2017整理中枢神经系统感染-1.ppt

VIRAL MENINGITIS ENCEPHALITIS Viral meningitis refers to meningitis caused by a viral infection. Children and young adults are frequently affected. Viral meningitis is most often caused by enteric 肠道的viruses Viral encephalitis by childhood exanthems皮疹, arthropod-borne节肢动物agents虫媒性病原体, and herpes simplex type 1. Cause 最常见 柯萨奇病毒 ECHO病毒 肠道病毒 Pathology Viral infections can affect the central nervous system in three ways 血源性播散 ：hematogenous dissemination of a systemic viral infection(eg, arthropod-borne viruses虫媒性病毒); 轴突传播：neuronal spread of the virus by axonal transport (eg, herpes simplex, rabies狂犬病病毒); 自身免疫性感染后脱髓鞘：autoimmune postinfections demyelination脱髓鞘 (eg, varicella水痘病毒, influenza). Pathologic changes in viral meningitis consist of an inflammatory meningeal reaction mediated by lymphocytes. 病毒性脑膜炎的病理改变是由淋巴细胞介导的炎性脑膜反应。 Encephalitis is characterized by perivascular cuffing, lymphocytic infiltration, and microglial proliferation mainly involving subcortical gray matter regions. Internuclear or intracytoplasmic inclusions are often seen.  病毒性脑炎的病理改变特点是血管周围套袖样改变、淋巴细胞浸润，以及累及皮层下灰质的小胶质增生，并经常可见到核浆或细胞浆内包涵体。 Clinical findings---symptoms and signs Clinical manifestations include fever, headache, neck stiffness, photophobia畏光, pain with eye movement, and mild impairment of consciousness. Patients usually do not appear as ill as those with bacterial meningitis. Systemic viral infection may cause skin rash, pharyngitis咽炎, lymphadenopathy淋巴结病, pleuritis胸膜炎, carditis心肌炎, jaundice黄疸, organomegaly器官肿大, diarrhea腹泻, or orchitis睾丸炎, and these findings may suggest a particular etiologic agent病原体. Because viral encephalitis involves the brain directly, marked alterations of consciousness, seizures, and focal neurologic signs can occur. When signs of meningeal irritation脑膜刺激征and brain dysfunction coexist共存, the condition is termed meningoencephalitis脑膜脑炎. Laboratory findings CSF analysis is the most important laboratory test. CSF pressure is normal or increased a lymphocy