{"id":11731,"date":"2023-09-27T15:26:24","date_gmt":"2023-09-27T07:26:24","guid":{"rendered":"https:\/\/docquity.com\/?post_type=articles&#038;p=11731"},"modified":"2025-02-11T13:37:04","modified_gmt":"2025-02-11T05:37:04","slug":"bao-cao-ca-bieu-hien-kho-hieu-cua-viem-noi-tam-mac-cho-thay-vai-tro-cua-mri-nao-bo","status":"publish","type":"articles","link":"https:\/\/docquity.com\/vi\/articles\/bao-cao-ca-bieu-hien-kho-hieu-cua-viem-noi-tam-mac-cho-thay-vai-tro-cua-mri-nao-bo\/","title":{"rendered":"B\u00c1O C\u00c1O CA: Bi\u1ec3u hi\u1ec7n kh\u00f3 hi\u1ec3u c\u1ee7a vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c cho th\u1ea5y vai tr\u00f2 c\u1ee7a MRI n\u00e3o b\u1ed9"},"content":{"rendered":"\n<p><strong>M\u1ede \u0110\u1ea6U<\/strong><\/p>\n\n\n\n<p><em>Escherichia coli<\/em>&nbsp;l\u00e0 nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p c\u1ee7a nhi\u1ec1u t\u00ecnh tr\u1ea1ng nhi\u1ec5m tr\u00f9ng. Tuy nhi\u00ean, vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n do&nbsp;<em>E.coli<\/em>&nbsp;l\u1ea1i hi\u1ebfm g\u1eb7p v\u00e0 c\u00f3 t\u1ef7 l\u1ec7 t\u1eed vong kh\u00e1 cao<sup>1<\/sup>. C\u00e1c bi\u1ec3u hi\u1ec7n tr\u00ean th\u1ea7n kinh c\u1ee7a vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n do&nbsp;<em>E.coli&nbsp;<\/em>c\u0169ng hi\u1ebfm g\u1eb7p. M\u1eb7c d\u00f9 ch\u1ee5p \u0111i\u1ec7n to\u00e1n (CT) n\u00e3o b\u1ed9 c\u00f3 th\u1ec3 d\u1ec5 d\u00e0ng th\u1ef1c hi\u1ec7n \u0111\u1ec3 lo\u1ea1i tr\u1eeb t\u00ecnh tr\u1ea1ng xu\u1ea5t huy\u1ebft, ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb (magnetic resonance imaging \u2013 MRI) c\u0169ng l\u00e0 bi\u1ec7n ph\u00e1p c\u00f3 \u0111\u1ed9 nh\u1ea1y cao \u0111\u1ec3 xu\u1ea5t hi\u1ec7n c\u00e1c t\u00ecnh tr\u1ea1ng t\u1eafc ngh\u1ebdn<sup>2<\/sup>. B\u00e1o c\u00e1o ca d\u01b0\u1edbi \u0111\u00e2y gi\u1edbi thi\u1ec7u v\u1edbi qu\u00fd v\u1ecb \u0111\u1ed3ng nghi\u1ec7p vai tr\u00f2 c\u1ee7a MRI \u0111\u1ec3 ph\u00e1t hi\u1ec7n t\u00ecnh tr\u1ea1ng t\u1eafc ngh\u1ebdn trong ch\u1ea9n \u0111o\u00e1n.<\/p>\n\n\n\n<p><img decoding=\"async\" alt=\"\" src=\"https:\/\/s3-ap-southeast-1.amazonaws.com\/bucket.docquity.com\/journals\/editor\/file-6437abfbfe74e3d9b6136af898ad5a6f.png\"><strong>CA L\u00c2M S\u00c0NG<\/strong><\/p>\n\n\n\n<p>B\u1ec7nh nh\u00e2n n\u1eef, 60 tu\u1ed5i \u0111\u1ebfn ph\u00f2ng kh\u00e1m v\u1edbi ti\u1ec1n s\u1eed s\u1ed1t 9 ng\u00e0y k\u00e8m \u1edbn l\u1ea1nh, kh\u00f3 th\u1edf, \u0111au c\u01a1, xu\u1ea5t hi\u1ec7n \u1ea3o gi\u00e1c v\u00e0 thay \u0111\u1ed5i \u00fd th\u1ee9c. B\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed t\u1ed5n th\u01b0\u01a1ng nhi\u1ec1u nhanh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ph\u1eabu thu\u1eadt b\u1eafc c\u1ea7u n\u1ed1i \u0111\u1ed9ng m\u1ea1ch v\u00e0nh, suy tim ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u b\u1ea3o t\u1ed3n, block tim ho\u00e0n to\u00e0n \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng m\u00e1y t\u1ea1o nh\u1ecbp c\u1ea5y \u0111\u01b0\u1ee3c, suy h\u00f4 h\u1ea5p gi\u1ea3m oxy, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng v\u00e0 b\u1ec7nh th\u1eadn m\u1ea1n giai \u0111o\u1ea1n III.