ĐẶC ĐIỂM TỔN THƯƠNG THẦN KINH TRÊN LÂM SÀNG VÀ ĐIỆN CƠ Ở BỆNH NHÂN RẮN CẠP NIA CẮN

Abstract

Objective: To describe the clinical features and electromyographic changes of nerve damage in patients bitten by Bungarus multicinctus. Method: A descriptive study of 19 snakebite patients treated at Poison Control Center of Bach Mai Hospital. Results: Symptoms of cranial nerve and peripheral motor nerve paralysis included ptosis (100%), diplopia (89.5%), mydriasis (100%), extraocular muscle paralysis (89.5%), limited mouth opening (100%), neck muscle paralysis (100%), upper and lower limb muscle weakness (89.5%), and decreased deep tendon reflexes (89.5%). The duration of ptosis in the antivenom group was significantly shorter with a mean of 4.0 ± 1.83 days compared to the non-antivenom group with a mean of 7.86 ± 3.13 days, with a statistically significant difference of p = 0.013. Electromyography on the first day of hospital admission showed that the average latent period, conduction velocity of motor nerves were within normal limits, but the amplitude of motor nerve wave was reduced. The average latent period, conduction velocity of sensory nerves, and the amplitude of sensory nerve wave in the intermediate nerve were within normal limits. Among the patients who underwent repetitive stimulation tests on the first day, 10.0% had a positive result, and 30.0% had suspected positive results. Conclusion: Electromyography on the first day of patients bitten by Bungarus multicinctus initially indicates the detection of synaptic motor nerve damage, which is consistent with the mechanism of alpha-neurotoxin and beta-neurotoxin found in krait venom.