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病例 现病史 A 38-year-old woman was admitted to the hospital because of fever and confusion.The patient had been well until four days earlier, when a headache gradually developed and increased in intensity, accompanied by mild photophobia and stiffness of the neck. Two days before admission, she believed that she was mildly febrile. The day before admission, she was examined at another facility, where she was told she had a “viral illness.” She was given fluids intravenously and was discharged. On the morning of admission, she awoke with shaking chills and a temperature of 40?C. During the day she was aware of a rapid heartbeat, lightheadedness, and lethargy. Her husband observed that she was confused, and she was brought to this hospital and admitted. 病例 体检 T 36.4, HR 99bpm, RR 20, BP90/60 mmHg. SaO2 99%,The neck was rigid, and Kernig’s sign (+),She was alert and oriented but spoke in phrases of two to four words, rather than complete sentences. The neurologic examination otherwise revealed no abnormalities. 病例 辅助检查--器械 MRI showed a subtle hyperintensity on T2 images in both hippocampal regions and possible slight meningeal enhancement. EEG revealed generalized low-amplitude slowing and continuous focal slowing over the entire left hemisphere; no epileptiform activity 病例 病情演变 Shortly after the patient’s arrival at the hospital, T rose to 39.8, and the fever was accompanied by somnolence. On the 2nd hospital day, T rose to 39.5. When questioned, she knew the month but not the date or year or the ages of her children. Later on the 2nd day, she became more lethargic and responded to questions only with “yes.”. During the night, the patient’s mental status improved and she was able to follow simple commands .On the 3rd hospital day, the maximal T 39.2. The patient was more responsive to commands than she had been on the previous day, although she could not distinguish the right hand from the left. 中枢神经系统感染定义、解剖和病原学 病毒、细菌、真菌、寄生虫、螺旋体、立克次体、朊蛋白 细菌性脑膜炎 化脓性脑膜