Infections of Central Nervous System

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.

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

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

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

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

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

Ⅳ clinical 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

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

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

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

Ⅶ differential diagnosis Other viral encephalitis － pathogen Psychosis Demyelination disease

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

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

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:

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

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

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

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

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

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

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.

dementia Section one summary Section two Alzheimer

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

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

Section two Alzheimer 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.

Ⅱ etiology 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.

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

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

Ⅳ clinical 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 :

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

Ⅵ diagnosis probable 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

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.

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

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