中樞神經(jīng)系統(tǒng)感染-2ppt(完整版)
【正文】 。 ? 退變死亡期： T1加權(quán)像水腫區(qū)低信號內(nèi)有高信號環(huán)或結(jié)節(jié)，或僅有低信號區(qū)； T2加權(quán)像水腫區(qū)高信號，內(nèi)有低信號環(huán)或結(jié)節(jié)。 第四十七頁，共六十八頁。 第四十二頁，共六十八頁。 ? For susceptible strains, ethambutol乙胺丁醇 can be discontinued, and triple therapy continued for 2 months, followed by 410 months of treatment with isoniazid異煙肼 and rifampin利福平 alone. ? Pyridoxine,維生素 B6 50mg/d, can be used to decrease the likelihood可能性of isoniazidinduced polyneuropathy. 第三十四頁，共六十八頁。 Treatment ? Treatment should be started as early as possible。 ? Acidfast smears抗酸染色涂片 of CSF should be performed in all cases of suspected tuberculous meningitis , but they are positive in only a minority of cases. 第二十四頁，共六十八頁。 Clinical Findings A. SYMPTOMS ? Symptoms have usually been present for less than 4 weeks at the time of presentation and include fever, lethargy昏睡 or confusion, and headache. Weight loss, vomiting, neck stiffness, visual impairment, diplopia 復(fù)視 , focal weakness, and seizures may also occur. ? A history of contact with known cases of tuberculosis is usually absent. 第十六頁，共六十八頁。腦膜及腦外表可見結(jié)核結(jié)節(jié)。 第七頁，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。 第八頁，共六十八頁。 ? 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。 ? 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。 ? 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。 it should not be withheld while awaiting culture results. ? The decision to treat is based on the CSF findings described above。 Side effect of drugs Complications of therapy include ： ? hepatic 肝臟的 dysfunction (isoniazid異煙肼 , rifampin利福平 , and pyrazinamide吡嗪酰胺 ) ? polyneuropathy多神經(jīng)炎 (isoniazid) ? optic neuritis (ethambutol乙胺丁醇 ) ? seizures (isoniazid) ? ototoxicity 耳毒性 (streptomycin鏈霉素 ) 第三十五頁，共六十八頁。 Pathology 病理上典型的包囊大小為 5~10mm，可有薄壁，或呈多個(gè)囊腔，內(nèi)有囊尾蚴。 第四十八頁，共六十八頁。 ? 非活動(dòng)期： T1\T2加權(quán)像上多呈圓形低信號。 ? MRI. Sagittal brain T2W images show cysticerci in the extra
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