Tập huấn Viêm não

Bnh vim no tr em
BNH VIM NO NHT BN
Cn nguyn, mt s yu t dch t,
lm sng, cn LS, chn on v T
PGS.TS. Phm Nht An
Pham Nhat An - NHP / HMU
Ni dung / Mc tiu
Cc thut ng, nh ngha; cc cn nguyn
vim no thng gp tr em
c im Dch t ca cc VN do cc virus
thng gp ti Vit nam
LS, cn LS v chn on cc loi Vim no
thng gp ti Vit nam / Vim no Nht bn
iu tr v phng bnh 3 loi vim no
thng gp ti Vit nam c bit l vim
no Nht bn
I. nh ngha
Vim no l tnh trng vim (nhim) ti t chc
no do nhiu cn nguyn gy nn
Nguyn nhn ch yu l nhim khun - thng gp
nht l do virus nhng cng c th do mt s vi
khun, k sinh trng, n bo.
Cc nguyn nhn khc: cc bnh min dch t
min, ri lon chuyn ha, ng c
Khng xc nh c nguyn nhn.
Hnh nh Gii phu bnh

(c phn nh qua LS v C hnh nh)
4 hnh nh t chc hc bnh l
thng gp trong vim no l:
Ph n t chc no (lan ta hoc khu tr)
Phn ng vim (xm nhp t bo vim vo t chc,
tng sinh ni mc...); nng hn l biu hin
Xut huyt, hoi t (thng ri rc, vi th...)
V cui cng l thoi ha, teo t chc.
Mt s thut ng
Vim no tin pht (primary encephalitis) :
Vim no xut hin khi virus trc tip tn
cng no v ty sng (ty gai) chia 2 loi
- Vim no tn pht: Bnh c th xut hin
l t vo bt c thi gian no (sporadic
encephalitis)
- Vim no dch t: c th xut hin theo

ma, i khi thnh dch (epidemic
encephalitis).
Thut ng...
Vim no th pht ( Secondary
Encephalitis / Vim no sau nhim

trng (post-infectious encephalitis):
Trc tin virus (VK) gy bnh mt s c

quan khc (ngoi h TK trung ng) v sau
mi biu hin no ty.
Thut ng...
Vim no-mng no (Meningoencephalitis):thc t
c coi l ng ngha vi thut ng vim no

Vim no ty (Encephalomyelitis):Th bnh c tn
thng c no v ty sng.
Bnh no (Encephalopathy): Thng ch bnh
cnh ging vim no nhng khng r bng chng
ca bnh nhim trng hoc cha nh hng c
nguyn nhn.
Phn loi theo cn nguyn

Nhim trng (Infection)
1. Virus:
+ Ly t ngi sang ngi (Adenovirus,
Herpes simplex types 1, 2, CMV, ECHO,
EnteroViruses, Influenza A, B, Si, Quai b,
HBV...)
+ Ly t ve, mui (Arbor Viruses...)
+ Ly t ng vt mu nng (Di, Herpes
virus similae, encephalomyocarditis )
Mt s loi vim no do virus

1.
2.
3.
4.
5.
Japanese Encephalitis
Herpes Encephalitis (HSV1)
Enterovirus
CMV, EBV
Rubella, Measle, Mumb, Dengue...
6.
7.
8.
9.
10.
11.
12.
St. Louis Encephalitis

Equine Encephalitis
La Crosse encephalitis
Murray Valley encephalitis
California encephalitis
Tick-borne meningoencephalitis
Herpes simplex, Herpes zoster...
...cn nguyn...
2.Vim no do vi khun
-
Nesseria Meningitidis
HIb
TB
S. Typhy
Others (mucoplasma pneumonie,
S.Pneumonia)
...cn nguyn..
3. Vim no do K sinh trng
Granulomatous amoebic encephalitis
Naegleria Fowleri
Malaria
Toxoplasmosis
Angiostrongilus Cantonensis
Giun u gai - Gnathostoma spinigerum

Others
4. Fungal
5. Vim no do cc cn nguyn khc

- Alergy
- Toxic
- Metabolic disorders (Reye, VN xm
Wernicke do ru, VN trng sau tiu
chy, VN chm G)
- Vim no min dch: Limbic
encephalitis; Rasmussen's encephalitis
- Unknown origin
Sinh bnh hc & Dch t

