第二章神经系统疾病常见症状(symptomatologyofthe.pptVIP

中枢神经系统感染 INFECTIONS OF THE CENTRAL NERVOUS SYSTEM Neurology Department The Second Hospital of Harbin Medical University 第一节 概述 Term：Infections of CNS All kinds of pathogen (bacteia,viruses,spirochete ,parasites,fungi,rickettsia and prion prottein) invade cerebral parenchyma, meninges and blood vessel lead to acute and subacute infections. 第一节 概述 分类： 感染的部位 ；发病情况及病程 ；特异性致病因子 CNS感染途径(pathway of infection) ①hematogenous spread； ②direct infection ； ③Peripheral nerves pathway CNS病毒感染性疾病新的认识 第二节 病毒感染性疾病 Viral infections of CNS 单纯疱疹病毒性脑炎 Herpes Simplex Encephalitis Creutzfeldt-Jakob Disease Herpes Simplex Encephalitis 病因及发病机制( Causes and Mechanisms) 病理（pathology) 临床表现 (Clinical features) 辅助检查 (laboratory finding) 诊断及鉴别诊断 (Diagnosis and Differential Diagnosis) 治疗（treatment) HSE--Causes and Mechanisms HSV-嗜神经(neurotropic )DNA病毒 90%的人类HSE是由I型引起 70%HSE起因于内源性病毒的活化 (复发性疱疹感染 ) 25%的病例是原发感染 (口腔和呼吸道 ) 6%~15%系由II型所致 (产妇生殖道HSV-II原发感染 ) 绝大多数新生儿的HSE系HSV-II引起 HSE-- Pathology 颞叶、额叶等部位出血性坏死 |、渗出 急性期后可见小胶质细胞增生 Intense hemorrhagic necrosis of the inferior and medial parts of the temporal lobes and the medial-orbital parts of the frontal lobes. HSE-Pathology Cowdry A型包涵体 (A type inclusion body)存在于病灶边缘的部分神经细胞核内 及星型细胞和少突胶质细胞核内。 HSE-- Clinical feature 1．任何年龄、季节均可发病原发感染的潜伏期为2~21天，平均6天；前驱期症状 2．病程 多急性起病 ，口唇疱疹史 （1/4），高热，首发症状 ：头痛、轻微的意识和人格改变 或全身性或部分性运动性发作 ；病情缓慢进展精神症状表现突出智能障碍也较明显 3 ．神经症状 局灶性脑损害 ；脑膜刺激征 ；意识障碍 ；全身性或部分性癫痫 。重症脑疝形成而死亡 （死亡率高达40%~70% ）。 HSE-Clinical feature 1.It occurs sporadically throughout the year and in patients of all ages. During prodromal stage:fever,headache,muscular ache etc. 2.The onset is acute,patients may had herpes labialis(1/4) and fever.The early manifestations:headach,personality change,slight concious disorder and seizures .Psychotic behavior, memory loss become evident later. HSE-Clinical feature 3.Neurologic symptom and sign hemiparesis,aphasia,meningeal rritatioin,disorder of conciousness,focal or generalized seizures.It