中樞神經(jīng)系統(tǒng)感染2課件

TUBERCULOUSMENINGITIS結(jié)核性腦膜炎LongnanHospitalChenjingTUBERCULOUSMENINGITIS結(jié)核性腦膜炎Lo1Tuberculousmeningitisisaninfectionofthemembranes

膜coveringthebrainandspinalcord(meninges).Tuberculosis(TB)iscausedbythebacteriumMycobacteriumtuberculosis結(jié)核分枝桿菌andisannuallyresponsiblefornearlytwomilliondeathsworldwide.Athirdoftheworld'spopulationiscurrentlyinfectedwiththeTBbacillus,andmorethaneightmillionnewcasesarediagnosedeachyear.TuberculousmeningitisisaniTuberculousmeningitismustbeconsideredinpatientswhopresentwithaconfusionalstate,especiallyifthereisahistoryofpulmonarytuberculosis,alcoholism,corticosteroidtreatment,HIVinfection,orotherconditionassociatedwithimpairedimmuneresponses.TuberculousmeningitismustbeItshouldalsobeconsideredinpatientsformareas(eg,Asia,Africa)orgroups(eg,thehomelessandinner-citydrugusers)withahighincidenceoftuberculosis.ItshouldalsobeconsiderediCausesRiskfactorsincludeahistoryof:

AIDSExcessivealcoholusePulmonarytuberculosisWeakenedimmunesystemCauses中樞神經(jīng)系統(tǒng)感染2課件中樞神經(jīng)系統(tǒng)感染2課件中樞神經(jīng)系統(tǒng)感染2課件Pathogenesis&Pathology發(fā)病機(jī)制&病理Tuberculousmeningitisusuallyresultsfromreactivationoflatentinfectionwithmycobacteriumtuberculosis.結(jié)核性腦膜炎多是由于潛伏的結(jié)核桿菌復(fù)發(fā)感染引起的。Pathogenesis&Pathology發(fā)病機(jī)制&病Primaryinfection,typicallyacquiredbyinhalingbacilluscontainingdroplets,maybeassociatedwithmetastaticdisseminationofblood-bornebacillifromthelungstothemeningesandsurfaceofthebrain.

Heretheorganismsremaininadormantstateintuberclesthatcanruptureintothesubarachnoidspaceatalatertime,resultingintuberculousmeningitis.

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表面的播散有關(guān)。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。Primaryinfection,typicallya主要發(fā)現(xiàn)是含有大量單核細(xì)胞的腦基底部腦膜分泌物。腦膜及腦表面可見結(jié)核結(jié)節(jié)。Themainfindingisabasalmeningealexudate滲出物containingprimarilymononuclearcells.Tuberclesmaybeseenonthemeningesandsurfacesofthebrain.主要發(fā)現(xiàn)是含有大量單核細(xì)胞的腦基底部腦膜分泌物。腦膜及腦表面Theventriclemaybeenlargedasaresultofhydrocephalus,andtheirsurfacesmayshowependymalexudateorgranularependymitis.

Arteritiscanresultincerebralinfarction,andbasalinflammationandfibrosiscancompresscranialnerves.

腦積水可引起腦室擴(kuò)大，并且腦室表面可有大量室管膜滲出物或顆粒狀室管膜炎。動(dòng)脈炎可導(dǎo)致腦梗塞，而顱底部炎癥反應(yīng)和纖維化可壓迫神經(jīng)。TheventriclemaybeenlargedAcutetuberculousmeningitiswithmarkedinvolvementofthevesselwallsandocclusionofsmallervessels.Thevascularinvolvementcanresultininfarction.Acutetuberculousmeningitisw中樞神經(jīng)系統(tǒng)感染2課件中樞神經(jīng)系統(tǒng)感染2課件ClinicalFindings

