sporadic encephalitis
Introduction
Introduction to sporadic encephalitis Sporadic encephalitis, also known as sporadic viral encephalitis, non-specific encephalitis and atypical encephalitis. It is one of the common syndromes of the nervous system. It mainly includes two types of diseases, such as sporadic viral encephalitis with pathogens and allergic demyelinating encephalopathy after infection, but it is difficult to distinguish clinically. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: hemorrhoids sepsis
Cause
Causes of sporadic encephalitis
The pathogens of viral encephalitis include ECHO virus, herpes simplex virus and adenovirus. Demyelinating encephalopathy may be caused by viral infection impairing the immune function of the patient, resulting in demyelination of the brain allergic reaction, and acute dissemination. The pathogenesis of encephalomyelitis is the same.
Prevention
Sporadic encephalitis prevention
There are no special preventive measures for this disease. Early detection and early treatment are the key to prevention.
Complication
Sporadic encephalitis complications Complications acne sepsis
Pulmonary infection, post-occipital hemorrhoids, skin purulence, oral infections and sepsis.
Symptom
Sporadic encephalitis symptoms common symptoms nuzzle tongue mental disorder nausea perception disappeared typhoid face central fever fatigue diarrhea consciousness change state ataxia
Some patients have prodromal symptoms, such as headache, fatigue, anorexia, vomiting, sleep disorders or decreased mental activity, acute or subacute onset, common first symptoms include mental disorders, paralysis, headache, fever , disturbance of consciousness, nausea and vomiting and epileptic seizures, according to the patient's main clinical manifestations, can often be divided into the following five types.
First, mental disorders:
With emotional disorders (emotional instability, apathy, depression, euphoria, fear), mental retardation (understanding, memory, calculation, judgment, association, etc.), thinking disorder (silence, multi-word, speech disorder and delusion), behavior Obstacles (reduced movement, increased movement, impulsive, stupor state) and other common, mental disorders and consciousness disorders (, confusion, confusion) coexist, according to the patient's main mental symptoms can be divided into tension-like syndrome, schizophrenia Subtypes such as dementia-like syndrome, in the progression of the disease, the performance of mental disorders often changes, such as from psychomotor excitement to psychomotor inhibition, generally in the course of the disease can detect neurological signs, such as hemiplegia, Positive pyramidal tract signs, laboratory tests, such as cerebrospinal fluid, EEG, evoked potentials, head CT and MRI, etc. often have certain changes, and can be distinguished from non-organic psychosis such as affective psychosis, schizophrenia.
Second, coma type:
Rapid onset of severe conscious disturbances, such as varying degrees of coma or special disturbances of consciousness, bilateral cerebral hemisphere damage, strong manifestations of de-cortical state and blink coma; upper brain stem damage occurs when the brain is strong; base If the lesion is damaged, there may be tremors, dance-like involutes, and extrapyramidal movements; when the pyramidal tract is damaged, hemiplegia or bilateral hemiplegia may occur. The patient may have pneumonia due to coma, urinary tract infection, etc., and the duration of coma may vary. In the process of improvement of consciousness disorder, mental abnormalities may occur, and certain neuropsychiatric sequelae may remain after waking up.
Third, brain tumor type:
Mainly manifested as headache, vomiting, papilledema, spasm, partial sports seizures, etc., often accompanied by varying degrees of disturbance of consciousness, although these are intended to be symptoms of intracranial space-occupying lesions, but the onset is acute, the condition is rapidly aggravated, From the onset to the shortness of symptoms, only a few hours, most of them within one month; intracranial pressure increased sharply, some patients can quickly develop increased intracranial pressure crisis; head CT and MRI examination can be seen diffuse brain edema and brain Softening areas, etc., can help identify brain tumors, but the diagnosis sometimes depends on craniotomy or stereotactic drilling puncture for brain biopsy.