<\/p>\n\n\n\n<p>K\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m sinh h\u00f3a cho th\u1ea5y t\u00ecnh tr\u1ea1ng t\u0103ng b\u1ea1ch c\u1ea7u trung t\u00ednh (s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u 16,700 t\u1ebf b\u00e0o\/mm<sup>3<\/sup>, b\u1ea1ch c\u1ea7u trung t\u00ednh 82,7%) v\u00e0 t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p (blood urea nitrogen 42 mg\/dL, creatinine 2.4 mg\/dL). Ph\u00e2n t\u00edch n\u01b0\u1edbc ti\u1ec3u th\u1ea5y c\u00f3 m\u1ee7 trong n\u01b0\u1edbc ti\u1ec3u v\u1edbi kh\u1ed1i leukocyte trong n\u01b0\u1edbc ti\u1ec3u, d\u1ea5u hi\u1ec7u c\u1ee7a nhi\u1ec5m khu\u1ea9n \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u. Kh\u00f4ng ghi nh\u1eadn c\u00f3 vi khu\u1ea9n m\u1ecdc khi c\u1ea5y n\u01b0\u1edbc ti\u1ec3u, v\u1edbi m\u1eabu n\u01b0\u1edbc ti\u1ec3u thu \u0111\u01b0\u1ee3c 8 gi\u1edd sau khi b\u1ec7nh nh\u00e2n b\u1eaft \u0111\u1ea7u \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng kh\u00e1ng sinh. K\u1ebft qu\u1ea3 c\u1ea5y m\u00e1u l\u1ea7n \u0111\u1ea7u ti\u00ean d\u01b0\u01a1ng t\u00ednh v\u1edbi&nbsp;<em>E.coli<\/em>. Ban \u0111\u1ea7u, b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng cefepime 2 g\/q12 gi\u1edd \u0111\u01b0\u1eddng ti\u00eam t\u0129nh m\u1ea1ch trong 4 ng\u00e0y. C\u1ea5y m\u00e1u \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n l\u1eb7p l\u1ea1i v\u00e0 cho k\u1ebft qu\u1ea3 \u00e2m t\u00ednh, sau \u0111\u00f3 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111\u1ed5i sang trimethoprim\/sulfamethoxazole li\u1ec1u 800\/160 x 2 l\u1ea7n\/ng\u00e0y \u0111\u01b0\u1eddng u\u1ed1ng. Tuy nhi\u00ean, t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng c\u1ee7a b\u1ec7nh nh\u00e2n l\u1ea1i tr\u1edf n\u1eb7ng v\u1edbi c\u00e1c bi\u1ec3u hi\u1ec7n l\u01a1 m\u01a1, c\u1ea3m x\u00fac kh\u00f4ng \u1ed5n \u0111\u1ecbnh v\u00e0 th\u1ea5t ng\u00f4n.<\/p>\n\n\n\n<p>K\u1ebft qu\u1ea3 CT n\u00e3o b\u1ed9 v\u00e0 k\u1ebft qu\u1ea3 ch\u1ee5p m\u1ea1ch m\u00e1u kh\u00f4ng cho th\u1ea5y b\u1ea5t k\u1ef3 b\u1eb1ng ch\u1ee9ng n\u00e0o c\u1ee7a \u0111\u1ed9t qu\u1ef5 ho\u1eb7c t\u1eafc ngh\u1ebdn \u0111\u1ed9ng m\u1ea1ch. K\u1ebft qu\u1ea3 MRI n\u00e3o b\u1ed9 g\u1ee3i \u00fd t\u00ecnh tr\u1ea1ng t\u1eafc m\u1ea1ch r\u1ea3i r\u00e1c (h\u00ecnh 1). K\u1ebft qu\u1ea3 MRI T2* n\u00e3o b\u1ed9 kh\u00f4ng cho th\u1ea5y t\u00ecnh tr\u1ea1ng vi xu\u1ea5t huy\u1ebft s\u1ecd n\u00e3o. K\u1ebft qu\u1ea3 si\u00eau \u00e2m tim qua th\u1ef1c qu\u1ea3n (transesophageal echocardiography \u2013 TEE) cho th\u1ea5y kh\u1ed1i h\u00ecnh da b\u00e1o di \u0111\u1ed9ng \u1edf m\u1ea3nh P2 v\u00e0 A2 c\u1ee7a van 2 l\u00e1, k\u00edch th\u01b0\u1edbc t\u01b0\u01a1ng \u1ee9ng 1.3&#215;0.42 cm v\u00e0 0.4&#215;0.52 cm (h\u00ecnh 2 A v\u00e0 B). T\u1eeb \u0111\u00f3, ch\u1ea9n \u0111o\u00e1n vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n \u0111\u01b0\u1ee3c \u0111\u01b0a ra.<\/p>\n\n\n\n<p><img decoding=\"async\" alt=\"\" src=\"https:\/\/s3-ap-southeast-1.amazonaws.com\/bucket.docquity.com\/journals\/editor\/file-71e8a9e59b0d12f31a6aaeab01677ee6.png\"><br><strong>H\u00ecnh 1.&nbsp;<\/strong>K\u1ebft qu\u1ea3 MRI T2-FLAIR v\u00e0 ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb khu\u1ebfch t\u00e1n<\/p>\n\n\n\n<p><img decoding=\"async\" alt=\"\" src=\"https:\/\/s3-ap-southeast-1.amazonaws.com\/bucket.docquity.com\/journals\/editor\/file-4b423d4e3ef7510e1297f0d082776f33.png\">&nbsp;&nbsp;&nbsp;&nbsp;<br><strong>H\u00ecnh 2.