A.SYMPTOMSSymptomshaveusuallybeenpresentforlessthan4weeksatthetimeofpresentationandincludefever,lethargy昏睡

orconfusion,andheadache.Weightloss,vomiting,neckstiffness,visualimpairment,diplopia復(fù)視,focalweakness,andseizuresmayalsooccur.Ahistoryofcontactwithknowncasesoftuberculosisisusuallyabsent.ClinicalFindingsA.SYMPTOMSB.SIGNSFever,signsofmeningealirritation腦膜刺激征,andaconfusionalstatearethemostcommonfindingsonphysicalexamination,butallmaybeabsent.Papilledema視乳頭水腫,ocularpalsies眼肌麻痹,andhemiparesis輕偏癱

aresometimesseen.B.SIGNSFever,signsofmeningeComplicationsincludespinalsubarachnoidblock脊髓蛛網(wǎng)膜下腔梗阻,hydrocephalus腦積水,brainedema腦水腫,cranialneverpalsies顱神經(jīng)麻痹,andstrokecausedbyvasculitisorcompressionofbloodvesselsatthebaseofthebrain因血管炎或顱底血管受壓導(dǎo)致的卒中.Complicationsincludespinals結(jié)核球結(jié)核球strokestrokehydrocephalushydrocephalusLaboratoryFindings

Onlyone-halftotwo-thirdofpatientsshowapositiveskintestfortuberculosisorevidenceofactiveorhealedtubercularinfectiononchestx-ray.LaboratoryFindingsOnlyone-hCSFThediagnosisisestablishedbyCSFanalysis.CSFpressureisusuallyincreased,andthefluidistypicallyclearandcolorlessbutmayformaclotuponstanding.Lymphocyticandmononuclearcellpleocytosisof50-500cells/mLismostoftenseen,butpolymorphonuclear多形核細(xì)胞pleocytosiscanoccurearlyandmaygiveanerroneousimpressionofbacterialmeningitis.CSFproteinisusuallymorethan100mg/dL,particularlyinpatientswithspinalsubarachnoidblock.Theglucoselevelisusuallydecreasedandmaybelessthan20mg/dL.CSFThediagnosisisestablisheAcid-fastsmears抗酸染色涂片ofCSFshouldbeperformedinallcasesofsuspectedtuberculousmeningitis,buttheyarepositiveinonlyaminorityofcases.Acid-fastsmears抗酸染色涂片ofCSFDefinitivediagnosisismostoftenmadebyculturingMtuberculosisfromtheCSF,aprocessthatusuallytakesseveralweeksandrequireslargequantitiesofspinalfluidformaximumyield.Definitivediagnosisismosto中樞神經(jīng)系統(tǒng)感染2課件中樞神經(jīng)系統(tǒng)感染2課件Thepolymerasechainreaction(PCR)聚合酶鏈反應(yīng)

hasalsobeenusedfordiagnosis.ThepolymerasechainreactionFinally,theCTscanmayshowcontrastenhancementofthebasalcisternsandcorticalmeninges,orhydrocephalus.Finally,theCTscanmayshowMRIappearanceofthetypicalpatternofcentralnervoussystemtuberculousmeningitisMRIappearanceofthetypicalDifferentialDiagnosisManyotherconditionscanasubacuteconfusionalstatewithmononuclearcell單核細(xì)胞pleocytosis腦脊液細(xì)胞增多,includingsyphilitic梅毒的,fungal,neoplastic腫瘤的,andpartiallytreatedbacterialmeningitis.Thesecanbediagnosedbyappropriatesmears涂片,cultures,andserologic血清學(xué)的andcytologicexaminations細(xì)胞學(xué)檢查.DifferentialDiagnosisManyothTreatmentTreatmentshouldbestartedasearlyaspossible;itshouldnotbewithheldwhileawaitingcultureresults.ThedecisiontotreatisbasedontheCSFfindingsdescribedabove;lymphocyticpleocytosisanddecreasedglucoseareparticularlysuggestive,evenifacid-fastsmearsarenegative.綜合治療：藥物治療、全身支持、并發(fā)癥的預(yù)防、耐藥與多耐藥TB菌感染的治療、對(duì)癥治療。藥物治療原則：早期、聯(lián)合、足量、長(zhǎng)期、頓服TreatmentTreatmentshouldbesDRUGSFourdrugsareusedforinitialtherapy,untilcultureandsusceptibilitytestresultsareknown.四聯(lián)治療isoniazid,異煙肼300mg;rifampin,利福平600mg;pyrazinamide,吡嗪酰胺25mg/kg;ethambutol,乙胺丁醇15mg/kg,eachgivenorallyoncedaily.DRUGSFourdrugsareusedforiForsusceptiblestrains,ethambutol乙胺丁醇canbediscontinued,andtripletherapycontinuedfor2months,followedby4-10monthsoftreatmentwithisoniazid異煙肼andrifampin利福平alone.Pyridoxine,維生素B650mg/d,canbeusedtodecreasethelikelihood可能性ofisoniazid-inducedpolyneuropathy.Forsusceptiblestrains,ethamSideeffectofdrugsComplicationsoftherapyinclude：hepatic肝臟的dysfunction(isoniazid異煙肼,rifampin利福平,andpyrazinamide吡嗪酰胺

