Infections of Central Nervous System

1. Infections of Central Nervous System

2. Section one: Survey Ⅰ.concept : all kinds of pathogens of organisms intrude into cerebral parenchyma, cerebral membrane, vasculature et.al ,causing acute or chronic disease of inflammation . Ⅱ.pathogen virus 、 bacteria 、 spirochet、 worms、 rickettsia、prion.

3. Ⅲ Infection’site 1.parenchyma: encephalitis , myelitis encephalomyelitis. 2.meninges: meningitis, pachymeningitis. 3.both of parenchyma and meninges : meningoencephalitis.

4. Ⅳ Infection’s pathway 1.infection through circulation 2.direct infection : trauma ,otitis media 3.retrograde along peripheral nerves

5. Section twoherpes simplex virus encephalitis Ⅰ.concept: It is inflammation of the brain parenchyma, caused by herpes simplex virus.

6. Ⅱ etiology and mechanism 1.etiology: HSV, HSV is a neurotrophic DNA virus (Ⅰ、Ⅱmold ) 2. mechanism: HSV-Ⅰ：90 percent 1) Original onset 2) succeed onset HSV-Ⅱ: 6 to 15 percent , neonate

7. Ⅲ pathology 1 .hemorrhagic necrosis: in bilateral temporal , frontal lobe. 2.Cowdry A inclusion: intranuclear eosinophilic inclusion

8. Ⅳclinical manifestation 1. any age and any season ,acute attack. 2 .prodromic symptom 3. mental symptom 4. convulsion 5. disturbance of consciousness 6. focal symptom: 7 .meningeal irritation

9. Ⅴ investigation 1.EEG 2.CT or MRI 3.CSF 4.pathogen of CSF 1) antigen 2) antibody 3) HSV－DNA

10. Ⅵ diagnosis 1 .clinical diagnosis 1) recurrent or recent herpes infection 2) fever, headache, mental symptom convulsion ,disturbance of consciousness , focal signs. 3)CSF ,EEG, CT, MRI 4)responsive to specific antivirus agent

11. 2 definite diagnosis besides the above, the followings are needed 1)CSF: HSV－antigen, HSV－Ab 2)brain biopsy or pathology: Cowdry in intranuclear 3)CSF: the DNA of the HSV(PCR) 4)cerebral tissue or specimen of the CSF:HSV 5)except other viral encephalitis

12. Ⅶ differential diagnosis • Other viral encephalitis－pathogen • Psychosis • Demyelination disease

13. Ⅷ treatment 1 、antivirotic chemotherapy: Acyclovir ； Cancilovir 2 、immune therapy: interferon 、 trans-factor、 corticosteroids 3、supportive therapy: water-electrolyte balance infection: antibiofics ICP: mannitol

14. Section threeCryptococcosis Ⅰ.definition: cryptococcosis is one of the most commonly fungal infection of CNS, the meningitis is caused by cryptococcus. Ⅱ.etiology: cryptococcus

15. Ⅲ Pathogenesis 1.cryptococcus distribution 2.infection path 3.Conditioned pathogenic bacteria 1) reduction in immune capacity of body 2) debilitating diseases ,especially immune deficit diseases:

16. Ⅳ pathology 1.meningovascular lesion 2.granuloma, nodule ,abscess 3.cryptococcus

17. Ⅴclinical manifestation 1.onset: insidious subacute or acute 2.early symptom 3.main symptoms 4.mental change 5.focal neurologic deficit 6.others ：hydrocephalus

18. Ⅶ investigation 1.CSF 2.cranium CT or MRI: 3.lung X-ray : pulmonary lesions

19. Ⅷ diagnosis 1.chronic and debilitating disease or general physical immune deficit disease 2.chronic or insidious course 3.mainly clinical manifestation 4.CSF: cyptococcous

20. Ⅵ differential diagnosis tuberculous meningitis 1)fever 2)distinctive pulmonary lesions 3)organisms in CSF

21. Ⅸ treatment 1.Anti-fungus therapy 1)amphotericin B 2)fluconazole 3)flucytosine,5-FC 2.supportive therapy

22. Ⅹ prognosis The patient’condition is steadily progressive worsened.It may be fatal with a few month if untreated . Average course of disease is 6 months.

23. dementia • Section one summary • Section two Alzheimer

24. Summary of the dementia Ⅰ.concept: It is an acquired and continual impairment of intelligence, caused by cerebral dysfunction.

25. Ⅱ classification 1.degenerative dementing disorder Alzheimer disease Pick’ disease and Frontotemporal dementia Lewy body dementia 2.nondegenerative demening disorder vascular dementia infective dementing disorder metabolic encephalopathy

26. Section twoAlzheimer disease Ⅰ.definition: Alzheimer’disease is identified the presence of senile plaques and neurofibrillary tangles in the brain and cause memorial, cognitive and psychic impairment . It is the most common neuro－degeneration disease.

27. Ⅱetiology and pathogenesis 1、etiology: unclear, may be relation with inheritance and environments. 2、pathogenesis: 1) reduction in choline acetyltransferase(CHAT) and acetylcholine(ACH) in the hippocampus and neocortex. 2)cholinergicfibres of neocotex originate nucleus basolis of meynert.

28. Ⅱetiology and pathogenesis 3)inheritance mechanism: (1) 10 percent patients with pedigree history. (2) amyloid precursor protein, APP presenilin 1,PS1 Presenilin 2,PS2 4) environment effect

29. Ⅲ pathology 1 .Senile plaques. 2.neurofibrillay tangles 3.granulovacuolar degeneration 4.cerebral amyloid angiopathy.

30. Ⅳclinical manifestation 1.memory impairment 2.cognitive impairment 1)language impairment 2)arithmetic impairment 3)visuospatial disorientation. 4)skill action impairment. 3.psychic impairment 4.Others :

31. Ⅴ investigation 1.CSF 2.MRI or CT 3.PET SPET and functional MRI 4.neural psychology examination

32. Ⅵ diagnosisprobable Alzheimer disease Diagnosis 1.dementia defined by clinical examination 2.deficits in two or more are of cognition 3.progressive worsening of memory and other cognitive functions. 4.absence of disturbed consciousness, and accompanying abnormality in mental and behavior. 5.age of patient: over 40 year. 6.exclusion of other brain diseases

33. Definite diagnosis (Using these criteria, the correct diagnosis is achieved in more than 85 percent of patients.) A definite diagnosis can be made only from pathologic findings. A typical history with progressive dementia and negative findings in routine test will allow a diagnosis of probable.

34. Ⅶ differential diagnosis 1.Pick’disease 2.Vascular dementia

35. Ⅷ treatment 1.Tacrine 2 .aricept (donepezil) 3.Exelon, rivastigmine 4.Huperzine A