&nbsp;<\/strong>TEE 3 chi\u1ec1u c\u1ee7a m\u1eb7t tr\u01b0\u1edbc v\u00e0 m\u1eb7t sau van 2 l\u00e1<\/p>\n\n\n\n<p>D\u1ef1a theo ti\u00eau chu\u1ea9n Duke \u0111i\u1ec1u ch\u1ec9nh, b\u1ec7n nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n do \u0111\u00e1p \u1ee9ng \u0111\u1ea7y \u0111\u1ee7 ti\u00eau ch\u00ed ch\u00ednh v\u1ec1 b\u1eb1ng ch\u1ee9ng tr\u00ean h\u00ecnh \u1ea3nh si\u00eau \u00e2m tim v\u00e0 4 ti\u00eau ch\u00ed ph\u1ee5: s\u1ed1t, b\u1ec7nh l\u00fd tr\u00ean tim, t\u00ecnh tr\u1ea1ng t\u1eafc m\u1ea1ch v\u00e0 k\u1ebft qu\u1ea3 c\u1ea5y m\u00e1u d\u01b0\u01a1ng t\u00ednh v\u1edbi vi sinh v\u1eadt kh\u00f4ng \u0111i\u1ec3n h\u00ecnh [3]. K\u1ebft qu\u1ea3 ph\u1ea3n \u1ee9ng chu\u1ed7i polymerase v\u00e0 c\u1ea5y m\u00f4 van tim \u0111\u1ec3 \u0111\u1ecbnh danh&nbsp;<em>E.coli&nbsp;<\/em>kh\u00f4ng kh\u1ea3 d\u1ee5ng v\u00ec ph\u1eabu thu\u1eadt kh\u00f4ng \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh.<\/p>\n\n\n\n<p>K\u1ebft qu\u1ea3 c\u1ea5y m\u00e1u v\u00e0o th\u1eddi \u0111i\u1ec3m sau \u0111\u00f3 12 gi\u1edd ti\u1ebfp t\u1ee5c \u00e2m t\u00ednh, bao g\u1ed3m kh\u00e1ng th\u1ec3&nbsp;<em>Coxiella burnetii.<\/em>&nbsp;B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n v\u1edbi k\u1ebft qu\u1ea3 c\u1ea5y m\u00e1u \u00e2m t\u00ednh do nhi\u1ec5m khu\u1ea9n huy\u1ebft&nbsp;<em>E.coli&nbsp;<\/em>tr\u01b0\u1edbc \u0111\u00f3 v\u00e0 v\u1eeba \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng kh\u00e1ng sinh. Nh\u1eadn th\u1ea5y b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 ph\u1eabu thu\u1eadt cao v\u00e0 b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a suy tim ho\u1eb7c tr\u00e0o ng\u01b0\u1ee3c, ceftriaxone trong v\u00f2ng 6 tu\u1ea7n \u0111\u01b0\u1eddng ti\u00eam t\u0129nh m\u1ea1ch \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn cho b\u1ec7nh nh\u00e2n.<\/p>\n\n\n\n<p>Hai tu\u1ea7n sau, b\u1ec7nh nh\u00e2n l\u1ea1i ti\u1ebfp t\u1ee5c c\u1ea3m th\u1ea5y kh\u00f3 th\u1edf, gi\u1ea3m oxy m\u00e1u v\u00e0 suy th\u1eadn do nhi\u1ec5m SARS-CoV-2. B\u1ec7nh nh\u00e2n ti\u1ebfp t\u1ee5c \u0111\u01b0\u1ee3c ch\u1ee5p TEE, k\u1ebft qu\u1ea3 cho th\u1ea5y c\u00f3 t\u00ecnh tr\u1ea1ng s\u00f9i v\u00f4i h\u00f3a k\u00edch th\u01b0\u1edbc 2&#215;1.5 cm \u1edf \u0111\u1ea7u c\u1ee7a l\u00e1 sau van 2 l\u00e1, th\u00e0nh ph\u00e2n di \u0111\u1ed9ng c\u00f3 k\u00edch th\u01b0\u1edbc 1.5&#215;0.7 cm (h\u00ecnh 2 C v\u00e0 D). Ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u c\u1ee7a b\u1ec7nh nh\u00e2n b\u00ecnh th\u01b0\u1eddng v\u00e0 ch\u1ec9 c\u00f3 t\u00ecnh tr\u1ea1ng s\u00f9i v\u00f4i h\u00f3a \u0111\u01b0\u1ee3c ghi nh\u1eadn. K\u1ebft qu\u1ea3 c\u1ea5y m\u00e1u c\u1ee7a b\u1ec7nh nh\u00e2n ti\u1ebfp t\u1ee5c \u00e2m t\u00ednh. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi cefepime v\u00e0 daptomycin trong v\u00f2ng 6 tu\u1ea7n (thay th\u1ebf cho ceftriaxone). V\u00e0i ng\u00e0y sau, b\u1ec7nh nh\u00e2n l\u1ea1i ti\u1ebfp t\u1ee5c nh\u1eadp vi\u1ec7n (tr\u01b0\u1edbc khi ho\u00e0n th\u00e0nh \u0111\u1ee3t \u0111i\u1ec1u tr\u1ecb 6 ng\u00e0y v\u1edbi cefepime v\u00e0 daptomycin) v\u00ec \u0111\u1ed9t nhi\u00ean b\u1ecb y\u1ebfu ch\u00e2n v\u00e0 t\u00e9 ng\u00e3. B\u1ec7nh nh\u00e2n ti\u1ebfp t\u1ee5c \u0111\u01b0\u1ee3c ch\u1ee5p MRI n\u00e3o b\u1ed9, k\u1ebft qu\u1ea3 cho th\u1ea5y nhi\u1ec1u sang th\u01b0\u01a1ng m\u1edbi \u1edf v\u1ecf n\u00e3o b\u00ean tr\u00e1i th\u00f9y th\u00e1i d\u01b0\u01a1ng, ti\u1ec3u n\u00e3o ph\u1ea3i v\u00e0 ch\u1ea5t tr\u1eafng quanh n\u00e3o th\u1ea5t. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c t\u00e1i \u0111\u00e1nh gi\u00e1 \u0111\u1ec3 ti\u1ebfn h\u00e0nh ph\u1eabu thu\u1eadt tim m\u1ea1ch. Sau khi c\u00e2n nh\u1eafc t\u1ed5ng tr\u1ea1ng v\u00e0 x\u00e9t nghi\u1ec7m cho th\u1ea5y ch\u1ee9c n\u0103ng ph\u1ed5i suy gi\u1ea3m nghi\u00eam tr\u1ecdng, ng\u01b0\u1eddi nh\u00e0 b\u1ec7nh nh\u00e2n l\u1ef1a ch\u1ecdn kh\u00f4ng ph\u1eabu thu\u1eadt tim m\u1ea1ch cho b\u1ec7nh nh\u00e2n.<\/p>\n\n\n\n<p><strong>B\u00c0N LU\u1eacN<\/strong><\/p>\n\n\n\n<p>Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n l\u00e0 m\u1ed9t t\u00ecnh tr\u1ea1ng nhi\u1ec5m tr\u00f9ng kh\u00f4ng ph\u1ed5 bi\u1ebfn, t\u1ef7 l\u1ec7 nhi\u1ec5m h\u00e0ng n\u0103m kho\u1ea3ng 10\/10,000<sup>4<\/sup>. Trong s\u1ed1 c\u00e1c tr\u01b0\u1eddng h\u1ee3p vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n,&nbsp;<em>Staphylococcus aureus&nbsp;<\/em>&nbsp;chi\u1ebfm 26.6% tr\u01b0\u1eddng h\u1ee3p,&nbsp;<em>Viridans&nbsp;<\/em>streptococci chi\u1ebfm 18.7%, streptococci nh\u00f3m D chi\u1ebfn 12.5% v\u00e0 enterococci chi\u1ebfm 10.5%<sup>5<\/sup>. Vi khu\u1ea9n gram (-) l\u00e0 nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p \u1edf b\u1ec7nh nh\u00e2n vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n bao g\u1ed3m Heamophilus, Aggregatibacter, Cardiovacterium, Eikenella v\u00e0 Kingella<sup>6<\/sup>.<\/p>\n\n\n\n<p>M\u1eb7c d\u00f9&nbsp;<em>E.coli&nbsp;<\/em>l\u00e0 nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p g\u00e2y nhi\u1ec5m khu\u1ea9n huy\u1ebft, nh\u01b0ng&nbsp;<em>E.coli&nbsp;<\/em>ch\u1ec9 chi\u1ebfm kho\u1ea3ng 0.5% tr\u01b0\u1eddng h\u1ee3p vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n<sup>1<\/sup>. Nhi\u1ec5m khu\u1ea9n \u0111\u01b0\u1eddng sinh d\u1ee5c \u2013 ti\u1ebft ni\u1ec7u th\u01b0\u1eddng xuy\u00ean l\u00e0 ngu\u1ed3n l\u00e2y nhi\u1ec5m&nbsp;<em>E.coli<\/em>&nbsp;cho c\u00e1c c\u01a1 quan kh\u00e1c, sau \u0111\u00f3 l\u00e0&nbsp;<em>Pseudomonas aeruginosa<\/em><sup>7<\/sup>. Nhi\u1ec1u b\u1ec7nh m\u1eafc k\u00e8m \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o c\u00f3 li\u00ean quan \u0111\u1ebfn vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c do&nbsp;<em>E.coli<\/em>&nbsp;bao g\u1ed3m b\u1ec7nh th\u1eadn m\u1ea1n giai \u0111o\u1ea1n cu\u1ed1i, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, b\u1ec7nh \u00e1c t\u00ednh v\u00e0 u\u1ed1ng r\u01b0\u1ee3u th\u01b0\u1eddng xuy\u00ean<sup>1<\/sup>.<\/p>\n\n\n\n<p>M\u1eb7c d\u00f9 nguy c\u01a1 t\u1eed vong trong v\u00f2ng 30 ng\u00e0y t\u0103ng l\u00ean g\u1ea5p 7 l\u1ea7n n\u1ebfu ngu\u1ed3n nhi\u1ec5m khu\u1ea9n kh\u00f4ng \u0111\u01b0\u1ee3c lo\u1ea1i b\u1ecf, nh\u01b0ng lo\u1ea1i b\u1ecf thi\u1ebft b\u1ecb c\u1ea5y \u0111\u01b0\u1ee3c c\u0169ng \u0111i k\u00e8m v\u1edbi nhi\u1ec1u nguy c\u01a1 nh\u01b0 \u00e9p tim, \u0111\u1ed9t qu\u1ef5 v\u00e0 ch\u1ea5n th\u01b0\u01a1ng tim m\u1ea1ch<sup>9<\/sup>. Do v\u1eady, quy\u1ebft \u0111\u1ecbnh lo\u1ea1i b\u1ecf c\u00e1c thi\u1ebft b\u1ecb n\u00ean \u0111\u01b0\u1ee3c c\u00e1 nh\u00e2n ho\u00e1 \u0111\u1eb7c bi\u1ec7t l\u00e0 nhi\u1ec5m