VN do Virus
Sinh bnh hc:
- ng lan truyn: Mu, ng h hp,
tiu ho, cn trng t, theo dn truyn
TK...
- Xm nhp ca tc nhn gy bnh:
Trc tip vo h TKT & Qua c ch min
dch hoc c 2
- Cc tt c bn t chc TKT ( nu)
Cc yu t dch t
Dch t: Ty theo loi virus
Ngun bnh
Vecter truyn bnh
a d
Ma
Tui
Chu k dch t
Triu chng lm sng

Du hiu LS trong trng hp vim no
th nh gm:
St, c th vim long ng h hp
Nhc u, chong vng
Gim nh hng
Chn n
Mt mi...
Nhng trng hp in hnh hoc nng

St cao
Nhc u d di
Bun nn v nn ma
Ri lon tri gic ty theo mc , hn m
HC mng no
Co git (thng ton th)
Lit
Ri lon h hp, tim mch...
Du hiu cn lm sng
Dch no ty: nh gi mu, p lc v xt nghim
t bo-vi trng, ha sinh, PCR hay phn lp virus .

Chn on hnh nh: nh chp ct lp in ton
(CT scan) hay chp cng hng t (MRI) pht
hin tnh trng ph n, xut huyt hay cc bt
thng khc ca no
in no (EEG):nhm pht hin cc sng bt
thng.
Xt nghim mu: nh cng thc mu, xt nghim
ha sinh, xt nghim huyt thanh hc nhm pht
hin cc khng th c hiu, PCR, c cht, cc RL
chuyn ha...
Phn lp virus (t dch no ty, dch hng hu,
mu, phn...) Pham Nhat An - NHP / HMU
Chn on xc nh
Ty theo cn nguyn:
- Da vo triu chng lm sng

- Cc yu t dch t, c bit l a
phng, ma v la tui
- Xt nghim:
+ Xc nh ng vim no
+ Xc nh cn nguyn
Vim no do cc loi Virus

Thng gp ti VN:
VN nht bn, VN EV, VN HSV
1.1. Yu t dch t
Cn
nguyn
Ma
VN nht
bn
Tp trung cc
thng 5,6,7
VN do EV
VN do HSV
Quanh nm, nhiu

hn vo cc thng
3,4,5
Quanh nm
Tr nh
Mi la tui,
SS
Tui
2-8 tui
Ngun
bnh/ng
ly truyn
i gia xc, chim Ngi /Thng qua

/ Mui
ng tiu ha
Tnh cht
dch
++
+
Ngi / H
hp, m
truyn
1.2. Lm sng
Cn
nguyn
VN nht
bn
Khi pht
Rt cp, au
u, vim long
HHvi nhiu
th bnh
Triu chng ni Cn co git, co

tri
cng, st cao
VN do EV
Cp, ri lon
tiu ha, pht
ban, mn
phng
VN do HSV
Co git, lit
khu tr
H/C Hand-Foot- Co git, lit

Mouth
khu tr
Din bin nng Ngng th, suy Shock, suy tim, LS din bin
hay gp, tin
HH nng
ph phi
chm hn
trin
1.3. Cn lm sng
Cn nguyn
VN nht
bn
Bch cu mu Thng
ngoi bin
tng
VN do EV
Dch no ty
SIMILA,
Pr. Tng t
SIMILA
SIMILA
Pr. Thay i Pr. Thay i
CT, MRI s
no
Ph no lan Ph no, c TT thy thi

to, TT i th ri rc, dng,
th
TT thn no trn
Khc
ELISA,
PCR
BT
PCR
VN do HSV
BT
PCR
1.3. Cn lm sng
1.3.1. Dch no-tu:
C ngha quan trng trong chn on,
Cn xt nghim dch no- tu khi nghi ng vim no.
- Dch trong, p lc thng tng
- T bo thng tng t vi chc n vi trm BC/mm3, ch yu BC
Lympho v n nhn;
- Protein bnh thng hoc tng , glucose v mui bnh thng.
Xt nghim chn on cn nguyn (nh PCR, ELISA, phn lp virus...);
Khng chc d dch no- tu khi:

