中樞神經(jīng)系統(tǒng)感染(2)(已修改)
2025-06-09 01:26 本頁面
【正文】 VIRAL MENINGITIS amp。ENCEPHALITIS ? Viral meningitis refers to meningitis caused by a viral infection. ? Children and young adults are frequently affected. ? Viral meningitis is most often caused by enteric 腸道的viruses ? Viral encephalitis by childhood exanthems皮疹 , arthropodborne節(jié)肢動物 agents蟲媒性病原體 , and herpes simplex type 1. Cause 最常見 ? 柯薩奇病毒 ? ECHO病毒 ? 腸道病毒 其次 ?流行性腮腺炎 ?單純皰疹病毒 ?腺病毒 Pathology ? Viral infections can affect the central nervous system in three ways 1. 血源性播散 ： hematogenous dissemination of a systemic viral infection(eg, arthropodborne viruses蟲媒性病毒 )。 2. 軸突傳播 ： neuronal spread of the virus by axonal transport (eg, herpes simplex, rabies狂犬病病毒 )。 3. 自身免疫性感染后脫髓鞘 ： autoimmune postinfections demyelination脫髓鞘 (eg, varicella水痘病毒 , influenza). Pathologic changes in viral meningitis consist of an inflammatory meningeal reaction mediated by lymphocytes. ? 病毒性腦膜炎的病理改變是由淋巴細(xì)胞介導(dǎo)的炎性腦膜反應(yīng)。 ? Encephalitis is characterized by perivascular cuffing, lymphocytic infiltration, and microglial proliferation mainly involving subcortical gray matter regions. Internuclear or intracytoplasmic inclusions are often seen. ? 病毒性腦炎的病理改變特點是血管周圍套袖樣改變、淋巴細(xì)胞浸潤，以及累及皮層下灰質(zhì)的小膠質(zhì)增生，并經(jīng)?？梢姷胶藵{或細(xì)胞漿內(nèi)包涵體。 Clinical findingssymptoms and signs ? Clinical manifestations include fever, headache, neck stiffness, photophobia畏光 , pain with eye movement, and mild impairment of consciousness. ? Patients usually do not appear as ill as those with bacterial meningitis. ? Systemic viral infection may cause skin rash, pharyngitis咽炎 , lymphadenopathy淋巴結(jié)病 , pleuritis胸膜炎 , carditis心肌炎 , jaundice黃疸 , anomegaly器官腫大 , diarrhea腹瀉 , or orchitis睪丸炎 , and these findings may suggest a particular etiologic agent病原體 . ? Because viral encephalitis involves the brain directly, marked alterations of consciousness, seizures, and focal neurologic signs can occur. ? When signs of meningeal irritation腦膜刺激征 and brain dysfunction coexist共存 , the condition is termed meningoencephalitis腦膜腦炎 . Laboratory findings ? CSF analysis is the most important laboratory test. ?
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