khu\u1ea9n khoang \u0111\u1eb7t t\u00fai, d\u1eabn \u0111\u1ebfn s\u00f9i ho\u1eb7c nhi\u1ec5m khu\u1ea9n huy\u1ebft dai d\u1eb3ng m\u00e0 kh\u00f4ng c\u00f3 \u1ed5 nhi\u1ec5m kh\u00e1c. N\u00ean c\u00e2n nh\u1eafc \u0111\u1ebfn vi sinh cho quy\u1ebft \u0111\u1ecbnh lo\u1ea1i tr\u1eeb thi\u1ebft b\u1ecb, ch\u1eb3ng h\u1ea1n g\u1ee1 b\u1ecf thi\u1ebft b\u1ecb \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho nhi\u1ec5m khu\u1ea9n Staphylococcus, Propionibacterium ho\u1eb7c Candida, trong khi \u0111\u00f3 nhi\u1ec5m khu\u1ea9n do vi khu\u1ea9n gram (-) th\u00ec th\u01b0\u1eddng ch\u1ec9 c\u1ea7n \u0111i\u1ec1u tr\u1ecb b\u1eb1ng kh\u00e1ng sinh<sup>8<\/sup>.<\/p>\n\n\n\n<p>M\u1eb7c d\u00f9 c\u00e1c bi\u1ec3u hi\u1ec7n th\u1ea7n kinh li\u00ean quan \u0111\u1ebfn vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n c\u00f3 t\u1ef7 l\u1ec7 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o thay \u0111\u1ed5i trong c\u00e1c nghi\u00ean c\u1ee9u (t\u1eeb 30 \u2013 47%), tuy nhi\u00ean vi\u1ec7c ch\u1ea9n \u0111o\u00e1n th\u01b0\u1eddng b\u1ecb ch\u1eadm tr\u1ec5, d\u1eabn \u0111\u1ebfn t\u0103ng nguy c\u01a1 t\u1eed vong v\u00e0 g\u00e1nh n\u1eb7ng b\u1ec7nh t\u1eadt&nbsp;<sup>9 \u2013 11<\/sup>. C\u00e1c bi\u1ec3u hi\u1ec7n t\u00e2m th\u1ea7n kinh bao g\u1ed3m l\u01a1 m\u01a1, thay \u0111\u1ed5i t\u00ednh c\u00e1ch v\u00e0 \u1ea3o gi\u00e1c th\u01b0\u1eddng \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o \u1edf kho\u1ea3ng 50% b\u1ec7nh nh\u00e2n, v\u1edbi t\u1ef7 l\u1ec7 l\u01b0u h\u00e0nh cao nh\u1ea5t \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o \u1edf b\u1ec7nh nh\u00e2n cao tu\u1ed5i<sup>10<\/sup>. Th\u1ea5t ng\u00f4n v\u00e0 l\u01a1 m\u01a1 th\u01b0\u1eddng l\u00e0 nh\u1eefng bi\u1ec3u hi\u1ec7n \u0111\u1ea7u ti\u00ean c\u1ee7a b\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng th\u1ea7n kinh. \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n trong b\u00e0i, v\u1ecb tr\u00ed t\u1eafc ngh\u1ebdn c\u00f3 th\u1ec3 gi\u1ea3i th\u00edch cho t\u00ecnh tr\u1ea1ng th\u1ea5t n\u00f4ng, trong khi \u0111\u00f3 t\u00ecnh tr\u1ea1ng l\u01a1 m\u01a1 c\u00f3 th\u1ec3 l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a \u0111\u1ed9t qu\u1ef5 t\u1eafc ngh\u1ebdn v\u00e0 nhi\u1ec5m khu\u1ea9n tu\u1ea7n ho\u00e0n n\u00e3o. B\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh ch\u1ecdc d\u00f2 t\u1ee7y s\u1ed1ng v\u00ec ti\u00eau ch\u00ed kh\u1eb3ng \u0111\u1ecbnh vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n \u0111\u00e3 \u0111\u00e1p \u1ee9ng \u0111\u1ea7y \u0111\u1ee7 v\u00e0 kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng c\u1ee7a k\u00edch th\u00edch m\u00e0ng n\u00e3o.<\/p>\n\n\n\n<p>Trong m\u1ed9t t\u1ed5ng quan h\u1ec7 th\u1ed1ng \u1edf b\u1ec7nh nh\u00e2n m\u1eafc vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n, MRI n\u00e3o b\u1ed9 cho th\u1ea5y \u0111\u1ed9 nh\u1ea1y t\u1ed1t trong vi\u1ec7c x\u00e1c \u0111\u1ecbnh m\u1ed9t s\u1ed1 sang th\u01b0\u01a1ng nh\u01b0 vi nh\u1ed3i m\u00e1u (microinfarcts) v\u00e0 vi xu\u1ea5t huy\u1ebft kh\u00f4ng th\u1ec3 x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c b\u1eb1ng ch\u1ee5p CT&nbsp;<sup>2, 11<\/sup>. Sang th\u01b0\u01a1ng \u1edf n\u00e3o \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh b\u1eb1ng MRI s\u1ecd n\u00e3o h\u1ec7 