)polyneuropathy多神經(jīng)炎

(isoniazid)opticneuritis(ethambutol乙胺丁醇)seizures(isoniazid)ototoxicity耳毒性(streptomycin鏈霉素)SideeffectofdrugsComplicatiCorticosteroidsPrednisone潑尼松60mg/dorallyinadultsor1-3mg/kg/dorallyinchildren,taperedgraduallyover3-4weeksCorticosteroidsareindicatedasadjunctive輔助的therapyinpatientswithspinalsubarachnoidblock.Theymayalsobeindicatedinseriouslyillpatientswithfocalneurologicsignsorwithincreasedintracranialpressurefromcerebraledema.CorticosteroidsPrednisone潑尼松Theriskofusingcorticosteroidsmaybehigh,howeverespeciallyiftuberculousmeningitishasbeenmistakenlydiagnosedinapatientwithfungalmeningitis.Therefore,iffungalmeningitishasnotbeenexcluded,antifungaltherapyshouldbeaddedalongwithcorticosteroids.TheriskofusingcorticosteroPrognosisEvenwithappropriatetreatment,aboutone-thirdofpatientswithtuberculousmeningitissuccumb死.Comaatthetimeofpresentationisthemostsignificantpredictorofapoorprognosis.PrognosisEvenwithappropriateCerebralCysticercosis腦囊蟲病CerebralCysticercosis腦囊蟲病CysticercosisiscommoninMexico,CentralandSouthAmerica,westernandsouthernAfrica,India,China,andsoutheastAsia.CysticercosisiscommoninMexThediseasefollowsingestionoflarvae幼蟲

oftheporktapeworm(taeniasolium-豬肉絳蟲)andaffectsthebrainin60-90%ofcases.Thediseasefollowsingestion中樞神經(jīng)系統(tǒng)感染2課件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。囊蟲的囊尾蚴囊腫常為圓形或卵圓形，內(nèi)膜上有一小白色的囊蟲結(jié)節(jié)突起。當(dāng)蟲體死亡或液化時(shí)，囊腔內(nèi)為暗褐色混濁液體，內(nèi)含大量蛋白質(zhì)、當(dāng)蟲體液化被吸收后囊腔變小，囊壁增厚，囊蟲死后常發(fā)生鈣化。

Pathology病理上典型的包囊大小為5~10mm，可有薄中樞神經(jīng)系統(tǒng)感染2課件中樞神經(jīng)系統(tǒng)感染2課件中樞神經(jīng)系統(tǒng)感染2課件中樞神經(jīng)系統(tǒng)感染2課件中樞神經(jīng)系統(tǒng)感染2課件ClinicalFindingLarvaeundergohematogenous血源性dissemination,formingcysts囊腫

inthebrain,ventricles腦室,andsubarachnoidspace.Neurologicmanifestationsofcysticercosisresultfrom1.themasseffect占位效應(yīng)

ofintraparenchymal腦實(shí)質(zhì)內(nèi)cysts2.obstructionofCSFflowbyintraventricularcysts3.inflammationthatcausebasilarmeningitis.ClinicalFindingLarvaeundergoTheyincludeseizures,headache,focalneurologicsigns,hydrocephalus腦積水,myelopathy脊髓病,andsubacutemeningitis.Peripheralbloodeosinophilia嗜酸性細(xì)胞增多癥,softtissuecalcifications鈣化,orparasites寄生蟲

inthestool糞便suggestthediagnosis.Theyincludeseizures,headach

LaboratoryFindings

TheCSFtypicallyshowsalymphocyticpleocytosis(＜100cells/mL),witheosinophils嗜酸細(xì)胞usuallypresent.Openingpressureisoftenincreasedbutmaybedecreasedwithspinalsubarachnoidblock;ifthisissuspectedmyelography椎管造影術(shù)shouldbeperformed.Proteinisincreasedto50-100mg/dL,andglucoseis20-50mg/dLinmostcases.Complementfixation補(bǔ)體結(jié)合andhemagglutination紅血球凝聚studiescanassistinthediagnosis.LaboratoryFindingsTheCSFtTheCTscanorMRImayshowcontrast-enhancedmasslesionswithsurroundingedema,intracerebralcalcifications,orventricularenlargement.