-
C du hiu tng p lc ni s nng (nguy c tt kt)
ang sc,
Suy h hp nng.
Cc xt nghim xc nh cn nguyn:
- Tm khng th IgM c hiu: bng k thut th
nghim min dch gn enzym (ELISA): JE
- Tm khng nguyn c hiu: bng k thut phn
ng khuych i chui polymeza (PCR),
- Phn lp virus t dch no-tu, mu, bng nc
da, dch mi hng, phn:(Hand Foot Mouth...)
Mu
-
Cng thc mu: bch cu tng nh hoc bnh thng;
- in gii : trong gii hn bnh thng.
- ng huyt : trong gii hn bnh thng.
Cc xt nghim khc:
-
in no : tn thng vng trn, thi dng gi do

Herpes;
- Chp ct lp vi tnh (CT scan) no;

- Chp tim phi.
1.4. Chn on phn bit

Cn phn bit vi cc bnh sau y:
- Co git do st cao;
- Vim mng no m; Vim mng no do lao;
- Ng c cp;
- St rt th no;
- Chy mu no-mng no;
-
ng kinh.
- U no...
iu tr VN: Nguyn tc chung
L mt bnh cp cu c th tin trin

rt nhanh, cn c s tr kp thi, theo
di cht ch
Chng ph no
iu tr cc T/C v RL chc nng: St
cao, Co git, SHH, RLG...
iu tr h tr v chm sc, nui dng
iu tr c hiu
Liu php KS (khi no?)
2. iu tr
A. Nguyn tc iu tr c th:
* Bo m cc chc nng sng
Bo m thng kh, chng suy h hp, ri lon tun hon, sc;
* Chng ph no;
* iu tr triu chng
- H nhit;
- Chng co git;
- iu chnh ri lon nc, in gii, ng huyt (nu c).
* Chm sc v iu tr h tr
- m bo chm sc v dinh dng;
- Phc hi chc nng sm;
- Phng v chng bi nhim; nhim khun bnh vin.
* iu tr nguyn nhn
B/ iu tr c th:
1/ Bo m thng kh, chng suy h hp
- T th: t tr nm nga, k gi di vai, u nga ra sau v nghing
v mt bn, ht m di khi c xut tit, ng.
- Nu suy h hp:
Th oxy:
Ch nh: co git, suy h hp, bo ho oxy SpO2 t 85 - 90%.
Th oxy qua ng thng, liu lng 1-3 lt/pht hoc
Th mt n, liu lng 5-6lt/pht theo la tui v mc suy h hp.
t ni kh qun v th my:
+ Ch nh: Ngng th hoc c cn ngng th, SpO2 < 85%.
Phng php th my
Ch : th kim sot th tch
FiO2 ban u: 100%
Th tch kh lu thng (TV): 10- 15ml/kg.

Tn s th:
Di 1 tui: 25 ln/pht;
T 1-5 tui: 20 ln/pht;
Trn 5 tui: 15 ln/pht.
T l ht vo/th ra (I/E):1/2
Ci t PEEP: ban u 4 cm H2O
Phng php th my (tip theo)

iu chnh cc thng s: theo din bin, p ng lm
sng, SaO2, kh mu;
Nu khng c my th:
Bp bng qua NKQ.
Tn s bp bng t 20 n 30 ln/pht.
Dng th my khi:
Bnh nhn t th,
Ht co git, huyt ng hc n nh,
Tri gic ci thin,
Kh mu bnh thng vi FiO2 < 40% v PEEP = 4 cm H2O.

2. Chng ph no
Ch nh: khi c cc du hiu ca ph no nh
Nhc u km theo du hiu kch thch, vt v hoc
Li b, hn m
Ph gai th, ng t khng u; lit khu tr; co cng;
Th khng u; mch chm km theo huyt p tng.
Phng php:
T th nm: u cao 15- 30 ;

Th my: tng thng kh, gi PaO2 t 90 - 100mmHg v PaCO2 t 30 - 35
mmHg;
Dung dch Manitol 20%:
Liu 0,5 g/kg/ 15-30 pht (2,5 ml/kg) truyn TM.
Nhc li sau 8 gi nu cn du hiu ph no, khng qu 3 ln/24 gi.
Khng dng Manitol trong trng hp c sc, ph phi.
C th dng Dexamethason 0,15 0,20mg/kg/6gi tim TM trong vi

ngy u.
3/ Chng sc
Nu c sc:
Truyn dch theo phc chng sc.
Sau c th s dng Dopamin truyn TM:

Liu bt u t 5 g/kg/pht v tng dn,
Ti a khng qu 15 g/kg/pht,
- S dng Dobutamin nu c vim c tim.