th\u1ed1ng \u1edf 78% tr\u01b0\u1eddng h\u1ee3p<sup>12<\/sup>. M\u1ed9t nghi\u00ean c\u1ee9u \u0111\u00e3 cho th\u1ea5y c\u00f3 83% sang th\u01b0\u01a1ng n\u00e3o b\u1ed9 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh qua MRI, trong khi \u0111\u00f3 ch\u1ec9 c\u00f3 15% tr\u01b0\u1eddng h\u1ee3p \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh b\u1eb1ng CT scan<sup>2<\/sup>. Khi ph\u00e2n t\u00edch k\u1ebft qu\u1ea3 MRI, s\u00f9i c\u00f3 k\u00edch th\u01b0\u1edbc &gt; 4 mm v\u1ec1 chi\u1ec1u d\u00e0i c\u00f3 li\u00ean quan \u0111\u1ebfn thuy\u00ean t\u1eafc s\u1ecd n\u00e3o v\u00e0 \u0111a s\u1ed1 c\u00e1c sang th\u01b0\u01a1ng th\u01b0\u1eddng kh\u00f4ng th\u1ec3 ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c b\u1eb1ng CT scan&nbsp;<sup>12<\/sup>. Vi\u1ec7c \u00e1p d\u1ee5ng MRI s\u1edbm k\u00e8m v\u1edbi ch\u1ee5p h\u00ecnh m\u1ea1ch m\u00e3u d\u1eabn \u0111\u1ebfn s\u1ef1 thay \u0111\u1ed5i trong ch\u1ea9n \u0111o\u00e1n, t\u1eeb vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n kh\u00f4ng x\u00e1c \u0111\u1ecbnh cho \u0111\u1ebfn vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n x\u00e1c \u0111\u1ecbnh ho\u1eb7c c\u00f3 kh\u1ea3 n\u0103ng vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n<sup>13<\/sup>. Khi \u00e1p d\u1ee5ng ph\u1ed1i h\u1ee3p c\u1ed9ng h\u01b0\u1edfng t\u1eeb khu\u1ebfch t\u00e1n v\u00e0 c\u1ed9ng h\u01b0\u1edfng t\u1eeb chu\u1ed7i xung, c\u00f3 th\u1ec3 x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c tu\u1ed5i th\u1ecd c\u1ee7a sang th\u01b0\u01a1ng. Sang th\u01b0\u01a1ng c\u1ea5p c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh qua h\u00ecnh h\u00ecnh c\u1ed9ng h\u01b0\u1edfng t\u1eeb khu\u1ebfch t\u00e1n k\u00e8m v\u1edbi nh\u1eefng thay \u0111\u1ed5i kh\u00f3 quan s\u00e1t \u0111\u01b0\u1ee3c tr\u00ean c\u1ed9ng h\u01b0\u1edfng t\u1eeb chu\u1ed7i xung. Sang th\u01b0\u01a1ng b\u00e1n c\u1ea5p v\u00e0 m\u1ea1n t\u00ednh c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ec3 hi\u1ec7n qua vi\u1ec7c t\u0103ng t\u00edn hi\u1ec7u, k\u00e8m theo\/kh\u00f4ng k\u00e8m theo t\u1ed5n th\u01b0\u01a1ng ch\u1ea5t tr\u1eafng tr\u00ean c\u1ed9ng h\u01b0\u1edfng t\u1eeb chu\u1ed7i xung, nh\u01b0ng kh\u00f4ng th\u1ea5y \u0111\u01b0\u1ee3c tr\u00ean c\u1ed9ng h\u01b0\u1edfng t\u1eeb khu\u1ebfch t\u00e1n<sup>14<\/sup>. K\u1ebft qu\u1ea3 ch\u1ee5p MRI ban \u0111\u1ea7u c\u1ee7a b\u1ec7nh nh\u00e2n trong b\u00e0i g\u1ee3i \u00fd t\u00ecnh tr\u1ea1ng \u0111\u1ed9t qu\u1ef5 do thuy\u00ean t\u1eafc c\u1ea5p t\u00ednh.<\/p>\n\n\n\n<p>M\u1eb7c d\u00f9 vai tr\u00f2 c\u1ee7a ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh n\u00e3o b\u1ed9 (CT scan ho\u1eb7c MRI) kh\u00e1 r\u00f5 r\u00e0ng \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n k\u00e8m theo c\u00e1c tri\u1ec7u ch\u1ee9ng th\u1ea7n kinh, vai tr\u00f2 c\u1ee7a MRI n\u00e3o b\u1ed9 trong ch\u1ea9n \u0111o\u00e1n v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c kh\u1eb3ng \u0111\u1ecbnh v\u00e0 quy\u1ebft \u0111\u1ecbnh n\u00ean \u0111\u01b0\u1ee3c c\u00e1 nh\u00e2n h\u00f3a. M\u1eb7c d\u00f9 ph\u1eabu thu\u1eadt \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p nhi\u1ec5m khu\u1ea9n huy\u1ebft dai d\u1eb3ng m\u1eb7c d\u00f9 \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng kh\u00e1ng sinh th\u00edch h\u1ee3p, huy\u1ebft \u0111\u1ed9ng kh\u00f4ng \u1ed5n \u0111\u1ecbnh do suy gi\u1ea3m ch\u1ee9c n\u0103ng van tim v\u00e0 k\u00edch th\u01b0\u1edbc s\u00f9i l\u1edbn, th\u1eddi \u0111i\u1ec3m ph\u1eabu thu\u1eadt \u1edf b\u1ec7nh nh\u00e2n c\u00f3 bi\u1ebfn ch\u1ee9ng th\u1ea7n kinh ti\u1ec1n ph\u1eabu v\u1eabn ch\u01b0a r\u00f5 r\u00e0ng do lo ng\u1ea1i xu\u1ea5t huy\u1ebft<sup>15<\/sup>.