TheCTscanorMRImayshowcoMRI活動(dòng)期：T1加權(quán)像囊蟲呈圓形低信號(hào)，頭節(jié)呈點(diǎn)狀或逗點(diǎn)狀高信號(hào)，T2加權(quán)像囊蟲呈圓形高信號(hào)，頭節(jié)呈點(diǎn)狀低信號(hào)。退變死亡期：T1加權(quán)像水腫區(qū)低信號(hào)內(nèi)有高信號(hào)環(huán)或結(jié)節(jié)，或僅有低信號(hào)區(qū)；T2加權(quán)像水腫區(qū)高信號(hào)，內(nèi)有低信號(hào)環(huán)或結(jié)節(jié)。非活動(dòng)期：T1\T2加權(quán)像上多呈圓形低信號(hào)?；祀s期：T1\T2加權(quán)像上均呈混雜密度病灶。MRI活動(dòng)期：T1加權(quán)像囊蟲呈圓形低信號(hào)，頭節(jié)呈點(diǎn)Vesicular囊狀的colloidal膠體的granular顆粒狀的calcified鈣化的Vesicular囊狀的col中樞神經(jīng)系統(tǒng)感染2課件中樞神經(jīng)系統(tǒng)感染2課件中樞神經(jīng)系統(tǒng)感染2課件

AxialbrainMRI.aT1-W,bT2-W,cFLAIRanddcontrast-enhancedT1-Wsequences.Imagesrevealinnumerablecystsinbilateralbasalganglia(arrowsinaandb)andcerebralhemispheres,givingthe“starry-sky”pattern.Afewlesionsdemonstrateperifocaloedemaandring-enhancement(arrowsincandd)suggestiveofthecolloidvesicularstageAxialbrainMRI.aT1-W,MRI.SagittalbrainT2-Wimagesshowcysticerciintheextra-orbitalmuscles(arrow)(a)andtongue(arrows)(b)aswellasinthecranialandcervicalmuscles.cSagittalspineT2-Wimagerevealshyperintenselesionsinnearlyeveryparaspinalmuscle(arrows)MRI.SagittalbrainT2-WimageTreatmentTheindicationsoftreatmentofcerebralcysticercosisarecontroversial有爭(zhēng)論的.However,patientswithsymptomaticneurologicinvolvement(usuallyseizures)andeithermeningitisoroneormorenoncalcified非鈣化的intraparenchymalcystsshouldbetreated.Intraventricular,subarachnoid,andracemosecystsrespondpoorlytotreatmentCalcifiedcystsdonotrequiretreatment.TreatmentTheindicationsoftrAlbendazole,阿苯達(dá)唑15mg/kg/dinthreedosestakenwithmeals,andcontinuedfor8days,isthepreferredtherapy.Praziquantel,吡喹酮50mg/kg/dinthreedivideddoses,canalsobeused,butbloodlevelsarereducedbyanticonvulsants抗驚厥藥andcorticosteroids皮質(zhì)類固醇,whichareoftenrequiredinthesepatients.Albendazole,阿苯達(dá)唑15mg/kg/dinPatientswithseizuresshouldalsoreceiveanticonvulsants.Corticosteroidsareindicatedforincreasedintracranialpressureorlesionsnearthecerebralaqueduct中腦導(dǎo)水管orintraventricularforamina室間孔;thesemayprogresstocauseobstructivehydrocephalus梗阻性腦積水.Singleaccessibleintraparenchymal腦實(shí)質(zhì)內(nèi)lesionscanberemovedsurgically,andshunting分流術(shù)isrequiredforintraventricularlesionscausinghydrocephalus.Patientswithseizuresshould中樞神經(jīng)系統(tǒng)感染2課件中樞神經(jīng)系統(tǒng)感染2課件中樞神經(jīng)系統(tǒng)感染2課件中樞神經(jīng)系統(tǒng)感染2課件中樞神經(jīng)系統(tǒng)感染2課件TUBERCULOUSMENINGITIS結(jié)核性腦膜炎LongnanHospitalChenjingTUBERCULOUSMENINGITIS結(jié)核性腦膜炎Lo68Tuberculousmeningitisisaninfectionofthemembranes

