\u1ebb m\u1ea1nh, c\u1ea7n nghi ng\u1edd c\u00f3 t\u1ed5n th\u01b0\u01a1ng n\u00e3o th\u1ef1c th\u1ec3 v\u00e0 l\u00e0m th\u00eam c\u00e1c x\u00e9t nghi\u1ec7m chuy\u00ean s\u00e2u \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n. \u0110i\u1ec1u n\u00e0y c\u00f3 vai tr\u00f2 v\u00f4 c\u00f9ng quan tr\u1ecdng v\u00ec ti\u00ean l\u01b0\u1ee3ng b\u1ec7nh c\u00e0ng t\u1ed1t n\u1ebfu \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n v\u00e0 \u0111i\u1ec1u tr\u1ecb s\u1edbm. Do \u0111\u00f3, khi th\u1ea5y tr\u1ebb c\u00f3 c\u00e1c bi\u1ec3u hi\u1ec7n th\u1ea7n kinh b\u1ea5t th\u01b0\u1eddng nh\u01b0: r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n, r\u1ed1i lo\u1ea1n nh\u1eadn th\u1ee9c, r\u1ed1i lo\u1ea1n h\u00e0nh vi ho\u1eb7c r\u1ed1i lo\u1ea1n gi\u1ea5c ng\u1ee7, ph\u1ee5 huynh c\u1ea7n \u0111\u01b0a tr\u1ebb \u0111\u1ebfn c\u00e1c c\u01a1 s\u1edf y t\u1ebf chuy\u00ean khoa \u0111\u1ec3 \u0111\u01b0\u1ee3c th\u0103m kh\u00e1m v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi. \u0110\u1eebng \u0111\u1ec3 nh\u1eefng hi\u1ec3u l\u1ea7m v\u1ec1 b\u1ec7nh vi\u00eam n\u00e3o t\u1ef1 mi\u1ec5n d\u1eabn \u0111\u1ebfn nh\u1eefng h\u1eadu qu\u1ea3 \u0111\u00e1ng ti\u1ebfc b\u1edfi s\u1ee9c kh\u1ecfe tinh th\u1ea7n v\u00e0 th\u1ec3 ch\u1ea5t c\u1ee7a tr\u1ebb l\u00e0 m\u00f3n qu\u00e0 qu\u00fd gi\u00e1 nh\u1ea5t<\/p>\n\n\n\n

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M\u1edbi \u0111\u00e2y, khoa Nhi, B\u1ec7nh vi\u1ec7n Nh\u00e2n d\u00e2n Gia \u0110\u1ecbnh ti\u1ebfp nh\u1eadn v\u00e0 \u0111i\u1ec1u tr\u1ecb cho b\u00e9 g\u00e1i 14 tu\u1ed5i \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n vi\u00eam n\u00e3o t\u1ef1 mi\u1ec5n c\u00f3 kh\u00e1ng th\u1ec3 NMDA (N-methyl \u2013D-aspartate) d\u01b0\u01a1ng t\u00ednh. \u0110\u00e2y l\u00e0 m\u1ed9t b\u1ec7nh hi\u1ebfm g\u1eb7p \u1edf tr\u1ebb em v\u00e0 d\u1ec5 b\u1ecb b\u1ecf s\u00f3t ho\u1eb7c ch\u1ea9n \u0111o\u00e1n nh\u1ea7m v\u1edbi c\u00e1c 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