SLf DUNG KHAM NGHIEM DIEN CHAM KICH THICH TRONG DANH GIA CHLfC NANG D U 6 N G D A N TRUYEN THj GIAC
Nguyen Canh T h i n g Benh vien Mit trung uang Nhdng benh ly giy ton thifang dddng din truyen thj giac thudng li benh ning, can ddac phit hien va dieu trj sdm. Kham nghiem dien cham kich thich cd kha nang khao sat rit td't chdc ning cua dddng din truyen, tuy nhien vin chda ddac ap dung rdng rai. Muc tieu: md ta ddac gii trj cua kham nghidm dien cham trong danh gii chdc nang cua dddng din truyen thj giie mdt sd trddng hap benh ly. Ddi tUgng va phuang phap nghien cufu: bio cio trddng hdp 3 ca lim sing cd ton thuang thj than kinh ddac kham lim sing vi kham nghiem dien cham kich thich. Ket qua: ket qua khim nghiem dien cham kich thich cua 3 ca phu hap vdi ket qua cua cac kham nghiem chdc nang khic (thj luc, thj trudng) vi trieu chdng lam sang chan doan hinh anh (chup mach huynh quang vdng mac). Ket luan va kien nghi: dien cham kich thich la phdang phap khim nghiem cd kha dinh gii mde do ton thdang cua dddng din truyen than kinh thi giac. Chung ta nen phd'i hap chat che gida chuyen khoa than kinh va chuyen khoa Mit de ip dung trong kham va chda benh.
Tii khoa: dien cham kich thich, dodng d i n truyen thj giac
L D A T V A N D E
Dien cham kfch thfeh la ddng dien hoat dpng tai thuy cham cua vd nao (vung thi giac) khi cd kfch thfch thj giac la chdp sang, hinh I n h . Ddng dien hoat dpng nay dfldc ghi lai bang phflpng phap ghi dien nao thdng thfldng vdi cae dien cflc t i l p xuc da d i u dat tai vung cham [5]. K h l m nghiem nay da dflpc flng dung rpng rai trong ehuyen khoa t h i n kinh de ehan d o l n nhflng benh xd edng mang, benh Creutzfeldt - Jacob, migraine... [ 1 , 2, 3, 4 ] .
Trong chuyen khoa MaL kham nghiem eho phep d i n h gia thi Iflc khach quan, tat khde xa, kiem tra chdc nang dfldng d i n t r u y i n thj giae [5, 6, 7], nhifng thflc te tai Viet Nam chifa dflpc ehd y ap dung n h i l u trong tham kham. M u c tieu: Mo ta gia tri kham nghiem dien cham trong danh gia chdc nang cua dUdng dan truyen thi giac trong mgt sd trudng hgp benh ly.
II. D O I T U O N G v A PHU'ONG P H A P N G H I E N CL/U
1. D o i tOdng nghien cOu: 3 benh nhan ed b i l u
hien benh ly than kinh thj giac dUpe kham va d i l u trj tai khoa D5y mat - Mang bd dao benh vien Mat Trung Udng.
2. PhOdng phap nghien cOu: gidi thieu ea lam s i n g . 3. Cac bode tien hanh
- Benh nhan dope khai thac benh sd, k h l m lam sang ban p h i n trUde nhan c l u , soi d i y mat.
- Cac xet nghiem ehfle nang:
Danh gia thi Iflc bang bang Landolt, thi trifdng dflpc l l m tren m i y thj trUdng k l matrix Carl Zeiss, ehup maeh huynh quang vdng mac bang may chup Carl Zeiss.
Kham nghiem do dien cham kfch thfch dUdc thflc hien tai bp mdn Sinh ly hpe - Dai hoc Y Ha Npi tren m i y ghi dien nao Nihon Kohden.
De phan tfch ke't q u i ghi dien cham kfch thich, ngUdi ta thfldng dfla vao d e thdng sd:
- Thdi gian tiem tang eua sdng PI 00 (sdng dflpng thfldng x u i t hien d k h o i n g thdi gian 100ms sau khi ed kfch thieh thi giae, cdn dupe gpi la sdng L2). Thdi gian t i l m tang bi keo dai khang dinh cd dpt t i l n tien nang eua benh ly dUdng thi giac.
TCNCYH 70 (SJ - 2010
- Hinh dang cua d e sdng (chu yeu sdng PI 00).
Sdng PlOO cd 2 dinh chi ra da tflng ed giai doan benh ly gay tdn thfldng 1 phan dfldng thj g i l c .