膜coveringthebrainandspinalcord(meninges).Tuberculosis(TB)iscausedbythebacteriumMycobacteriumtuberculosis結(jié)核分枝桿菌andisannuallyresponsiblefornearlytwomilliondeathsworldwide.Athirdoftheworld'spopulationiscurrentlyinfectedwiththeTBbacillus,andmorethaneightmillionnewcasesarediagnosedeachyear.TuberculousmeningitisisaniTuberculousmeningitismustbeconsideredinpatientswhopresentwithaconfusionalstate,especiallyifthereisahistoryofpulmonarytuberculosis,alcoholism,corticosteroidtreatment,HIVinfection,orotherconditionassociatedwithimpairedimmuneresponses.TuberculousmeningitismustbeItshouldalsobeconsideredinpatientsformareas(eg,Asia,Africa)orgroups(eg,thehomelessandinner-citydrugusers)withahighincidenceoftuberculosis.ItshouldalsobeconsiderediCausesRiskfactorsincludeahistoryof:

AIDSExcessivealcoholusePulmonarytuberculosisWeakenedimmunesystemCauses中樞神經(jīng)系統(tǒng)感染2課件中樞神經(jīng)系統(tǒng)感染2課件中樞神經(jīng)系統(tǒng)感染2課件Pathogenesis&Pathology發(fā)病機(jī)制&病理Tuberculousmeningitisusuallyresultsfromreactivationoflatentinfectionwithmycobacteriumtuberculosis.結(jié)核性腦膜炎多是由于潛伏的結(jié)核桿菌復(fù)發(fā)感染引起的。Pathogenesis&Pathology發(fā)病機(jī)制&病Primaryinfection,typicallyacquiredbyinhalingbacilluscontainingdroplets,maybeassociatedwithmetastaticdisseminationofblood-bornebacillifromthelungstothemeningesandsurfaceofthebrain.

Heretheorganismsremaininadormantstateintuberclesthatcanruptureintothesubarachnoidspaceatalatertime,resultingintuberculousmeningitis.

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表面的播散有關(guān)。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。Primaryinfection,typicallya主要發(fā)現(xiàn)是含有大量單核細(xì)胞的腦基底部腦膜分泌物。腦膜及腦表面可見結(jié)核結(jié)節(jié)。Themainfindingisabasalmeningealexudate滲出物containingprimarilymononuclearcells.Tuberclesmaybeseenonthemeningesandsurfacesofthebrain.主要發(fā)現(xiàn)是含有大量單核細(xì)胞的腦基底部腦膜分泌物。腦膜及腦表面Theventriclemaybeenlargedasaresultofhydrocephalus,andtheirsurfacesmayshowependymalexudateorgranularependymitis.

Arteritiscanresultincerebralinfarction,andbasalinflammationandfibrosiscancompresscranialnerves.

腦積水可引起腦室擴(kuò)大，并且腦室表面可有大量室管膜滲出物或顆粒狀室管膜炎。動(dòng)脈炎可導(dǎo)致腦梗塞，而顱底部炎癥反應(yīng)和纖維化可壓迫神經(jīng)。TheventriclemaybeenlargedAcutetuberculousmeningitiswithmarkedinvolvementofthevesselwallsandocclusionofsmallervessels.Thevascularinvolvementcanresultininfarction.Acutetuberculousmeningitisw中樞神經(jīng)系統(tǒng)感染2課件中樞神經(jīng)系統(tǒng)感染2課件ClinicalFindings

A.SYMPTOMSSymptomshaveusuallybeenpresentforlessthan4weeksatthetimeofpresentationandincludefever,lethargy昏睡

orconfusion,andheadache.Weightloss,vomiting,neckstiffness,visualimpairment,diplopia復(fù)視,focalweakness,andseizuresmayalsooccur.Ahistoryofcontactwithknowncasesoftuberculosisisusuallyabsent.ClinicalFindingsA.SYMPTOMSB.SIGNSFever,signsofmeningealirritation腦膜刺激征,andaconfusionalstatearethemostcommonfindingsonphysicalexamination,butallmaybeabsent.Papilledema視乳頭水腫,ocularpalsies眼肌麻痹,andhemiparesis輕偏癱

aresometimesseen.B.SIGNSFever,signsofmeningeComplicationsincludespinalsubarachnoidblock脊髓蛛網(wǎng)膜下腔梗阻,hydrocephalus腦積水,brainedema腦水腫,cranialneverpalsies顱神經(jīng)麻痹,andstrokecausedbyvasculitisorcompressionofbloodvesselsatthebaseofthebrain因血管炎或顱底血管受壓導(dǎo)致的卒中.Complicationsincludespinals結(jié)核球結(jié)核球strokestrokehydrocephalushydrocephalusLaboratoryFindings

