08/06/2011

ThS BS Nguyn B Thng B mn Th Kinh, HYD TPHCM Thn Ki h

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08/06/2011

Nhn bit chng mt, phn bit vi xy xm g g chong vng Nhn bit cc trng hp chng mt do nguyn nhn tin nh v thn kinh trung ng Nhn bit cc trng hp chong vng c nguyn nhn ni khoa Nm vng phng php iu tr chng mt t th kch pht lnh tnh

1. 2. 3. 4. 5. 6.

Chong vng Thy mnh/ vt y / quay trn Lng lng Nh u Thy mnh lc l, nhi ln xung Cg nh b ko ng ng, nghing v mt bn

7. 8.

9. 10. 11.

Xy xm Thy mnh/ vt y / ang tri, trt, chy v mt hng Chao o Mt thu Thy sn/tng nghing chm nghing, xung hoc nh cao ln

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08/06/2011

Vertigo:

Dizziness:

y g o g gic chuyn ng ca ch th hoc ca mi trng xung quanh (xoay, thng, nghing) Thng km bun nn v mt thng bng

Cm gic chong vng, xy xm, lng lng, nh u, mt thu

1. 2. 3. 4. 5. 6.

Chong vng Thy mnh/ vt y / quay trn Lng lng Nh u Thy mnh lc l, nhi ln xung Cg nh b ko ng ng, nghing v mt bn

7. 8.

9. 10. 11.

Xy xm Thy mnh/ vt y / ang tri, trt, chy v mt hng Chao o Mt thu Thy sn/tng nghing chm nghing, xung hoc nh cao ln

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08/06/2011

1. 2. 3. 4. 5. 6. 7 7. 8.

Chng mt? Nhc u? Nh ? Chong vng, xy xm? Nh u? Yu mt? Xu? L ln tm thn? Ri lon dng i?

Khng phi tn bnh, khng phi hi chng Khng chn on RLT g Chc nng tin nh = thng bng

Cc triu chng khng lin quan tin nh Nhc u yu mt l ln tm thn xu u, mt, thn,

ri lon chc nng tin nh gy chng mt, mt thng bng phi Ploi, tm NN, chn on theo NN

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08/06/2011

Gii phu tai trong Chc nng tai trong: c tai Tin nh

Nghe Gi thng bng Pht hin chuyn ng gia tc

M o mng: ng bn khuyn, soan nang, cu nang Thn kinh tin nh (dy VIII)

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08/06/2011

Mo bng (crista)

y Nhn bit chuyn ng xoay Ba ng BK ba mt phng Quay ni dch di chuyn kt lng mo bng to tn g hiu TK trong dy Tnh

Nhn bit chuyn ng thng Nhn bit t th u

y lch si tai, un cong TB lng to xung tai TK u nghing: trng lc ko si tai xung lch TB lng xung TK

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08/06/2011

Cc tn hiu cn cho thng bng: Th gic: i

Tin nh ngoi bin (Peripheral vestibular system - PVS) Cm gic bn th Tn hiu v v tr cc phn c th

Tn hiu v bn thn v mi trng

Tn hiu v t th u v cc chuyn ng ca u

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08/06/2011

Cc tn hiu cn cho thng bng: Th gic i Cm gic bn th H tin nh ngoi bin (Peripheral vestibular system - PVS)

S n g gin cc ng tin nh TN v tin nh gai, cng cc kt ni T vi cc nhn vn nhn h

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08/06/2011

Tai trong ( g (tin nh): 50%. ) Trung ng (thn kinh): 5% Ni khoa: 5% Tm l tm thn: 15% Khng r NN: 25%.

