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Infections of the Central Nervous System

Infections of the Central Nervous System. Zheng dongming. Pathogen. all kinds of pathogens,such as virus,bacteria,Rickettsia,Spirochaeta,parasite,prion protein,etc. Encephalitis:brain parenchyma Meningitis:meninges Meningoencephalitis. Hematogenous disemination

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Infections of the Central Nervous System

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  1. Infections of the Central Nervous System Zheng dongming

  2. Pathogen all kinds of pathogens,such as virus,bacteria,Rickettsia,Spirochaeta,parasite,prion protein,etc.

  3. Encephalitis:brain parenchyma Meningitis:meninges Meningoencephalitis Hematogenous disemination Neuronal spread of the virus Direct infection Category

  4. Herpes simplex virus encephalitisHSE • The most common type viral encephalitis.

  5. Etiology and Pathogenisis • HSV-I:90%(70%) • trigeminal ganglia • HSV • (DNA) • HSV-II:neunatal

  6. Pathology • An acute necrotic ,asymmetric hemorrhagic process with lymphotic and plasma cell reaction. • Usually involves the medial temporal and inferior frontal lobe.

  7. 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) 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

  8. Laboratory findings • CT,MRI: 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 with midline shift.

  9. Laboratory findings • EEG:slow-wave, from one or two temporal or frontal lobes. • CSF: • Biopsy Pressure:normal or increased cell:lymphocyte and monocyte increased ,RBC. protein:increased mild glucose and CL-:normal pathogen:antigen,antibody,DNA.

  10. 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 .

  11. Differential Diagnosis • Varicella-zoster encephalitis • cytomegalovirus encephalitis • gastrointestinal viral encephalitis • ADEM

  12. Treatment • Antiviral therapy :Acyclovir 15~30mg/kg.d 14~21 days Ganciclovir • immune therapy • symptomatic therapy High fever seizure high intracranial pressure infections

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