Основна информация
причина
1.Гноен менингит
Meningealinflammationcausedbyvariouspyogenicbacteriaisalargecategoryofbacterialmeningitis.Itisoneoftheseriousintracranialinfections,oftenaccompaniedbypurulentencephalitisandbrainabscess.Thecommonpathogenicbacteriaare3types,namelyHaemophilusinfluenzaetypeB,Neisseriameningitidis(Diplococcus)andStreptococcuspneumoniae(Streptococcuspneumoniae).Usuallyasmallnumberofhealthypeoplecarrythesegermsinthenoseoronthebodyanddonotharmthehumanbody.Theyarespreadthroughcoughingorsneezing.Peoplearemostlikelytobeinfectedbygermswhentheyhaveacold,becauserhinitismakesitextremelyeasyforbacteriatoentertheskull.
2. Туберкулозен менингит
Itisanon-purulentinflammationofthemeningescausedbyMycobacteriumtuberculosis.Itaccountsforabout6%ofsystemictuberculosisandisthemostcommoncentralnervoussystemtuberculosis.Itisnotonlythemostserioustypeoftuberculosis,butalsotheleadingcauseofdeathfromtuberculosisinchildren.AftertheinfectionofMycobacteriumtuberculosisisspreadthroughtheblood,itisplantedunderthepiamatertoformtuberculosisnodules.Afterthenodulesareruptured,alargenumberoftuberculosisbacteriaenterthesubarachnoidspace.Inrecentyears,theincidenceandmortalityoftuberculousmeningitishaveincreased.Earlydiagnosisandtreatmentcanimproveefficacyandreducemortality.
3. Вирусен менингит
Itisaninfectionofthecentralnervoussystemcausedbyavarietyofviruses.Virusesthatcancausemeningitisincludearbovirus,enterovirus,Echovirus,poliovirus,CoxsackievirusAandB,Echovirus,myxovirusandparamyxovirus,herpesvirus,arenavirus,etc.Followedbymumpsvirus,herpessimplexvirusandadenovirus.Virusesofteninvadethebrainparenchymaandshowmeningoencephalitis,whichisclassifiedasasepticmeningitis.
4. Криптококов менингит
Mingingitiscanalsobecausedbyfungi.ThemostcommononeisCryptococcus,whichcanbefoundinpigeonfeces.CryptococcalmeningitisisadeepfungalinfectioncausedbycertainspeciesorvariantsofCryptococcusinvadingthecentralnervoussystem.Healthypeoplearenotsusceptibletofungus-relatedmeningitis,butitisdifferentforthoseinfectedwiththeHIVvirus.CryptococcalmeningitiscanoccurafterinfectionwithCryptococcus.
Клинични проявления
1. Туберкулозен менингит
Ранните прояви са промени в психическото състояние на детето, като раздразнителност и плач; умствена мудност; не обича игри; може също да има субфебрилна температура, загуба на апетит, повръщане, неспокоен сън, загуба на тегло.
Olderchildrencancomplainofheadaches.Iftheconditionissevere,theheadacheispersistentandaggravated,vomitingcanbeaggravatedandcanbecomejet,drowsinessgraduallyappears,andconvulsionsmayoccur.Iftheconditionisfurtheraggravated,coma,frequentconvulsions,looselimbs,andparalysismayoccur.Irregularbreathingmayalsooccur,andsomechildrendie.
2.Гноен менингит
Itiscommoninchildrenandtheelderly,causedbyvariouspurulentbacteriaMeningealinflammation.Themainmanifestationsarefever,headache,vomiting,irritabilityandothersymptoms.Nervoussystemexaminationandcerebrospinalfluidexaminationareabnormal.Duetotheweakresistanceofchildrenandtheimperfectdevelopmentoftheblood-brainbarrier,bacteriacaneasilyenterthecerebralnervoussystem.Generally,sepsisiscausedbyinfectioninotherpartsofthebody,andbacteriaenterthebrain.Partlyduetoinfectionafterotitismediaandheadtrauma,bacteriadirectlyenterthemeninges.
Inchildhood,theonsetisrapid,withhighfeverreachingabove39℃.Childrenoftencomplainofsevereheadache,poorspirits,fatigue,lossofappetite,andfrequentvomiting.Attheonsetoftheillness,thechildisconsciousanddrowsiness,confusion,disorganizedspeech,inabilitytodistinguishthedirectioncorrectly,convulsions,andcomamayoccurintheprogressofthedisease.Inseverecases,convulsionsandcomaappearwithin24hoursaftertheonsetofillness.Ifitisnottreatedintime,theconditionprogresses,theneckisstiff,theheadistiltedback,thebackisstiff,andthewholebodybendsbacklikea"bow",whichismedicallycalledreflex.Irregularbreathingmayalsooccur,andevenrespiratoryfailuremayoccur,andsomechildrenhavebleedingspotsontheskin.
Becausethelesionscancausemeningealadhesionsandbrainparenchymaldamage,cranialnervepalsy,blindness,hearingimpairment,limbparalysis,epilepsy,andmentalretardationcanoccur.
Преглед
1. Лабораторно изследване
(1)BloodpicturePeripheralbloodpicturewhitebloodcellsinacutephaseThecountissignificantlyincreased,andimmaturecellsmayappearmainlyduetoneutrophils.