Onlyone-halftotwo-thirdofpatientsshowapositiveskintestfortuberculosisorevidenceofactiveorhealedtubercularinfectiononchestx-ray.LaboratoryFindingsOnlyone-hCSFThediagnosisisestablishedbyCSFanalysis.CSFpressureisusuallyincreased,andthefluidistypicallyclearandcolorlessbutmayformaclotuponstanding.Lymphocyticandmononuclearcellpleocytosisof50-500cells/mLismostoftenseen,butpolymorphonuclear多形核細(xì)胞pleocytosiscanoccurearlyandmaygiveanerroneousimpressionofbacterialmeningitis.CSFproteinisusuallymorethan100mg/dL,particularlyinpatientswithspinalsubarachnoidblock.Theglucoselevelisusuallydecreasedandmaybelessthan20mg/dL.CSFThediagnosisisestablisheAcid-fastsmears抗酸染色涂片ofCSFshouldbeperformedinallcasesofsuspectedtuberculousmeningitis,buttheyarepositiveinonlyaminorityofcases.Acid-fastsmears抗酸染色涂片ofCSFDefinitivediagnosisismostoftenmadebyculturingMtuberculosisfromtheCSF,aprocessthatusuallytakesseveralweeksandrequireslargequantitiesofspinalfluidformaximumyield.Definitivediagnosisismosto中樞神經(jīng)系統(tǒng)感染2課件中樞神經(jīng)系統(tǒng)感染2課件Thepolymerasechainreaction(PCR)聚合酶鏈反應(yīng)

hasalsobeenusedfordiagnosis.ThepolymerasechainreactionFinally,theCTscanmayshowcontrastenhancementofthebasalcisternsandcorticalmeninges,orhydrocephalus.Finally,theCTscanmayshowMRIappearanceofthetypicalpatternofcentralnervoussystemtuberculousmeningitisMRIappearanceofthetypicalDifferentialDiagnosisManyotherconditionscanasubacuteconfusionalstatewithmononuclearcell單核細(xì)胞pleocytosis腦脊液細(xì)胞增多,includingsyphilitic梅毒的,fungal,neoplastic腫瘤的,andpartiallytreatedbacterialmeningitis.Thesecanbediagnosedbyappropriatesmears涂片,cultures,andserologic血清學(xué)的andcytologicexaminations細(xì)胞學(xué)檢查.DifferentialDiagnosisManyothTreatmentTreatmentshouldbestartedasearlyaspossible;itshouldnotbewithheldwhileawaitingcultureresults.ThedecisiontotreatisbasedontheCSFfindingsdescribedabove;lymphocyticpleocytosisanddecreasedglucoseareparticularlysuggestive,evenifacid-fastsmearsarenegative.綜合治療：藥物治療、全身支持、并發(fā)癥的預(yù)防、耐藥與多耐藥TB菌感染的治療、對(duì)癥治療。藥物治療原則：早期、聯(lián)合、足量、長(zhǎng)期、頓服TreatmentTreatmentshouldbesDRUGSFourdrugsareusedforinitialtherapy,untilcultureandsusceptibilitytestresultsareknown.四聯(lián)治療isoniazid,異煙肼300mg;rifampin,利福平600mg;pyrazinamide,吡嗪酰胺25mg/kg;ethambutol,乙胺丁醇15mg/kg,eachgivenorallyoncedaily.DRUGSFourdrugsareusedforiForsusceptiblestrains,ethambutol乙胺丁醇canbediscontinued,andtripletherapycontinuedfor2months,followedby4-10monthsoftreatmentwithisoniazid異煙肼andrifampin利福平alone.Pyridoxine,維生素B650mg/d,canbeusedtodecreasethelikelihood可能性ofisoniazid-inducedpolyneuropathy.Forsusceptiblestrains,ethamSideeffectofdrugsComplicationsoftherapyinclude：hepatic肝臟的dysfunction(isoniazid異煙肼,rifampin利福平,andpyrazinamide吡嗪酰胺