4/ H nhit
Ung nc, ni qun o, chm mt
Nu st > 38.C:
H nhit bng paracetamol 10-15mg/kg/ln,
Ung hoc t hu mn 6 gi/ln.
Nu st > 40.C hoc ung khng hiu qu:
Tim TM propacetamol (Prodafalgan) 2030mg/kg/ln;

5/ Chng co git: Diazepam

Ln u theo mt trong cc cch di y:
Tim TM chm, liu 0,2- 0,3mg/kg, (ti ni c iu kin hi sc)
ng tim bp: liu 0,2 0,3mg/kg;
ng trc trng: liu 0,5mg/kg: Ly thuc (dng tim) vo bm

tim 1ml, rt b kim, a bm tim vo trc trng 4-5cm v bm
thuc. Kp gi mng tr trong vi pht.
Nu sau 10 pht vn git: cho liu Diazepam ln thhai.

Nu vn co git:
Cho liu Diazepam ln th ba, hoc
Phenobacbital 10-15 mg/kg pha vi dextrose 5% truyn TM 30

pht, duy tr 5-8mg/kg/24 gi chia ba ln, tim bp hoc chuyn
Khoa T tch cc.
6/ iu chnh ri lon in gii, ng

huyt
Bi ph nc v in gii.
Thn trng khi c du hiu ph phi;
Dng Natri Clorua v Glucoza ng trng,

Lng dch tnh theo trng lng c th;
iu chnh in gii v thng bng kim toan da vo in gii v kh mu.

7/ Dinh dng v chm sc, phc hi

chc nng
Dinh dng
Thc n d tiu, nng lng - mui khong - vitamin.
Nng lng cung cp 50 - 60 kcal/kg/ngy.
Nu tr khng t n c: n qua ng thng mi - d
dy, truyn tnh mch.
Nn b sung vitamin C, vitamin nhm B.
Nu tr b m:
Tip tc cho tr b m.
Tr khng b c:Pham
vt Nhat
saAn- -
hoc n qua Sonde
NHPtha
/ HMU
Chm sc v theo di:

Ht m di
Thng xuyn thay i t th,
V rung trnh xp phi v vim phi do ng.

Chng to bn, chm sc da, ming
B tiu tin, cng bng quang: n,KT bng quang. Hn ch
thng tiu v nguy c gy bi nhim;
Theo di cc du hiu sinh tn, mc tri gic; cc du
hiu ph no; SaO2, in gii v ng huyt.
Phc hi chc nng: Tin hnh sm khi tr n nh lm

sng.
8/ Thuc khng virus
Khi nghi ng vim no do Virus Herpes Simplex:

Dng Acyclovir, liu 10mg/kg/8 gi, truyn TM
trong 1 gi. Thi gian iu tr: t nht 14 ngy
CMV: Ganciclovir
9/ Thuc khng sinh
c ch nh trong nhng trng hp sau:
- Cha loi tr c vim mng no m;
- Khi bi nhim.
III. Phn tuyn iu tr

3.1. Tuyn x:
Pht hin cc trng hp nghi ng,
X tr cp cu ban u, h nhit, chng co git
Chuyn ln tuyn trn.
3.2. Tuyn huyn

Chn on v x tr th nh;
Chuyn tuyn trn: bnh nng hoc tin lng
nng, hoc khng c iu kin chc dch notu.
3.3. Tuyn tnh

- Tip nhn v iu tr cc trng hp vim no cp;
- Chuyn tuyn trn khi: bnh nhn nng, vt qu kh
nng chuyn mn trong chn on & iu tr.
3.4. Tuyn Trung ng

- Tip nhn v iu tr: cc trng hp vim no cp v khi
tuyn di chuyn ln;
- Ch o & h tr tuyn di trong chn on v iu tr;
- Lm cc xt nghim chn on nguyn nhn.
Lu iu tr theo cc cn nguyn
VN nht bn VN do EV VN do HSV
iu tr c
hiu
Manitol
Dexameth.
Chng co git,
st
Phng, chng
Shock, suy tim,
ph phi
(-)
Thng dng
hiu qu
(-)
Thn trng
+++
t gp
+
Cn ch
trng
(+)
t dng
++
Him
4. Phng bnh
4.1. V sinh phng bnh

