Đặc điểm lâm sàng và cận lâm sàng các rối loạn phổ viêm tủy thị thần kinh=Clinical and paraclinical characteristics of neuromyelitis optica spectrum disorders

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Tác giả: Thanh Hùng Trần

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2024

Mô tả vật lý: tr.340-346

Bộ sưu tập: Metadata

ID: 477908

Thêm vào giỏ

Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory disorder of the central nervous system, characterized by diverse clinical and imaging manifestations [1]. Methods: All adult patients aged 16 years and older, diagnosed with NMOSD, and tested positive for serum anti- Aquaporin-4 antibody were included. Exclusion criteria: patients with incomplete results of cerebrospinal fluid testing and/or imaging. Results: Felmal: 81,8%, NMOSD exhibits a clear predominance in women, with an average age of onset of 38 years. Diagnosis is often delayed, with an average disease duration before diagnosis of 3,75 years. Cerebrospinal fluid analysis revealed mild increases in lymphocytes and protein. Optic nerve MRI consistently showed bulging and increased signal intensity on T2-weighted images. Contrast enhancement of the optic nerve was observed in one-fifth of cases (20%). Spinal cord MRI showed widespread lesions involving ≥ 3 vertebrae and ≥ 1/2 spinal cord width in most cases. However, 16,67% of patients exhibited spinal cord lesions involving <
3 vertebrae, and 33,33% had lesions involving <
1/2 spinal cord width. Contrast enhancement on spinal cord MRI was present in 1/6 patients. Conclusion: NMOSD is frequently diagnosed late, underscoring the importance of considering this diagnosis in patients with suggestive clinical features. Early diagnosis and prompt treatment are crucial for improving patient outcomes.Rối loạn phổ viêm tủy thị thần kinh (Neuromyelitis optica spectrum disorder: NMOSD) là một rối loạn viêm của hệ thần kinh trung ương, có biểu hiện lâm sàng và hình ảnh học đa dạng1. Đối tượng, phương pháp: Tất cả bệnh nhân (BN) ≥16 tuổi, được chẩn đoán mắc NMOSD, có xét nghiệm kháng thể anti- Aquaporin-4 huyết thanh dương tính. Tiêu chuẩn loại trừ: BN không có đầy đủ kết quả xét nghiệm dịch não tủy và/hoặc hình ảnh học. Kết quả: 16 BN, nữ chiếm 81,8%, độ tuổi khởi phát trung bình: 38 tuổi. Bệnh thường được chẩn đoán trễ (thời gian mắc bệnh trước khi được chẩn đoán trung bình là 3,75 năm). Dịch não tủy cho thấy có hiện tượng tăng nhẹ tế bào lymphocyte và protein. Có 1/5 (20%) có MRI có dây thần kinh thị phình và tăng tín hiệu, bắt thuốc tương phản nhẹ. MRI tủy sống phần lớn có tổn thương lan rộng ≥ 3 chiều cao đốt sống và ≥ 1/2 độ rộng tủy sống. Có 16,67% BN có chiều dài tổn thương tủy <
3 đốt sống và 33,33% BN có tổn thương tủy <
1/2 độ rộng tủy sống. Có 1/6 BN có hiện tượng bắt thuốc tương phản trên MRI tủy sống. Kết luận: NMOSD là một bệnh thường được chẩn đoán trễ, cần lưu ý đến bệnh này trước bệnh nhân có biểu hiện lâm sàng gợi ý, giúp chẩn đoán sớm và điều trị kịp thời, cải thiện tiên lượng người bệnh.

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