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08/06/2011

BPPV : 50% (chng mt t th kch pht lnh tnh). Bnh Meniere : 18% Vim TK tin nh, vim m o: 14% Acoustic neuroma : 10% R ngoi dch: him Tn thng tin nh hai bn: him g

Migraine , t qu: 50% X cng ri rc (MS) : 5% i Thoi ha tiu no / Chiari: 5% Chn thng u Vim mng no p xe no

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08/06/2011

c tnh triu chng: Thi gian: o g gic chuyn ng y g

Yu t khi pht:

Chng mt khng bao gi lin tc, thng tng cn, gim dn T pht hoc khi thay i t th Chuyn ng u (mi loi chng mt)

Y t l nng th Yu lm thm:

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08/06/2011

Tnh trn ton b chng mt chong vng: 40% Tin nh ngoi bin 10% Sang thng tin nh trung ng 25% Tin ngt hoc nguyn nhn ni khoa 15% Cn nguyn tm l-tm thn 10% Khng r nguyn nhn

BPPV chng mt t th kch p pht lnh tnh Vim m o Vim TK tin nh Nhim trng ng bn khuyn y Say tu xe

Bnh Mnire R ngoi dch tai trong R dch ng bn khuyn U dy c tai Thuc c tai tin nh

Assessment of the dizzy patient, Australian Family Physician Vol. 31, No. 8, August 2002

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08/06/2011

Migraine thn nn Sang thng thn no tiu no

X cng ri rc i U di cn no U mng no

U gc cu tiu no (u dy VIII Thoi ha tiu no D dng Chiary

Cn thong thiu mu no t qu

Thi nng ng Thiu mch sng-nn

Nhi mu/xut huyt tiu no Nhi mu/xut huyt thn no

Assessment of the dizzy patient, Australian Family Physician Vol. 31, No. 8, August 2002

c im triu chng

im loi tr

C th chng mt, g g , gim thnh lc Km nhiu triu chng TK ca h sau: th gic, cm gic, yu c, thc Cn ko di vi pht Chng mt n thun rt him gp Chng mt n thun ti i ti li: khng bao gi do thiu nng M sng nn

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08/06/2011

Chng mt ngoi binTrchng km g Trchng thnh gic Mc CM Khi pht Km chn thng u Nystagmus Bun nn, nn, v m , , hi tai, gim thnh lc Nng n t ngt Hay Ha gp Ngang hoc xoay vi nh th Khng thay i vi hng nhn

Chng mt trung ngSong th, kh nut, t mt, g , , , tht iu, yu na ngi Him gp t nng n hn Chm hn Him Dc hoc nhiu hng vi nh th Thay i khi i hng nhn

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08/06/2011

Ri lon tm thn

Hi chng tng thng kh Tin ngt: BMV, suy tim, thuyn tc phi, lon nhp tim

Trm cm nng 25% RL lo u lan ta hoc ri lon hong s 25% Ri lon dng c th Nghin ru Ri lon nhn cch

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08/06/2011

Sp ngt, sp xu Ko di vi giy ti vi pht Nguyn nhn H huyt p t th Lon nhp tim Cn ph v

Khng do tim mch C ch phn x Ngt vasovagal v vasodepressor g g (ngt khng do tim) i tiu Nut Ho Ri lon TKTV (Dysautonomias) Thiu nc Bnh, nm lu, deconditioning Thuc chng trm cm, chn giao cm

Ngt do bnh tim Lon nhp Bloc nh tht vi tim chm (NN cu trc, thuc) Ngng xoang/tim chm (NN ph v, HC suy nt xoang, thuc lm chm nhp nh chn beta, chn knh calci Nhanh tht do bnh cu trc tim Bnh c tim ph i Hp M ch

H p t th

NN khng lon nhp

Tm l

Ngt khng r NN

ng kinh cha c chn on Khng phi ngt: trng thi l ln (h ng huyt, t qu) Mt thc do thuc (ru, thuc gy nghin)

Chuyn dng RL hong s RL lo u

Khong 50% cc bnh nhn ti BV

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08/06/2011

c im thi gian

Chng mt t th kch pht lnh tnh (BPPV): cn ko di di 1 pht, t gii hn, p ng km vi thuc chng chng mt Mch mu: mt t ko di vi pht-vi gi, thng do migraine hoc thong thiu mu m o hoc thn no; i khi l bnh Meniere Cn chng mt mi khi pht, ko di hn: vim thn kinh tin nh x cng ri rc thiu mu h nh, rc, sng nn