- V sinh c nhn.
- V sinh n ung trnh ly qua ng tiu ho;

- V sinh ngoi cnh, khng nui gia sc gn nh,
gn khu dn c;
- Dit cn trng, tit tc trung gian truyn bnh,

dit b gy, dit mui.
- Nm mn chng mui t
4.2. Tim chng

4.2.1. Tim phng vim no Nht Bn;
- Tim di da;
- Liu: 0,5ml cho tr < 5 tui; 1ml cho tr > 5 tui;
Mi 1: bt u tim
Mi 2: 7 ngy sau mi 1
Mi 3: 1 nm sau mi 2
Tim nhc li sau 3-4 nm
4.2.2. Tim chng vc xin bi lit, si, quai b, thu

u, rubella theo lch tim chng.
Phng bnh
Phng bnh ch ng
- Tim phng bnh (vi mt s loi virus
nh VNNB, Si, Thy u, Quai b)
Phng bnh th ng
- Dit mui, nm mn
- V sinh mi trng.
Tnh hnh vim no qua NC ti BV Nhi T

trong 5 nm t 2008 - 2012
Material and Method

Material:
- All patients confirmed with encephalitis /
meningoencephalitis admitted to NHP from 01/2008 to
30/12/2012.
- National Immunization Program and others health data.
Diagnosis criteria: Based on 2 criteria:
Clinical:
- SIRS
- Acute Encephalopathy Consious disorders
Investigation: CSF, Brain CT, MRI...
Etiology of the encephalitis was confirmed by the results of

immunology, bacteriology and bimolecular tests on CSF and
Serum of the patients (PCR, ELISA).
Pham Nhat An NHP / HMU
Material and Method (...)

Etiology diagnosis was divided into:
Confirmed : If the test of specific virus PCR or ELISA

was founded in CSF (such as HSV1, JE, EV, CMV,
EBV).
Probable: Specific clinical symptoms with specific viral

testing positive in the blood or other biosecretes (such as
encephalitis by Rubella, mumps, varicella, measles...).
Data analyzing was done by biostatistics method with the
software SPSS 18.0Pham Nhat An - NHP / HMU
- There were 2565 Acute Encephalitis cases admitted

to NHP during five years 2008 to 2012
- Average: 513 cases per year
- Etiology defined: 1011 cases (39,42%)
(Unknown origin remained 60.58%)
Mostly Viral Encephalitis: 874 cases ( 34,07%)
Others (Bacteria, Parasite, Ricketsia,
Fungal/
HIV/AIDS, Autoimmune, vaccine
related
and toxic): 137 (5,34%)
ETIOLOGY STRUCTURE OF AE IN DISEASE GROUP

Etiology
UNKNOWN ORIGIN
Number
1,554
60,58
VIRAL
874
34,07
Bacterial
58
2,26
Parasite
51
1,99
Ricketsia
0,12
Fungal/HIV/AIDS
0,16
Non Infection (ADEM,

Vaccine related, toxic acute
lead poisoning)
21
0,82
ETIOLOGY STRUCTURE OF AE OF DEFINED GROUP

Etiology
Numbers
Viral
874
86,45
Bacterial
58
5,74
Parasite
51
5,04
Ricketsia
0,3
Fungal/HIV/AIDS
0,4
Non Infection (ADEM,

Rasmussen, Vaccine
related, toxic poisoning)
21
2,08
Etiology of Encephalitis / five years of follow- up

the
cause
defined
13
170
371
19
221
515
30
26
186
514
12
33
245
600
60
22
46
189
565
356
160
68
29
137
1011
2565
HSV1
JE
EV
EBV
CMV
2008
30
94
19
11
2009
21
69
92
13
2010
27
79
15
2011
33
54
2012
47
158
Rub Others
ella Etiology
103
103
120
100
80
HSV1
JE
EV
60
EBV
CMV
Rubella
40
20
0
2008
2009
2010
2011
2012
Vim no nht bn
Dch t hoc: Ly do mui truyn bnh
- Tnh cht a l
-Theo ma
-Ngun bnh: Cc loi chim ln, cc i
gia sc
-Vecter truyn bnh: c tnh mui Culex
(tritaeniorhynchus v Vishnui)
The main epidemiologic region of JE