<\/p>\n\n\n\n<p><strong>NGU\u1ed2N<\/strong><\/p>\n\n\n\n<p>Benjanuwattra, J, Bell, AL, Yang, MV, Mora, BL, Jenkins, LA, Sethi, P. An enigmatic presentation of Escherichia coli endocarditis: Emphasizing the role of brain magnetic resonance imaging. Clin Case Rep. 2023; 11:e7878. doi:10.1002\/ccr3.7878<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\" \/>\n\n\n\n<p><strong>T\u00c0I LI\u1ec6U THAM KH\u1ea2O<\/strong><\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li>Akuzawa N, Kurabayashi M. Native valve endocarditis due to Escherichia coli infection: a case report and review of the literature. BMC Cardiovasc Disord. 2018; 18(1): 195-199. doi:10.1186\/s12872-018-0929-7<\/li>\n\n\n\n<li>Vitali P, Savoldi F, Segati F, et al. MRI versus CT in the detection of brain lesions in patients with infective endocarditis before or after cardiac surgery. Neuroradiology. 2022; 64(5): 905-913. doi:10.1007\/s00234-021-02810-y<\/li>\n\n\n\n<li>Topan A, Carstina D, Slavcovici A, Rancea R, Capalneanu R, Lupse M. Assesment of the Duke criteria for the diagnosis of infective endocarditis after twenty-years. An analysis of 241 cases. Clujul Med. 2015; 88(3): 321-326. doi:10.15386\/cjmed-469<\/li>\n\n\n\n<li>Rajani R, Klein JL. Infective endocarditis: a contemporary update. Clin Med (Lond). 2020; 20(1): 31-35. doi:10.7861\/clinmed.cme.20.1.1<\/li>\n\n\n\n<li>Selton-Suty C, C\u00e9lard M, Le Moing V, et al. Preeminence of Staphylococcus aureus in infective endocarditis: a 1-year population-based survey. Clin Infect Dis. 2012; 54(9): 1230-1239. doi:10.1093\/cid\/cis199<\/li>\n\n\n\n<li>Bouza E, Mu\u00f1oz P, Burillo A. Gram-negative endocarditis: disease presentation, diagnosis and treatment. Curr Opin Infect Dis. 2021; 34(6): 672-680. doi:10.1097\/qco.0000000000000788<\/li>\n\n\n\n<li>Morpeth S, Murdoch D, Cabell CH, et al. Non-HACEK gram-negative bacillus endocarditis. Ann Intern Med. 2007; 147(12): 829-835. doi:10.7326\/0003-4819-147-12-200712180-00002<\/li>\n\n\n\n<li>Kusumoto FM, Schoenfeld MH, Wilkoff BL, et al. 2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction. Heart Rhythm. 2017; 14(12): e503-e551. doi:10.1016\/j.hrthm.2017.09.001<\/li>\n\n\n\n<li>Kusumoto FM, Schoenfeld MH, Wilkoff BL, et al. 2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction. Heart Rhythm. 2017; 14(12): e503-e551. doi:10.1016\/j.hrthm.2017.09.001<\/li>\n\n\n\n<li>Greenlee JE, Mandell GL. Neurological manifestations of infective endocarditis: a review. Stroke. 1973; 4(6): 958-963. doi:10.1161\/01.str.4.6.958<\/li>\n\n\n\n<li>Champey J, Pavese P, Bouvaist H, Kastler A, Krainik A, Francois P. Value of brain MRI in infective endocarditis: a narrative literature review. Eur J Clin Microbiol Infect Dis. 2016; 35(2): 159-168. doi:10.1007\/s10096-015-2523-6<\/li>\n\n\n\n<li>Iung B, Tubiana S, Klein I, et al. Determinants of cerebral lesions in endocarditis on systematic cerebral magnetic resonance imaging: a prospective study. Stroke. 