(2)CerebrospinalfluidIncreasedpressure,turbidandpus-likeappearance,whitebloodcellcountbetween1000～10000/mm,higherinafewcases,mainlyneutrophils,butItaccountsformorethan90%ofthetotalnumberofwhitebloodcells.Sometimestheaccumulationofpuscellsislumpy.Atthistime,thesmearandthecultureofpathogenicbacteriaaremostlypositive.Occasionally,thefirstlumbarpuncturewasnormal,anditbecamepurulentafterafewhours.Theproteinincreases,upto1.0g/Lormore,thesugarcontentdecreases,usuallylessthan2.2mmol/L,thechloridecontentalsodecreases,andtheimmunoglobulinIgMandIgGincreasesignificantly.
(3)BacterialantigendeterminationCommonlyusedmethodsincludepolymerasechainreaction,convectionimmunoelectrophoresis,latexagglutinationtest,enzyme-linkedimmunosorbenttest,radioimmunoassay,etc.
(4)Otheroptionaltestsinclude:hematuria,bloodelectrolytes,bloodsugar,liverandkidneyfunction.
2. Други спомагателни изследвания
(1)X-rayradiographyChestX-rayisparticularlyimportantforpatientswithpurulentmeningitis,Canfindpneumonialesionsorabscesses.Craniocerebralandsinusplainfilmcanfindskullosteomyelitis,sinusitis,mastoiditis,buttheCTexaminationoftheabovelesionsisclearer.
(2)CTandMRIexaminationsEarlyCTorcranialMRIexaminationsofthelesioncanbenormal.Whenthereareneurologicalcomplications,abnormalmanifestationssuchasenlargementoftheventricles,narrowingofthesulcus,swellingofthebrain,andshiftingofthebraincanbeseen.Andcanfindependymitis,subduraleffusionandlocalizedbrainabscess.EnhancedMRIscanismoresensitivetothediagnosisofmeningitisthanenhancedCTscan.MRIscanscanshowmeningealoozingandcorticalreactions.Withappropriatetechnicalconditions,itcanshowvenousocclusionandinfarctionofthecorrespondingpart.
Диагноза
Inadditiontoclinicalmanifestationsandexaminations.Lumbarpunctureshouldbedonetodiagnosemeningitis.
Усложнения
Ifthetreatmentisimproper,thelesioncanbechangedfromacutetochronic,andthefollowingsequelaemayoccur:
1.Хидроцефалия
b>Duetomeningealadhesionsandcerebrospinalfluidcirculationdisorders;
2. Парализа на увреждане на черепно-мозъчните нерви
като глухота, зрително увреждане, страбизъм, парализа на лицевия нерв и др.;
3. Церебрален васкулит причинява запушване на слузта
причинаscerebralischemiaandinfarctionincorrespondingparts.
Лечение
Bacterialmeningitisisalife-threateningdiseaseandshouldbetreatedimmediately.Gototheemergencydepartmentimmediatelywhensymptomsappear.
Thetreatmentofbacterialmeningitisismainlytofindbacteriabasedoncerebrospinalfluidsmearsandculture,selecteffectiveantibioticsbasedondrugsensitivitytests,andtreatthemintimetoreducetheoccurrenceofsequelae.Itisnecessarytotreathighfeversymptomatically,controlconvulsions,reduceintracranialpressure,reducecerebraledema,andusehormonestoreduceintracranialinflammationandadhesion.
Antibioticshavenoeffectonviralmeningitis,andantiviraldrugsshouldbeadded.
Предотвратяване
1. Ранно откриване, изолиране и лечение на място.
2.Doagoodjobofhygienepromotionduringtheepidemic,trytoavoidlargegatheringsandgroupactivities,donotbringchildrentopublicplaces,andwearmaskswhengoingout.
3.Duringepidemicsofmeningococcaldisease,anyonewhohasfeverwithheadache;malaise;acutepharyngitis;skinandoralmucosalhemorrhagecanbeusedforsymptomaticpreventivetreatmentwithdrugs,whichcanbeeffectiveToreducetheincidencerateandpreventtheepidemic.
4.Инжектиране на ваксина.
Защо менингитът причинява главоболие?
Mingingitiscanbedividedintomanytypes.Accordingtothecause,itcanbedividedintocommonbacterial,tuberculosis,viral,fungal(mold),meningealcancer,etc.,andacutemeningitisaccordingtothespeedofonsetInflammation,suchascommonbacterialandviralinfections,ismostlyacute;chronicmeningitisismorecommonintuberculousorfungalinfections.Themainclinicalmanifestationsofacutepatientsarefever,headache,andneckandoccipitalstiffness.Forchronicpatients,headacheisthemaincause.Meningitisreferstosurroundingthebrainandspinalcord...
ChiefphysicianHuangYining,PekingUniversityFirstHospital,DepartmentofNeurology,comesfrom:EncyclopediaFamousMedicalNetwork
Suddenlyhaveahighfever,headache,Whatdiseaseshouldbeconsideredforvomiting?
Headache,nauseaandvomitingarealsocommonsymptomsofinfection.Whenhighfever,chills,headache,andvomitingareaccompaniedbyneckstiffness,andheadacheworsenswhentheheadislowered,thepossibilityofacutemeningitisshouldbehighlysuspected,andthehospitalshouldbeconsultedintime.Acutemeningitisisfierceandthemortalityrateishigh.Epidemicmeningitiscausedbymeningococcusiscommon,referredtoasmeningococcalmeningitis,andmeningitiscausedbypneumococcusisalsomorecommon.Thesepatientsoftenhavecold-likemanifestationsinthedaysbeforetheonset...
ChiefphysicianHuangYining,PekingUniversityFirstHospital,DepartmentofNeurology,from:EncyclopediaFamousMedicalNetwork