- Bien dp eua d e sdng (dien I p ) . Dien I p q u i e a o ' ( > 30mieroV thUdng the hien trong benh Creutzfeldt - Jacob. Dien I p qua thi'p cho biet ed
the tdn thuong bd spi than kinh di tO hdang diem.
Khi dodng d i n truyen thj giae bj tdn thUdng nang, gan mu, ta khdng phan biet dflde dfldng ghi dien c h i m vdi n h i l u n l n [5, 7].
Hinh anh dfldng ghi dien cham kich thfch binh thfldng.
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III. KET QUA vA BAN LUAN
Ca lam sang 1 :
Benh nhan nam, 42 tudi.
Ly do d i n kham benh: M d 2 mat (2M).
Dien b i l n : 2 mat md tfl tfl, khdng dau nhfle, khdng dd tfl 4 thang nay. Benh nhan chfla dfldc d i l u tri.
T i l n sfl: nghien rflpu (tieu thu trung binh 0,4 - 0,51/ngay) tfl 3 - 4 nam.
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Thj Iflc: 2 M d i m ngdn tay (DNT) 1,5m.
K h l m b i n phan trflde nhan c l u : binh thfldng.
K h l m d i y mat: binh thfldng.
Chan d o l n : 2 mat ngp dpc thj than kinh do rflpu.
Chup mach huynh quang vdng mac: 2M binh thfldng.
Thj trfldng: dp nhay d m g i l m sut - 9,93dB d mat phai va - 9,32dB d mat trai, the hien tren thj trUdng bang I m diem canh trung t i m .
Dien chim kich thich: khdng cd sdng dap dng do kich thich d ca 2 mit, khdng phan biet dddc eae dinh sdng nim lan trong nhiiu nin.
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Ca lam sang 2 Benh nhan nO 32 tudi;
Ly do d i n k h l m benh: md mat p h i i ;
D i l n b i l n : mat md nhanh, khdng dau nhde, khdng dd tfl 2 t u i n , chfla difpe dieu tri;
T i l n sfl: viem xoang sau;
Thj life: MP DNT 0,5m MT: 8/1 0 qua kfnh Id 1 0/1 0;
Khlm ban phan trflde nhan c l u va d i y mat: binh thfldng;
Chan d o l n : MP viem thj than kinh hau nhan c l u ; MT: tat khuc xa;
Thj trfldng: MP khdng lam dfldc, MT binh thfldng;
Chup maeh huynh quang vdng mac: 2 M binh thifdng;
Dien cham kfch thich:
Keo dai thdi gian t i l m tang eua sdng PI 00 (L2) d mat trai: 128ms. Bien dp 5,51 microV.
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TCNCYH 70 (SJ - 2010
Khdng ghi dddc dien the dap dng d mat phai, khdng phan biet duac cac dinh sdng trong nhiiu nin .
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Ca lam sang 3:
Benh nhan nfl 27 tudi, ly do den khlm benh: md mat phii (MP);
Diln bien: mat phii md nhanh, khdng dau nhfle, khdng dd tO 2-tuan; ^ Thj Iflc: MP DNT 0,5m MT: 8/10 kinh Id = 10/10;
Kham ban phin trUde nhan clu: binh thudng;
Kham d i y mat: MP dTa thi giae phd, mach mau cUdng tu, vdng mac canh dTa thj phu;
Chan doln: MP viem gai thj - mang bd dao;
Chup maeh huynh quang vdng mac:
Tang huyng quang tai dTa thj va vdng mac canh gai thi
Thj trudng: MP khdng lam dfldc, MT binh thfldng Dien cham kfch thich:
MP: keo dai thdi gian t i l m tang sdng PI00 (L2) 122ms.
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MT: thdi gian t i l m tang cua sdng PI 00 = 89,4ms va dien t h l = 7 , 9 3 m"icroV. Cac-gia trj t r e f i - d l u nam trong gidi han binh thudng
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Qua quan s i t 3 ca lam sang ta cd the tha'y difdng ghi dien cham kfch thfeh d tat ca d e mat cd dudng dan t r u y i n bj tdn thUdng d i u cd hien tupng b i l n ddi dUdng ghi v l hinh dang va thdi gian tiem t i n g cua d e sdng. Thdi gian t i l m tang cua sdng PI 00 bj keo dai.
Trong trfldng hpp ed tdn thfldng nang tren dfldng dfldng d i n t r u y i n than kinh thj giae, dien t h i dap flng vdi kfch thich thj giac khdng the x l c djnh, bi l l n vao n l n n h i l u tren difdng ghi dien nao (ca l l m sang 1 va 2) [7].