VN Nht bn ti Vit nam

- Ch yu pha Bc, tuy c hu ht cc tnh,
thnh.
- Thng xy ra thnh dch vo cc thng 5,6,7.
- Bnh gp mi la tui, nhiu nht l tr < 15
tui c bit t 2 -8 tui.
- Mui Culex Tritaeniorhynchus l vt ch trung gian
chnh lan truyn virt VNNB ti VN.
- C. Tritae. sinh sn ti mng mng, ng rung
ngp nc, v m mui ci a ht mu ng vt
c xng sng nh cc i gia sc, chim v c
ngi, sau bay tn pht i xa.
- Virus nhn ln trong mui vi hiu gi cao, sau
c kh nng truyn bnh sut i v c th truyn
virus sang th h sau qua trng.
Mui Culex
VN do JEV
Lm sng: th in hnh thng nh
H/C no cp, nhng cng c nhiu th
bnh a dng, t nh n nng
Chn on:
c bit hnh nh CT, MRI s no:
iu tr: c bit l chng ph no
VN do JEV
Ti sao c vaccine m bnh vn cn?

Ti sao bnh vo ma h:
c tnh Arbovirus type B
c tnh mui Culex
Ngun ly bnh: Chim ln, i gia xc
Life style ma h
VN do JEV
Lm sng: th in hnh thng nh
H/C no cp, nhng cng c nhiu th
bnh a dng, t nh n nng
Chn on:
- Ca bnh lm sng:
- Ca bnh xc nh: Vai tr ca CSF v
chn on hnh nh
Triu chng lm sng

bnh: 5-15 ngy
Giai on khi pht:
St: St l triu chng ph bin, xy ra t
ngt, st lin tc 39-40 C, cng c khi st
khng cao.
Nhc u, quy khc, kch thch
Bun nn, nn.
C th c cc triu chng khc nh:
-Vim long ng h hp.
-To bn tr lnPham Nhat An - NHP / HMU
Triu chng lm sng

Giai on ton pht: 7 10 ngy
Ri lon tri gic t nh n nng nh ng g, li b, l m
n hn m.
Thng c co git
C th c cc du hiu thn kinh khc: hi chng mng
no, cc du hiu thn kinh khu tr (lit na ngi hoc t
chi), tng hoc gim trng lc c...
C th c suy h hp
Cc th lm sng:
Th ti cp: st cao lin tc, hn m su, suy h hp, try
mch v dn n t vong nhanh.
Th cp tnh: din bin cp vi cc biu hin lm sng
nng, in hnh.
Th nh: ri lon tri gic mc nh v phc hi nhanh
chng.
Triu chng lm sng

Giai on hi phc /di chng
Cc bin chng:
Cc th lm sng:
Th ti cp: st cao lin tc, hn m su, suy h hp, suy
a tng v dn n t vong nhanh.
Th cp tnh: din bin cp vi cc biu hin lm sng
nng, in hnh.
Th nh: ri lon tri gic mc nh v phc hi nhanh
chng.
Ch trong T VN do JEV
-
c bit l chng ph no
Kim sot thn nhit
Kim sot cn co git, co cng
Chng Suy h hp
Kim sot ni mi ( nc, in gii,
ng, kh mu nu c suy h hp)
c im VN do Herpes
Subtype: HSV1
Dch t: Quanh nm, tr nh, ly ng H
hp
Lm sng:
Din bin
B hin TK khu tr
Cn LS:
iu tr: Acyclovir IV 21 ngy
c im Vim no do EV
Subtype: ECHO, EV71
Dch t: Quanh nm, tr nh, ly ng Tiu
ho
Lm sng:
H/C tay chn ming v cc pht ban
B hin tiu ho
BH H hp
Shock
Cn LS:
iu tri: c bit l chng shock, ph phi, suy
tim.
Cc loi VN do cn nguyn
khc
Do VK
Do cc loi VR khc
Si, thu u
Rubella
CMV
Quai b
HBV, EBV, HIV
Do cc cn nguyn khc: Sau tim
Vaccin, ng c, d ng
Head MRI in Japanese encephalitis
Girl, 13 years old, JE

Boy. 7yo/JE
T2WI
T1WI
FLAIR
DWI
JE
JE
Head MRI in Japanese encephalitis
Girl, 13 years old, JE

