中樞神經(jīng)系統(tǒng)感染-2ppt-wenkub
2024-10-04 13 本頁面
【正文】 res may also occur. ? A history of contact with known cases of tuberculosis is usually absent. 第十六頁，共六十八頁。 第十二頁，共六十八頁。腦膜及腦外表可見結(jié)核結(jié)節(jié)。 Primary infection, typically acquired by inhaling bacillus containing droplets, may be associated with metastatic dissemination of bloodborne bacilli from the lungs to the meninges and surface of the brain. Here the anisms remain in a dormant state in tubercles that can rupture into the subarachnoid space at a later time, resulting in tuberculous meningitis. 原發(fā)性感染，尤其是通過吸入含菌顆粒引起的感染，可能與血源性細(xì)菌從肺部到腦膜及大腦外表的播散有關(guān)。 第七頁，共六十八頁。 ? 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. 第三頁，共六十八頁。TUBERCULOUS MENINGITIS 結(jié)核性腦膜炎 Longnan Hospital Chenjing 第一頁，共六十八頁。 ? It should also be considered in patients form areas (eg, Asia, Africa) or groups (eg, the homeless and innercity drug users) with a high incidence of tuberculosis. 第四頁，共六十八頁。 第八頁，共六十八頁。此處的致病菌在結(jié)核結(jié)節(jié)中處于休眠狀態(tài)，后期可破入蛛網(wǎng)膜下腔，并導(dǎo)致結(jié)核菌性腦膜炎。 ? The main finding is a basal meningeal exudate滲出物 containing primarily mononuclear cells. ? Tubercles may be seen on the meninges and surfaces of the brain. 第十一頁，共六十八頁。 ? Acute tuberculous meningitis with marked involvement of the vessel walls and occlusion of smaller vessels. ? The vascular involvement can result in infarction. 第十三頁，共六十八頁。 ? Fever, signs of meningeal irritation腦膜刺激征 , and a confusional state are the most mon findings on physical examination, but all may be absent. ? Papilledema視乳頭水腫 , ocular palsies眼肌麻痹 , and hemiparesis輕偏癱 are sometimes seen. 第十七頁，共六十八頁。 hydrocephalus 第二十一頁，共六十八頁。 ? Definitive diagnosis is most often made by culturing M tuberculosis from the CSF, a process that usually takes several weeks and requires large quantities of spinal fluid for maximum yield. 第二十五頁，共六十八頁。 ? Finally, the CT scan may show contrast enhancement of the basal cisterns and cortical meninges, or hydrocephalus. 第二十九頁，共六十八頁。 it should not be withheld while awaiting culture results. ? The decision to treat is based on the CSF findings described above。 ? rifampin, 利福平 600mg。 Side effect of drugs Complications of therapy include ： ? h
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