Tdn thUPng difdng d i n t r u y i n thi giac cang tram trpng, b i l u hidn d cac sdng cang bien ddi.
Dieu n l y dupe the hien qua hinh dang sdng va dien t h i ghi do dUdc.
C I c ca lam sang 2 va 3 nay dc cd thi Iflc qua thap,'chdng tdi khdng the do dupe thj trfldng d mat bj tdn thifpng.
K i t q u i ehup maeh huynh quang vdng mac cua benh nhan thfl 3 eho thay mat phai ed tdn thfldng d thj than kinh va mang bd dao sau.
Su b i l n ddi cua k i t qua ghi dien cham tUdng xflng vdi k i t q u i d c kham nghiem ehfle nang khae (thj Ifle, thj trfldng) eung mpt p h i n k i t qua kham lam sang, chan doan hinh I n h .
Trong thflc tien lam sang d n h i l u trfldng hdp, khi Sdi day mat hoac ehup mach huynh quang vdng mac khdng phat hien dfldc tdn thfldng nhflng khi lam kham nghiem, k i t qua cho thay dfldng
TCNCYH 70 (SJ - 2010
d i n t r u y i n thj g i l c da bi tdn thflong tram trpng (trUdng hop 1 va 2) do tdn thUdng thflc te nam d phfa sau cua nhan cau. Chi khi benh da de lai di chflng teo gai thi mdi phat hien thI'y khi soi day mat va chup mach [7].
IV. KET LUAN
Quan s i t tren cho tha'y k i t qua ghi dien cham kfch thfch cd sfl bien ddi phu hdp vdi trieu ehdng lam sang va k i t q u i k h l m nghiem ehfle nang khIe d nhflng mat cd tdn thfldng dddng d i n t r u y i n thj giac
Day la phfldng phap k h l m nghiem tham dd chdc nang rat cd gia trj, nen dfldc dfla ra flng dung rpng rai trong chan d o l n va theo ddi k i t qua dieu trj cae benh ly Than kinh - Nhan khoa.
T A I LIEU T H A M
KHAO
1. Coppola G, Curra A, Sava SL, AllbardI A, Paris!
V, Plerelll F, Schoenen J. (2010). Changes in visual - evoked potential habituation induced by hyperventilation in migraine. J Headache Pain. Jul 13.
2. Henderson AP, Altmann DR, Trip AS, Kallis C, Jones SJ, Schlottmann PG, Carway - Heath DF,
Plant GT, Miller D H . (2010). A serial study of retinal changes following optic neuritis with sample size estimates for acute neuroprotection trials. Brain. Jun 20.
3. Supplej A, Gaspa G, Cappellarl A, Toldo I, Battlstella PA. The Role of Visual Evoked Potentials in the Differential Diagnosis of Functional Visual Loss and Optic Neuritis in Children.J Child Neurol. 2010 Jun 29.
4. Kllstorner A, Graham S, Fraser C, Garrick R, Nguyen T, Paine M, O'Day J, Grigg J, Arvind H, Blllson FA. Electrophysiological evidence for heterogeneity of lesions in optic neuritis.Invest Ophthalmol Vis Sci. 2007 Oct; 48 (10): 4549 - 56.
5. J.P. Renard, J.F. Maurin, H. Bourgeois.
(1996). Imagerie de la conduction. L'imagerie en ophtalmologie. Masson 1 9 6 - 1 9 8
6. S. Defoort - Dhellemmes. (1999) Potentiels evoques visuels de I'enfant. Exploration de la fonetion visuelle. Masson 631 - 634.
7. J.C.Hache, M.P. Delplace. (1999).
Electrophysiologie. Exploration de la fonetion visuelle. Masson, 308 - 324, 540 - 561
Summary •
VISUALLY EVOKED POTENTIALS IN EVALUATION ON FUNCTIONAL VISUAL PATHWAYS
Visual pathway disorders are eye emergencies requiring intensive and proper diagnosis and treatment.
Visually evoked potentials (VEP) is rarelly applied in dailly medical practice and have been a sensible exploration for visual nervous system. Objective: Significance of visually evoked potentials in clinics is demonstrated using ease study. Methods: VEPs of 3 cas report with optic neuropathy are repoterd. Results:
VEPs deterioration comes along with degraded visual acuity, visual field, angiography and clinical signs.
Conclusion:. VEPs have been used clinically to confirm the diagnosis of subclinical and clinical optic neuropathy and can be an important tool in the the evaluation functional of the visual pathways.
Keywords: visually evoked potentials, visual pathway