Boy. 7yo/JE
T2WI
T1WI
FLAIR
DWI
JE
JE
HSV1
Girl, 2 yo HSV1
HSV1
Male, 5 yo.
CT scanner on
admission
The same patient MRI after 3 days
Boy 11 MO / HSV1
T1W
T2W
T1W C+
Abnormal images Hnh nh tn thng v tr cht trng chm-nh

Trn nh T2W, gim tn hiu trn nh T1W, sau tim khng ngm thu
Boy 6,5TH HSV1

T2WI
T1WI
(The same Patient)

ADC
DIFFUSION
Boy 12 mo, EV Encephalitis
Boy 12 mo, EV Encephalitis
BTT ,Boy 14 yo
Cryptococus Neoformans
(Ampholip
Treatment)
TDT, 22mo / Neurocysticercosis
T2WI
FLAIR
T1WI
GING A KH 10T / Toxocara??

T1WI
T1WC+
TQH Boy 6 YO
ADEM
T2WI
FLAIR
DIFFUSION
Hnh nh nhiu tn thng v tr cht trng quanh no tht hai bn

Dch vim, tng tn hiu trn nh T2W, Flair, gim tn hiu trn nh T1
H s khuyech tn trn Diffusion, sau tim khng thy ngm thuc.
The male; 6 months old
Thank you
For your attention!
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Bnh vim no tr em

BNH VIM NO NHT BN

Hnh nh Gii phu bnh

- Vim no dch t: c th xut hin theo

Encephalitis / Vim no sau nhim

Trc tin virus (VK) gy bnh mt s c

Pham Nhat An - NHP / HMU

c coi l ng ngha vi thut ng vim no

Pham Nhat An - NHP / HMU

Phn loi theo cn nguyn

Mt s loi vim no do virus

St. Louis Encephalitis

Giun u gai - Gnathostoma spinigerum

5. Vim no do cc cn nguyn khc

Sinh bnh hc & Dch t

Triu chng lm sng

Nhng trng hp in hnh hoc nng

Pham Nhat An - NHP / HMU

t bo-vi trng, ha sinh, PCR hay phn lp virus .

- Da vo triu chng lm sng

Pham Nhat An - NHP / HMU

Vim no do cc loi Virus

Pham Nhat An - NHP / HMU

Quanh nm, nhiu

i gia xc, chim Ngi /Thng qua

Triu chng ni Cn co git, co

H/C Hand-Foot- Co git, lit

Ph no lan Ph no, c TT thy thi

Pham Nhat An - NHP / HMU

Khng chc d dch no- tu khi:

C du hiu tng p lc ni s nng (nguy c tt kt)

Pham Nhat An - NHP / HMU

Pham Nhat An - NHP / HMU

Cng thc mu: bch cu tng nh hoc bnh thng;

- in gii : trong gii hn bnh thng.

- ng huyt : trong gii hn bnh thng.

in no : tn thng vng trn, thi dng gi do

- Chp ct lp vi tnh (CT scan) no;

1.4. Chn on phn bit

iu tr VN: Nguyn tc chung

L mt bnh cp cu c th tin trin

Th tch kh lu thng (TV): 10- 15ml/kg.

T 1-5 tui: 20 ln/pht;

Trn 5 tui: 15 ln/pht.

Phng php th my (tip theo)

Bp bng qua NKQ.

Bnh nhn t th,

Ht co git, huyt ng hc n nh,

Tri gic ci thin,

Kh mu bnh thng vi FiO2 < 40% v PEEP = 4 cm H2O.

Nhc u km theo du hiu kch thch, vt v hoc

Ph gai th, ng t khng u; lit khu tr; co cng;

Th khng u; mch chm km theo huyt p tng.

T th nm: u cao 15- 30 ;

C th dng Dexamethason 0,15 0,20mg/kg/6gi tim TM trong vi

Truyn dch theo phc chng sc.

Sau c th s dng Dopamin truyn TM:

- S dng Dobutamin nu c vim c tim.

H nhit bng paracetamol 10-15mg/kg/ln,

Ung hoc t hu mn 6 gi/ln.

Nu st > 40.C hoc ung khng hiu qu:

Tim TM propacetamol (Prodafalgan) 2030mg/kg/ln;

5/ Chng co git: Diazepam