Fourth, epilepsy type:
The patient had no history of epilepsy before the disease. The common types of seizures were generalized tonic-clonic seizures and their continuous state, partial sexual seizures, combined partial seizures or mixed seizures. The patients with this type of disease were mainly treated with epilepsy. Symptoms, some patients may have fever, headache, dizziness, vomiting, decreased active activity and other prodromal symptoms before seizures, followed by diffuse abnormalities, cerebrospinal fluid examination mild abnormalities or normal, CT and MRI visible diffuse brain edema, single Or multiple focal lesions, etc., provide a basis for the diagnosis of symptomatic epilepsy; other manifestations of sporadic encephalitis contribute to the clinical diagnosis of this disease.
V. Limitations:
Hemiplegia, single sputum, cross sputum, quadriplegia, motor ataxia, extrapyramidal involuntary movement, cranial nerve damage as the main clinical manifestations, indicating that the lesion is located in a part of the brain, or in the cerebellum or brain stem, According to the onset of illness, the process of disease development, cerebrospinal fluid examination, CT or MRI and the response to experimental treatment are identified with cerebrovascular disease, brain tumor, multiple sclerosis.
The clinical diagnosis of sporadic encephalitis, pathological diagnosis can distinguish between viral encephalitis and allergic demyelinating encephalopathy. The main basis for clinical diagnosis is:
First, there is a history of infection within one month before the onset of illness, with a common cold and diarrhea.
Second, acute or subacute onset, clinical manifestations of diffuse brain damage, a small number of patients may also present with the symptoms and signs of localized brain damage, but more or less still have a background of diffuse brain damage.
Third, the cerebrospinal fluid is normal or white blood cells, the protein is mild to moderately increased, and when the white blood cells of the cerebrospinal fluid are normal, the white blood cell classification often sees that the immunocompetent cells are active.
4. EEG is mostly a focal change on the background of diffuse high amplitude slow wave or diffuse brain damage.
5. Other diseases similar to clinical manifestations should be excluded, such as central nervous system infections of known pathogens (type encephalitis, herpes simplex virus encephalitis), brain tumors, cerebral vascular malformations, and strokes.
Examine
Examination of sporadic encephalitis
1. Blood: The total number of white blood cells in the surrounding blood is normal or slightly increased. The white blood cell classification is normal or the percentage of neutrophils is higher than normal, and the erythrocyte sedimentation rate is normal or accelerated.
2. Cerebrospinal fluid:
1 viral encephalitis-like changes: increased white blood cell count, early neutrophils increased significantly, ~ days after a lymphocyte predominance, plasma cells and lymphocyte-like cells, protein normal or slightly increased.
2 demyelinating encephalopathy-like changes: the number of white blood cells is normal or slightly increased, the percentage of lymphocytes is increased in classification, and large lymphocytes, lymphocyte-like cells, plasma cells and activated monocytes are also seen. Neutrophils are rare. The protein is mostly normal. The cerebrospinal fluid changes in the above two lesions are relative and cannot provide a basis for diagnosis of viral encephalitis or demyelinating encephalopathy.
3. Pathogen examination: Cerebrospinal fluid or brain tissue (including brain biopsy and autopsy of craniotomy or drilling puncture) virus culture and isolation, serological examination, etc. have a diagnostic significance for viral encephalitis, but the virus separation time is more Long, the clinical diagnosis and treatment is often not very helpful.
Electroencephalography: Most patients have EEG abnormalities, but their changes are non-specific. The common changes are diffuse abnormalities and focal activities on the background of diffuse abnormalities. Dynamic EEG observation during the course of the disease helps. In judging the development and prognosis of the disease, the EEG changes are also aggravated with the development of the disease; when the condition is improved, the EEG is also improved, for the sporadic encephalitis of the psychiatric disease in the late language, EEG The change, there is, the definition of differential diagnosis.
4. Radiological examination: Conventional cranial radiology is of no value in the diagnosis of sporadic encephalitis. Sometimes CT can be seen in the cerebral hemisphere with multiple scattered softening lesions, which has certain significance for the exclusion of space-occupying lesions.
Diagnosis
Diagnosis and diagnosis of sporadic encephalitis
diagnosis
Diagnosis can be made based on medical history, symptoms, and examination.
Differential diagnosis
Need to be differentiated from schizophrenia, other symptomatic epilepsy and meningoencephalitis, metabolic and toxic encephalopathy, intracranial space-occupying lesions, and acute disseminated encephalomyelitis.