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08/06/2011

Cc triu chng phi hp

Cc yu t nguy c

Thiu mu h sng-nn: nhn i, RL pht m, nut kh, yu c, t b kh c Bnh Mnire: gim thnh lc, tai, y trong tai X cng ri rc (MS): c cc du chng thn kinh khc trc chng mt Cn hong s/tm l: v m hi, hi hp nh trng ngc Migraine THA, T, ht thuc, bnh M ngoi bin Chn thng u Bnh tm thn, tm l

nh gi t th dng b Khm h thng tin nh: rung git nhn cu, Romberg, NP Dix-Hallpike Khm thn kinh nh gi thnh gic: khm thnh lc, test Rinne, test Weber, o thnh lc

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08/06/2011

MRI/MRA tm cc nguyn nhn trung ng Thnh lc (Audiometry) phn bit cc nguyn nhn ngoi bin Brainstem evoked audiometry nhy 90-95% cho u dy VIII

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08/06/2011

iu tr triu chng

h h h Trn an: triu chng d rt kh chu nhng thng lnh tnh v t gii hn

B nc nht l ngi i nhiu v ncngi gi Nm ngh t th thoi mi nht Thuc gim triu chng antihistamines, anticholinergics, antiemetics and benzodiazapies

iu tr cc bnh cn nguyn Migraine Thiu mu no h sng nn sng-nn X cng ri rc U tiu no

Bnh Mnires: n lt, li tiu, +/- Pthut Vestibular neuronitis (labyrinthitis): khng vim, him khi cn khng sinh BPPV: cc nghim php ti nh v si tai Thuc, tp luyn

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08/06/2011

Chng mt T ngoi bin cp (ti a 1-3 ngy) Tn thng thn no cp gn nhn T Cc cn chng mt thng xuyn v nng n km bun nn v nn BPPV nng vi bun nn v nn (dng 30p trc khi lm cc nghim php) Phng nga say tu xe Chng mt t th trung ng km nn i

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08/06/2011

Bnh hi 3 triu chng: - Chng mt Ch - tai Normal membranous labyrinth - Mt thnh lc Tui : 30-60, nam = n Cn ko di: vi pht ti vi gi, ti i ti li Mc : rm r v trm trng g C ch sinh bnh: tng th tch ni dch iu tr: li tiu, n lt, +/PthutDilated membranous labyrinth in Meniere's disease (Hydrops)

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08/06/2011

Tui 30-50 Xy ra khi i t th u y Cn ngn 15-45 giy (thng 20) Km theo: bun nn, nn C ch ph bin: cn si tai tr: NP Epley, thuc chng nn; g +/- thuc chng chng mt Tin lng: tt, c ti pht

Cn kch pht c cc c trng

Chng mt khi thay i t th u g y C khong tim thi trc khi pht Cn ngn (25-40 giy) Khi nm ngi dy (NP Dix Hallpike) nystagmus o chiu Lm test vi ln s mt p ng (hin tng quen/mt) Hin din cc triu chng ch quan kh chu ca CM, hoc CM ti pht sau nhiu thng, nhiu nm m khng c triu chng no khc

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08/06/2011

NP Epley: ti nh v si tai

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08/06/2011

Nhn bit bng bnh s, xc nhn bng khm thc th, ch khm thn kinh th Phn bit chng mt vi chong vng; Vi chng mt, a s BN giai on sau c chong vng hoc mt thng bng Hu ht cc NN u lnh tnh v t gii hn Ch cc trng hp nng khi c mt thnh lc g p g mt bn, c du TKV, hoc c bng chng chng mt t tin nh trung ng

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08/06/2011

Chng mt nghim trng cn tr sinh hot Tht iu khng tng xng vi chng mt Chng mt ko di trn 4 tun Thay i thnh lc C nystagmus nh dc C du thn kinh nh v C b h l t th h c cn nguyn t bnh ton thn hoc tm l

Australian Family Physician Vol. 31, No 8, August 2002

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