1、第三节 病毒性脑膜炎、脑炎,Viral Meningitis, Encephalitis,Viral Meningitis or Encephalitis 是由各种病毒引起的中枢神经系统 感染性疾病。,ETIOLOGY,脑膜炎：,肠道病毒 80% 柯萨奇病毒、埃可病毒,虫媒病毒、腮腺炎病毒,脑炎：,肠道病毒、虫媒病毒 传染病病毒 单纯疱疹病毒,RNA DNA,EPIDEMIOLOGY,肠道病毒：夏季,虫媒病毒：季节流行性乙型脑炎-夏秋季,单纯疱疹病毒：散发,More common : in the summer in childhood in males,PATHOGENESIS,病毒,呼吸道
2、、胃肠道、叮咬,淋巴系统,脏器,血循环,神经全身,直接破坏,抗原-剧烈反应,脱髓鞘 血管损伤供血不足,PATHOLOGY,脑膜 血管 神经元 髓鞘,破坏,变性 脱髓鞘,内皮细胞 周围组织坏死,充血 细胞浸润,CLINICAL MANIFESTATION Viral Meningitis,起病：急性/前驱期,症状：发热、恶心、呕吐，皮疹,年长儿：头痛，眼球后痛，颈、背、 下肢痛 畏光，感觉过敏,婴儿：不安，易激惹,体征：颈强直,CLINICAL MANIFESTATION Viral Encephalitis,Type 1发病开始时症状较轻，随后迅速进展而陷入昏迷，可突然死亡,Type 2 病初
3、即高热、频繁惊厥发作 出现异常动作 幻觉， 其间可有短暂清醒期,CLINICAL MANIFESTATION Viral Encephalitis,Type 3 common,体温逐渐上升,精神萎靡、反应迟钝,惊厥发作、颈强直、 木僵状态、异常动作,病初：急性全身性感染征候,CLINICAL MANIFESTATION Viral Encephalitis,局限性神经系统体征,急性小脑共济失调： 眼球震颤，语言构音异常,急性小儿偏瘫,类似多发神经根炎,类似急性横贯性脊髓炎,脑干颅神经核受累,LABORATORY FINDINGS,CSF 压力增高，外观清亮 白细胞：量 0-1000x106/L
4、分类 中性粒细胞淋巴细胞 蛋白质：正常或轻度增高 糖： 正常疱疹脑炎红细胞,LABORATORY FINDINGS,病毒学检查大便、咽分泌物、脑脊液血清学检查 病毒培养,病初-2-3周,DIAGNOSIS,病史 临床表现 脑脊液 病毒学,DIFFERENTIATION,化脓性脑膜炎 不规则治疗 脑肿瘤 急性起病 寄生虫感染 急性播散性脑脊髓炎,TREATMENT,一般治疗 对症治疗控制惊厥发作处理颅内压增高处理呼吸、循环功能障碍,TREATMENT,药物治疗 抗生素 疱疹病毒脑炎：阿昔洛韦（acyclovir）10mg/kg.t，Q8h 1hr内静注 地塞米松 0.1-0.2mg/kg.d 干
5、扰素,TREATMENT,康复治疗,急性播散性脑脊髓炎,Acute Disseminated Encephalomyelitis ADEM,PATHOGENESIS,Viral infection,demyelination,PATHOLOGY,Foci of demyelinationScattered throughoutthe brain and spinal cord,CLINICAL MANIFESTATION,FOLLOW:,Viral infection rubeola,rubella,varicella,mumps,Immunization,Respiratory/Gastro
6、intestinal tractinfection,CLINICAL MANIFESTATION,Multifocal neurologic signs Widespread CNS disturbances:coma,drowsiness,seizures,CSF,Leukocytosis Protein concentration:mildly elevated Glucose concentration: normal,DIAGNOSIS,Clinical feature MRI,DIFFERENTIATION,MS multiple sclerosis,TREATMENT,Cortic
7、ostroidsMethylprednisolone Dexamethasonum,prednisone,DIFFERENTIATION OF CENTRAL NERVOUS SYSTEM INFECTIONS,PATHOLOGY,PurulentTuberculosisViral,CSF Pressure(kPa) Normal Purulent Tuberculosis Viral Fungal TE FC,0.69-1.96,Usually elevated,Usually elevated,Normal or slightly elevated,Usually elevated,Nor
8、mal or slightly elevated,Usually elevated,CSF Leukocytes(x106/L)Normal Purulent Tuberculosis Viral Fungal TE FC,0-5/0-20,100-10,000 PMN,100-3,000 PMN-LYM,0-1000 LYM,normal,normal,5-500 PMN-MN,CSF Protein(g/L) Normal Purulent Tuberculosis Viral Fungal TE FC,0.2-0.4/0.2-1.2,1-5,1-30 or higher,0.5-2,no
9、rmal or SE,normal,0.5-5,CSF Glucose(mmol/L) Normal Purulent Tuberculosis Viral Fungal TE FC,decreased,normal,normal,normal/mumps,decreased,2.2-4.4 (75%SG),decreased,CSF Immuglobulin Normal Purulent Tuberculosis Viral TE FC,IgG IgA IgM,Ig-N,IgM,IgA-N,CSF 乳酸盐(mg/L) Normal Purulent Tuberculosis Viral TE FC,30,30,50,CSF Others Normal Purulent Tuberculosis Viral Fungal TE FC,Gram stain/culture/LAT,Culture*/PCR,PCR,Other diseases,No CNS signs,Ink preparation/LAT,Thanks foryourattention,
