文档介绍：中枢神经系统感染医学知识讲座
第一节 概述
Term: Infections of CNS
All kinds of pathogen (bacteia,viruses,spirochete ,parasites,fungi,rickettsia and prion prottein)
invade cerebral parenchyma, meninges and blood vessel lead to acute and subacute infections.
第一节 概述
分类: 感染 部位 ; 发病情况及病程 ; 特异性致病因子
CNS感染路径(pathway of infection)
①hematogenous spread;
②direct infection ;
③Peripheral nerves pathway
CNS病毒感染性疾病新 认识
第二节 病毒感染性疾病 Viral infections of CNS
单纯疱疹病毒性脑炎
Herpes Simplex Encephalitis
Creutzfeldt-Jakob Disease
Herpes Simplex Encephalitis
病因及发病机制( Causes and Mechanisms)
病理（pathology)
临床表现 (Clinical features)
辅助检验 (laboratory finding)
诊疗及判别诊疗 (Diagnosis and Differential Diagnosis)
诊疗（treatment)
HSE--Causes and Mechanisms
HSV-嗜神经(neurotropic )DNA病毒
90% 人类HSE是由I型引发
70%HSE起因于内源性病毒 活化 (复发性疱疹感染 )
25% 病例是原发感染 (口腔和呼吸道 )
6%~15%系由II型所致 (产妇生殖道HSV-II原发感染 )
绝大多数新生儿 HSE系HSV-II引发
HSE-- Pathology
颞叶、额叶等部位出血性坏死 |、渗出
急性期后可见小胶质细胞增生
Intense hemorrhagic necrosis of the inferior and medial parts of the temporal lobes and the medial-orbital parts of the frontal lobes.
HSE-Pathology
Cowdry A型包涵体 (A type inclusion body)存在于病灶边缘 部分神经细胞核内 及星型细胞和少突胶质细胞核内。
HSE-- Clinical feature
1．任何年纪、季节均可发病原发感染 潜伏期为2~21天, 平均6天; 前驱期症状
2．病程 多急性起病 , 口唇疱疹史 （1/4）, 高热, 首发症状 : 头痛、轻微 意识和人格改变 或全身性或部分性运动性发作 ; 病情缓慢进展精神症状表现突出智能障碍也较显著
3 ．神经症状 局灶性脑损害 ; 脑膜刺激征 ; 意识障碍 ; 全身性或部分性癫痫 。重症脑疝形成而死亡 （死亡率高达40%~70% ）。
HSE-Clinical feature
occurs sporadically throughout the year and in patients of all ages. During prodromal stage:fever,headache,muscular ache etc.
onset is acute,patients may had herpes labialis(1/4) and early manifestations:headach,personality change,slight concious disorder and seizures .Psychotic behavior, memory loss become evident later.