流行脑脊髓膜炎 epidemic cerebrospinal meningitis流行性脑脊髓膜炎流行脑脊髓膜炎课件

1、Chapter 14 Diseases of the Nervous System南通大学基础医学院Chen li,The specificness of diseases of the nervous system:,1 The localization of function in the CNS, which has four major consequences: (1) The brain is vulnerable to small focal lesions that would be asymptomatic in other organs. (2) The same pathologic process manifests in a different way when it affects a different part of the system ，e.g. meningioma :in the factory groove -anosmia ， at the foramen magnum -progressive quadriparesis. (3) Ther

2、e are regions of selective vulnerability to particular pathologic insults, e.g., Purkinje cells of the cerebellum and pyramidal neurons of the hippocampus are particularly vulnerable to ischemia. (4) The same type of pathologic change can occur in different diseases (e.g., neurofibrillary tangles). Diagonosis is by distribution (localization) of the pathologic change. 2 The nervous system has specific anatomic and physiologic features that affect the expression of disease, principally the presen

3、ce of the skull, the CSF, the blood-brain barrier, and the absence of lymphatic drainage. 3 Diseases of the nervous system fall into two main groups: Those that occur in both the nervous system and other organs , e.g., ininfections. (2) Conditions unique to the nervous system, notably the diseases of myelin and system degenerations of neurons.,Section 1 Infectious diseases, those of the meninges and CSF -meningitis those of the brain parenchyma -encephalitis meningitis extends into the brain or

4、encephalitis spills over into the CSF-Meningoencephalitis,Bacterial infection-Epidemic cerebrospinal meningitis Viral infection-Epidemic encephalitis B - Poliomyelitis-Spongiform Encephalopathies,一、Epidemic cerebrospinal meningitis,It is an acute purulent inflammation of meninges which was caused by meningococcus .Epidemic cerebrospinal meningitis is the most frequent pyogenic infection of the nervous system. It may occur at any age but is most common in children.,Meningina ;arachnoid,（一）Etiolog

5、y and pathogenesis,Etiology The most cause was :meningococci, pneumococci, streptococci, and hemophilus. The second was：Staphylococci and gram-negative bacteria Pathogenesis microorganisms infected sinus meninges meningitisor earsepticemia breakthrough the blood brain barrier,2%-3%,（二）Clinical features （exclude fever and other systemic infection symptoms）,The main symptom of nervous system： 1、increased intracranial pressure （inflammation、hydropsia):intense headache, projectile vomiting,infant br

6、egmatic space projectile 2、the symptom of meningismus：stiffneck defend spasmus and limitation of movementinfant opisthotonuspositive of kernig 3、the symptom response to cranial nerve palsy（、 、 pair) 4、the variation of CSF ：cloudy 、increased pressure、as many as 90,000 neutrophils/mm3 , a raised protein level, a reduced glucose content, bacteria may be seen on a smear .,Grossly A varying amount of exudates is seen in the subarachnoid space overlying the base of the brain and spinal cord.,（三）Pathol

7、ogy,Exudates distribute along the blood vessel, yellow.The structer of cortical sulci and cerebral convolution are not clear.,Microscopical 1、 The subarachnoid space contains pus(many pus cells+Lc and Mc+diplococcus） 2、The exudates confined to the leptomeninges. The underlying brain and cord are edematous and congested. 3、In fulminant meningitis, inflammatory cells infiltrate and produce a venulitis that may lead to venous occlusions and infarctions.,（四）Prognosis,Recovery with complete resolutio

8、n is common motality is less than 5% to 10%.,（五）Complications,If a low-grade infection persists, trabeculae form across the subarachnoid space, follow by progressive fibrosis, with narrowing or localized obliteration of the subarachnoid space.When such changes are localized to basilar leptomeninges near the foramina, the outflow of CSF from the ventricular system is blocked, leading to hydrocephalus. The symptoms response to cranial nerve palsy ：Permanent disabilities include facial paralysis, d

9、eafness, strabilismus, speech defect,or mental deficiency.,Fulminant Neisseria intracellularis septicemia（addition） It is a type of fulminant cerebrospinal meningitis .And it most common in children. The onset is usually sudden. Patients condition is dangerous,and often die in short term. Clinical feature peripheral circulatory failure shockskin Purpura Pathology Waterhouse-Friederichsen syndrome pathological changes of meninges is light Waterhouse-Friederichsen syndrome fingers two sides adrenal gland severity bleeding in severity septemia ,and adrenal cortex nonfuction.It often occurs in fulminant Neisseria intracellularis septicemiaPathogenesis releasing of endotoxin induce toxic shock and DIC.,Fulminant meningocerebritis,Pathology meningitisbrain tissue beneath meningina:brain tissue congestionSeverity brain edema Clinical sudden increase of intracranial pressureoutbreak ardent feversevere headachefrequent vomituseclampsia、coma or cerebral hernia,

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