神经病学（第八版课件）-encephelitis.pptVIP

Infections of the Central Nervous System Zheng dongming Pathogen Category Encephalitis:brain parenchyma Meningitis:meninges Meningoencephalitis Hematogenous disemination Neuronal spread of the virus Direct infection Herpes simplex virus encephalitisHSE The most common type viral encephalitis. Etiology and Pathogenisis HSV-I:90%(70%) trigeminal ganglia HSV (DNA) HSV-II:neunatal Pathology An acute necrotic ,asymmetric hemorrhagic process with lymphotic and plasma cell reaction. Usually involves the medial temporal and inferior frontal lobe. Clinical manifestaion Prodromal infection:fever,headache,muscle pain,diarrhea. Acute onset.last for several days ~1 or 2 months unacceptably high mortality (20–30% with acyclovir) Laboratory findings CT,MRI: Laboratory findings EEG:slow-wave, from one or two temporal or frontal lobes. CSF: Biopsy Diagnosis The diagnosis of HSE is usually established from the combination of the clinical and investigative features. definitive diagnosis:find hsv in brain or CSF by all methods . Differential Diagnosis Varicella-zoster encephalitis cytomegalovirus encephalitis gastrointestinal viral encephalitis ADEM Treatment Antiviral therapy :Acyclovir 15~30mg/kg.d 14~21 days Ganciclovir immune therapy symptomatic therapy * * all kinds of pathogens,such as virus,bacteria,Rickettsia,Spirochaeta,parasite,prion protein,etc. 1 focal or generalized seizure 2 behavioral disorders;cognitive function impaired ,memory loss 3 hemiparesis,aphasia,ataxia,ophthalmoplegia, stiff neck,etc. 4disorder of consciousness.somnolent coma 5 intracranial pressure death MRI:the most sensitive method of detecting early lesions focal oedema in the medial region of the temporal and orbital surface of the frontal lobes. Meningeal and gyral enhancement , CT usually shows reduced attenuation in one or both frontal or temporal lobes and sometimes small haemorrhages and wit