中樞神經(jīng)系統(tǒng)感染(2)-資料下載頁
2025-05-28 01:26本頁面
【正文】 檢定 ? ELASA是現(xiàn)今國際上通用的 HSV抗體檢測方法。 ? 本方法采用雙份血清和雙份腦脊液作 HSV1抗體的動(dòng)態(tài)檢測。 ? 診斷標(biāo)準(zhǔn)： 雙份 CSF抗體有增高趨勢，滴度 1:8以上； 雙份 CSF抗體 4倍以上升高； 血與 CSF的抗體比值＜ 40。 Laboratory FindingsEEG ? The EEG may show periodic周期的 slowwave plexes arising from one or both temporal lobes Laboratory Findings CT MRI ? CT scans and MRI may show abnormalities in one or both temporal lobes. These can extend to frontal or parietal regions頂區(qū) and are sometimes enhanced with the infusion注入 of contrast material造影劑 . ? However, imaging studies may also be normal. Diagnosis Differential Diagnosis ? The symptoms and signs are not specific for herpes virus infection. The greatest diagnostic difficulty is distinguishing between HSV encephalitis and brain abscess腦膿腫 , and the tow disorders often cannot be differentiated on clinical grounds alone. brain abscess brain abscess ? Other CNS infections and vasculitis血管炎 can also mimic HSV encephalitis. Deginitive diagnosis can be made by biopsy of affected brain areas, with the choice of biopsy site guided by the EEG, CT, or MRI findings. ? However, because treatment is most effective when begun early and is paratively safe, the most mon approach is to treat patients with possible HSV encephalitis as described below and to reserve biopsy for those who fail to improve. Treatment ? The most effective drug is acyclovir阿昔洛韋 ? Given intravenously at a dosage of 10~15mg/kg every 8 hours, with each dose given over 1 hour. ? Treatment is continued for 14~21 days. ? Complications include erythema紅斑 at the infusion site, gastrointestinal 胃腸道 disturbances, headache, skin rash, tremor, seizures, and encephalopathy腦病 or a. ? Treatment is started as early as possible, since oute is greatly influenced by the severity of dysfunction at the time treatment is initiated. 腎上腺皮質(zhì)激素 ? 地塞米松 ? 甲潑尼龍 Prognosis ? Patients under the age of 30 years and those who are only lethargic昏睡的 at the onset of treatment are more likely to survive than are older or atose patients. ? The mortality rate is about 25% at 18 months in patients given acyclovir阿昔洛韋 .
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