2013; 44(11): 3056-3062. doi:10.1161\/strokeaha.113.001470<\/li>\n\n\n\n<li>Duval X, Iung B, Klein I, et al. Effect of early cerebral magnetic resonance imaging on clinical decisions in infective endocarditis: a prospective study. Ann Intern Med. 2010; 152(8): 497-504. doi:10.7326\/0003-4819-152-8-201004200-00006<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>M\u1ede \u0110\u1ea6U Escherichia coli&nbsp;l\u00e0 nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p c\u1ee7a nhi\u1ec1u t\u00ecnh tr\u1ea1ng nhi\u1ec5m tr\u00f9ng. Tuy nhi\u00ean, vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n do&nbsp;E.coli&nbsp;l\u1ea1i hi\u1ebfm g\u1eb7p v\u00e0 c\u00f3 t\u1ef7 l\u1ec7 t\u1eed vong kh\u00e1 cao1. C\u00e1c bi\u1ec3u hi\u1ec7n tr\u00ean th\u1ea7n kinh c\u1ee7a vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n do&nbsp;E.coli&nbsp;c\u0169ng hi\u1ebfm g\u1eb7p. M\u1eb7c d\u00f9 ch\u1ee5p \u0111i\u1ec7n to\u00e1n (CT) &hellip;<\/p>\n<p class=\"read-more\"> <a class=\"\" href=\"https:\/\/docquity.com\/vi\/articles\/bao-cao-ca-bieu-hien-kho-hieu-cua-viem-noi-tam-mac-cho-thay-vai-tro-cua-mri-nao-bo\/\"> <span class=\"screen-reader-text\">B\u00c1O C\u00c1O CA: Bi\u1ec3u hi\u1ec7n kh\u00f3 hi\u1ec3u c\u1ee7a vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c cho th\u1ea5y vai tr\u00f2 c\u1ee7a MRI n\u00e3o b\u1ed9<\/span> Read More &raquo;<\/a><\/p>\n","protected":false},"author":123,"featured_media":11846,"comment_status":"closed","ping_status":"closed","template":"","meta":{"content-type":"","inline_featured_image":false,"site-sidebar-layout":"default","site-content-layout":"default","ast-global-header-display":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","footnotes":""},"articles_categories":[1370],"articles_tags":[],"articles_topics":[1436],"articles_languages":[1375],"articles_filters":[],"class_list":["post-11731","articles","type-articles","status-publish","has-post-thumbnail","hentry","articles_categories-medical-content-vi","articles_languages-vietnamese-vi"],"_links":{"self":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles\/11731","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles"}],"about":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/types\/articles"}],"author":[{"embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/users\/123"}],"replies":[{"embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/comments?post=11731"}],"version-history":[{"count":0,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles\/11731\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/media\/11846"}],"wp:attachment":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/media?parent=11731"}],"wp:term":[{"taxonomy":"articles_categories","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_categories?post=11731"},{"taxonomy":"articles_tags","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_tags?post=11731"},{"taxonomy":"articles_topics","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_topics?post=11731"},{"taxonomy":"articles_languages","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_languages?post=11731"},{"taxonomy":"articles_filters","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_filters?post=11731"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}