中枢神经系统感染-2PPT.ppt

TUBERCULOUS MENINGITIS;Tuberculous meningitis is an infection of the membranes 膜covering the brain and spinal cord (meninges). Tuberculosis (TB) is caused by the bacterium Mycobacterium tuberculosis结核分枝杆菌 and is annually responsible for nearly two million deaths worldwide. A third of the worlds population is currently infected with the TB bacillus, and more than eight million new cases are diagnosed each year.;Tuberculous meningitis must be considered in patients who present with a confusional state, especially if there is a history of pulmonary tuberculosis, alcoholism, corticosteroid treatment, HIV infection, or other condition associated with impaired immune responses. ;It should also be considered in patients form areas (eg, Asia, Africa) or groups (eg, the homeless and inner-city drug users) with a high incidence of tuberculosis.;Causes;Pathogenesis Pathology发病机制病理;Primary infection, typically acquired by inhaling bacillus containing droplets, may be associated with metastatic dissemination of blood-borne bacilli from the lungs to the meninges and surface of the brain.Here the organisms remain in a dormant state in tubercles that can rupture into the subarachnoid space at a later time, resulting in tuberculous meningitis.;主要发现是含有大量单核细胞的脑基底部脑膜分泌物。脑膜及脑表面可见结核结节。;The ventricle may be enlarged as a result of hydrocephalus, and their surfaces may show ependymal exudate or granular ependymitis.Arteritis can result in cerebral infarction, and basal inflammation and fibrosis can compress cranial nerves.;Acute tuberculous meningitis with marked involvement of the vessel walls and occlusion of smaller vessels. The vascular involvement can result in infarction. ;Clinical Findings ;B.SIGNS;Complications include spinal subarachnoid block脊髓蛛网膜下腔梗阻, hydrocephalus脑积水, brain edema脑水肿, cranial never palsies颅神经麻痹, and stroke caused by vasculitis or compression of blood vessels at the base of the brain因血管炎或颅底血管受压导致的卒中. ;结核球;stroke;hydrocephalus;Laboratory Findings ;CSF;Acid-