aivokalvontulehdus

Perustiedot

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1. Mätillinen aivokalvontulehdus

Meningealinflammationcausedbyvariouspyogenicbacteriaisalargecategoryofbacterialmeningitis.Itisoneoftheseriousintracranialinfections,oftenaccompaniedbypurulentencephalitisandbrainabscess.Thecommonpathogenicbacteriaare3types,namelyHaemophilusinfluenzaetypeB,Neisseriameningitidis(Diplococcus)andStreptococcuspneumoniae(Streptococcuspneumoniae).Usuallyasmallnumberofhealthypeoplecarrythesegermsinthenoseoronthebodyanddonotharmthehumanbody.Theyarespreadthroughcoughingorsneezing.Peoplearemostlikelytobeinfectedbygermswhentheyhaveacold,becauserhinitismakesitextremelyeasyforbacteriatoentertheskull.

2. Tuberkuloosimeningiitti

Itisanon-purulentinflammationofthemeningescausedbyMycobacteriumtuberculosis.Itaccountsforabout6%ofsystemictuberculosisandisthemostcommoncentralnervoussystemtuberculosis.Itisnotonlythemostserioustypeoftuberculosis,butalsotheleadingcauseofdeathfromtuberculosisinchildren.AftertheinfectionofMycobacteriumtuberculosisisspreadthroughtheblood,itisplantedunderthepiamatertoformtuberculosisnodules.Afterthenodulesareruptured,alargenumberoftuberculosisbacteriaenterthesubarachnoidspace.Inrecentyears,theincidenceandmortalityoftuberculousmeningitishaveincreased.Earlydiagnosisandtreatmentcanimproveefficacyandreducemortality.

3. Virusmeningiitti

Itisaninfectionofthecentralnervoussystemcausedbyavarietyofviruses.Virusesthatcancausemeningitisincludearbovirus,enterovirus,Echovirus,poliovirus,CoxsackievirusAandB,Echovirus,myxovirusandparamyxovirus,herpesvirus,arenavirus,etc.Followedbymumpsvirus,herpessimplexvirusandadenovirus.Virusesofteninvadethebrainparenchymaandshowmeningoencephalitis,whichisclassifiedasasepticmeningitis.

4. Cryptococcalmeningitis

Mingingitiscanalsobecausedbyfungi.ThemostcommononeisCryptococcus,whichcanbefoundinpigeonfeces.CryptococcalmeningitisisadeepfungalinfectioncausedbycertainspeciesorvariantsofCryptococcusinvadingthecentralnervoussystem.Healthypeoplearenotsusceptibletofungus-relatedmeningitis,butitisdifferentforthoseinfectedwiththeHIVvirus.CryptococcalmeningitiscanoccurafterinfectionwithCryptococcus.

Kliiniset ilmentymät

1. Tuberkuloosimeningiitti

Varhaiset ilmenemismuodot ovat muutoksia lapsen mielentilassa, kuten ärtyneisyys ja itku; henkinen heikkous; älä pidä peleistä; voi myös olla alhainen kuume, ruokahaluttomuus, oksentelu, levoton uni, painonpudotus.

Olderchildrencancomplainofheadaches.Iftheconditionissevere,theheadacheispersistentandaggravated,vomitingcanbeaggravatedandcanbecomejet,drowsinessgraduallyappears,andconvulsionsmayoccur.Iftheconditionisfurtheraggravated,coma,frequentconvulsions,looselimbs,andparalysismayoccur.Irregularbreathingmayalsooccur,andsomechildrendie.

2. Mätillinen aivokalvontulehdus

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.

Tutkimus

1.Laboratoriotutkimus

(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. Muut apututkimukset

(1)X-rayradiographyChestX-rayisparticularlyimportantforpatientswithpurulentmeningitis,Canfindpneumonialesionsorabscesses.Craniocerebralandsinusplainfilmcanfindskullosteomyelitis,sinusitis,mastoiditis,buttheCTexaminationoftheabovelesionsisclearer.

(2)CTandMRIexaminationsEarlyCTorcranialMRIexaminationsofthelesioncanbenormal.Whenthereareneurologicalcomplications,abnormalmanifestationssuchasenlargementoftheventricles,narrowingofthesulcus,swellingofthebrain,andshiftingofthebraincanbeseen.Andcanfindependymitis,subduraleffusionandlocalizedbrainabscess.EnhancedMRIscanismoresensitivetothediagnosisofmeningitisthanenhancedCTscan.MRIscanscanshowmeningealoozingandcorticalreactions.Withappropriatetechnicalconditions,itcanshowvenousocclusionandinfarctionofthecorrespondingpart.

Diagnoosi

Inadditiontoclinicalmanifestationsandexaminations.Lumbarpunctureshouldbedonetodiagnosemeningitis.

Komplikaatiot

Ifthetreatmentisimproper,thelesioncanbechangedfromacutetochronic,andthefollowingsequelaemayoccur:

1. Vesipää

Duetomeningealadhesionsandcerebrospinalfluidcirculationdisorders;

2.Kallonhermovaurion halvaantuminen

kuten kuurous, näkövamma, karsastus, kasvohermohalvaus jne.;

3. Aivoverisuonitulehdus aiheuttaa lumentukoksen

Syyscerebralischemiaandinfarctionincorrespondingparts.

Hoito

Bacterialmeningitisisalife-threateningdiseaseandshouldbetreatedimmediately.Gototheemergencydepartmentimmediatelywhensymptomsappear.

Thetreatmentofbacterialmeningitisismainlytofindbacteriabasedoncerebrospinalfluidsmearsandculture,selecteffectiveantibioticsbasedondrugsensitivitytests,andtreatthemintimetoreducetheoccurrenceofsequelae.Itisnecessarytotreathighfeversymptomatically,controlconvulsions,reduceintracranialpressure,reducecerebraledema,andusehormonestoreduceintracranialinflammationandadhesion.

Antibioticshavenoeffectonviralmeningitis,andantiviraldrugsshouldbeadded.

Ennaltaehkäisy

1.Varhainen havaitseminen, eristäminen ja hoito paikan päällä.

2.Doagoodjobofhygienepromotionduringtheepidemic,trytoavoidlargegatheringsandgroupactivities,donotbringchildrentopublicplaces,andwearmaskswhengoingout.

3.Duringepidemicsofmeningococcaldisease,anyonewhohasfeverwithheadache;malaise;acutepharyngitis;skinandoralmucosalhemorrhagecanbeusedforsymptomaticpreventivetreatmentwithdrugs,whichcanbeeffectiveToreducetheincidencerateandpreventtheepidemic.

4. Rokoteinjektio.

Miksi aivokalvontulehdus aiheuttaa päänsärkyä?

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