中樞神經(jīng)系統(tǒng)感染(2)-全文預(yù)覽
【正文】 e second sample should show a mononuclear cell pleocytosis. ? A disorder that may be clinically indistinguishable from viral encephalitis is the immunemediated encephalomyelitis that may follow viral infections such as influenza, measles麻疹 , or chickenpox水痘 . ? Progressive neurologic disfunction typically begins a few days after the viral illness, but can also occur either simultaneously同時(shí)發(fā)生 or up to several weeks later. ? Neurologic abnormalities result from perivenous 靜脈周圍的 demyelination脫髓鞘 , with often severely affects the brainstem. The CSF shows a lymphocytic pleocytosis腦脊液細(xì)胞數(shù)增多 , usually with cell counts of 50~150/mL, and mild protein elevation. Treatment ? Except for herpes simplex encephalitis, which is discussed separately no specific therapy for viral meningitis and encephalitis is available. ? Corticosteroids are of no proven benefit except in immunemediated postinfectious syndromes. ? Headache and fever can be treated with acetaminophen醋氨酚 , but aspirin should be avoided, especially in children and young adults, because of its association with Reye’s syndrome. ? Seizures usually respond to phenytoin 苯妥英鈉 or phenobarbital苯巴比妥 . ? Supportive measures in atose昏睡的 patients include mechanical ventilation and intravenous or nasogastric feeding鼻飼 . Prognosis ? Symptoms of viral meningitis usually resolve spontaneously within 2 weeks regardless of the causative agent, although residual deficits后遺癥 may be seen. ? The oute of viral encephalitis varies with the specific virus for example, herpes simplex virus infections are associated with severe morbidity and high mortality rates. ? Mortality rates as high as 20% have also been reported in immunemediated encephalomyelitis腦脊髓炎 following measles麻疹 infections. Herpes simplex virus (HSV) encephalitis ? HSV is the most mon cause of sporadic散發(fā)的 fatal encephalitis in the United States. ? About twothirds of cases patients over 40 years of age. ? Primary herpes infections most often present as stomatitis口炎 ( HSV type 1) or a venereally 性交的 transmitted genital生殖器 eruption出疹 (HSV tpye 2). ? The virus migr
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