)polyneuropathy多神經(jīng)炎

(isoniazid)opticneuritis(ethambutol乙胺丁醇)seizures(isoniazid)ototoxicity耳毒性(streptomycin鏈霉素)SideeffectofdrugsComplicatiCorticosteroidsPrednisone潑尼松60mg/dorallyinadultsor1-3mg/kg/dorallyinchildren,taperedgraduallyover3-4weeksCorticosteroidsareindicatedasadjunctive輔助的therapyinpatientswithspinalsubarachnoidblock.Theymayalsobeindicatedinseriouslyillpatientswithfocalneurologicsignsorwithincreasedintracranialpressurefromcerebraledema.CorticosteroidsPrednisone潑尼松Theriskofusingcorticosteroidsmaybehigh,howeverespeciallyiftuberculousmeningitishasbeenmistakenlydiagnosedinapatientwithfungalmeningitis.Therefore,iffungalmeningitishasnotbeenexcluded,antifungaltherapyshouldbeaddedalongwithcorticosteroids.TheriskofusingcorticosteroPrognosisEvenwithappropriatetreatment,aboutone-thirdofpatientswithtuberculousmeningitissuccumb死.Comaatthetimeofpresentationisthemostsignificantpredictorofapoorprognosis.PrognosisEvenwithappropriateCerebralCysticercosis腦囊蟲病CerebralCysticercosis腦囊蟲病CysticercosisiscommoninMexico,CentralandSouthAmerica,westernandsouthernAfrica,India,China,andsoutheastAsia.CysticercosisiscommoninMexThediseasefollowsingestionoflarvae幼蟲

oftheporktapeworm(taeniasolium-豬肉絳蟲)andaffectsthebrainin60-90%ofcases.Thediseasefollowsingestion中樞神經(jīng)系統(tǒng)感染2課件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。囊蟲的囊尾蚴囊腫常為圓形或卵圓形，內(nèi)膜上有一小白色的囊蟲結(jié)節(jié)突起。當(dāng)蟲體死亡或液化時(shí)，囊腔內(nèi)為暗褐色混濁液體，內(nèi)含大量蛋白質(zhì)、當(dāng)蟲體液化被吸收后囊腔變小，囊壁增厚，囊蟲死后常發(fā)生鈣化。

Pathology病理上典型的包囊大小為5~10mm，可有薄中樞神經(jīng)系統(tǒng)感染2課件中樞神經(jīng)系統(tǒng)感染2課件中樞神經(jīng)系統(tǒng)感染2課件中樞神經(jīng)系統(tǒng)感染2課件中樞神經(jīng)系統(tǒng)感染2課件ClinicalFindingLarvaeundergohematogenous血源性dissemination,formingcysts囊腫

inthebrain,ventricles腦室,andsubarachnoidspace.Neurologicmanifestationsofcysticercosisresultfrom1.themasseffect占位效應(yīng)

ofintraparenchymal腦實(shí)質(zhì)內(nèi)cysts2.obstructionofCSFflowbyintraventricularcysts3.inflammationthatcausebasilarmeningitis.ClinicalFindingLarvaeundergoTheyincludeseizures,headache,focalneurologicsigns,hydrocephalus腦積水,myelopathy脊髓病,andsubacutemeningitis.Peripheralbloodeosinophilia嗜酸性細(xì)胞增多癥,softtissuecalcifications鈣化,orparasites寄生蟲

inthestool糞便suggestthediagnosis.Theyincludeseizures,headach

LaboratoryFindings

TheCSFtypicallyshowsalymphocyticpleocytosis(＜100cells/mL),witheosinophils嗜酸細(xì)胞usuallypresent.Openingpressureisoftenincreasedbutmaybedecreasedwithspinalsubarachnoidblock;ifthisissuspectedmyelography椎管造影術(shù)shouldbeperformed.Proteinisincreasedto50-100mg/dL,andglucoseis20-50mg/dLinmostcases.Complementfixation補(bǔ)體結(jié)合andhemagglutination紅血球凝聚studiescanassistinthediagnosis.LaboratoryFindingsTheCSFtTheCTscanorMRImayshowcontrast-enhancedmasslesionswiths