encephalitis
Introduction
Introduction to encephalitis Encephalitis refers to an inflammatory lesion caused by invasion of a brain parenchyma. The majority of the cause is a virus, which can also be caused by infections such as bacteria, mold, spirochetes, rickettsia, parasites, and some may be allergic diseases such as acute disseminated encephalomyelitis. The so-called encephalitis usually refers to viral encephalitis and post-infectious encephalomyelitis which is acutely disseminated encephalomyelitis. Encephalitis can occur in different genders and ages, mostly acute or subacute. Clinically, it is characterized by high fever, headache, vomiting, coma, convulsions, etc., mostly accompanied by changes in the composition of cerebrospinal fluid. Prevention should be based on different causes. basic knowledge Sickness ratio: 0.05% Susceptible people: no special people Mode of infection: non-infectious Complications: Bronchial pneumonia Oral disease Septicemia Acne
Cause
Cause of encephalitis
Viral encephalitis virus does not have a cell structure, and is divided into two types according to the different nucleic acid components: one is a DNA virus (DNA virus): including a microvirus, a papillomavirus (causing a multifocal leukoencephalopathy) ), adenovirus, herpes virus, varicella-zoster virus. The other is ribonucleic acid (RNA virus): including microRNA (poliovirus, coxsackie virus, ECHO virus), arbovirus, mucus virus, (influenza virus), paramyxovirus (measles) Virus and mumps virus), arenavirus (lymphocytic choriomeningitis virus), rhabdovirus (rabies virus). Viral encephalitis can be divided into acute, subacute and chronic encephalitis according to the onset of illness. According to the virus type and infection route, it can be divided into arbovirus, enterovirus, respiratory virus, herpes virus encephalitis and the like. According to the incidence, it can be divided into epidemic and sporadic encephalitis. Acute encephalitis is generally considered to represent acute viral infection, while subacute or chronic onset such as subacute sclerosing panencephalitis and cortical striatal spinal cord degeneration represent chronic viral infections.
Prevention
Encephalitis prevention
1, pay attention to changes in the condition, observe signs of body temperature, pulse, respiration, blood pressure, big pupils, respiratory arrhythmia and other signs.
2. Improve the immunity of the population.
Complication
Encephalitis complications Complications bronchopneumonia oral disease sepsis acne
First, complicated with illness
First, bronchial pneumonia: more common in severe patients, cough and swallowing reflexes weakened or disappeared and coma patients, prone to pneumonia. Atelectasis can be caused when the secretions of the respiratory tract cannot be discharged smoothly.
Bronchial pneumonia: Bronchopneumonia, also known as lobular pneumonia, is the most common pneumonia in children. According to the pediatric statistics of 16 units in China, 22,504 cases of pneumonia hospitalization accounted for 93.7% of bronchial pneumonia, which is more common in infants and young children. Pneumonia occurs mostly during the winter and spring seasons and when the climate suddenly changes, some southern China have more incidences in the summer. Indoor living is crowded, poor ventilation, air pollution, and more pathogenic microorganisms, which are prone to pneumonia. Bronchial pneumonia can be caused by bacteria or viruses. According to the pathological changes, it is divided into two categories: general bronchial pneumonia and interstitial bronchopneumonia. The former is mostly caused by bacteria, while the latter is mainly caused by viruses. Clinically, the general diagnosis is bronchial pneumonia. According to acute onset, respiratory symptoms and signs, general clinical diagnosis is not difficult. If necessary, you can do fluoroscopy, chest X-ray, or throat test, bacterial secretion of tracheal secretions or virus isolation. Other pathogen tests include antigen and antibody detection.
Second, oral infections: patients who do not pay attention to oral hygiene and do not take oral care can have oral ulcers.
Oral ulcers: Oral ulcers, also known as "mouth sores", are superficial ulcers that occur on the oral mucosa. They range in size from rice to soy, round or oval, with a concave surface and congestive congestion. Ulcers are characterized by periodicity, recurrence and self-limiting, which occur in the lips, cheeks, and tongue. The etiology and pathogenesis are still unclear. The cause may be local trauma, mental stress, changes in food, drugs, hormone levels, and vitamin or trace element deficiency. Systemic diseases, genetics, immunity, and microorganisms may play an important role in their occurrence and development. Treatment is mainly based on local treatment, and severe cases require systemic treatment. After 7 to 10 days, the ulcer can gradually heal itself without leaving scars. However, after a period of varying lengths, it can relapse. The interval between the elderly can be 10 to 20 years or longer; the short one can be one after another, the year is continuous, the patient is very painful.
Third, other infections: Staphylococcus aureus caused by sepsis and enteritis, E. coli caused by urinary tract infections.
Sepsis: Septicemia is a systemic infection caused by pathogenic bacteria invading the blood circulation and growing in it, producing toxins, which easily occurs when the body's resistance is reduced. Clinical manifestations include chills, hyperthermia, toxemia symptoms, rash, joint pain, hepatosplenomegaly, septic shock, and migratory lesions. The vast majority of patients have an acute course of disease, with severe illness and poor prognosis. It is now further believed that sepsis is a series of chain reaction processes caused by pathogens and their toxins and metabolites that activate and release inflammation mesons after entering the bloodstream. This process can lead to dysfunction and failure of multiple organs throughout the body.
Enteritis: Enteritis is gastroenteritis, enteritis, and colitis caused by bacteria, viruses, fungi, and parasites. Clinical manifestations include nausea, vomiting, abdominal pain, diarrhea, loose water or mucus pus and blood. Some patients may have fever and sensation after urgency, so it is also known as infectious diarrhea. Common enteritis has the following categories: ulcerative colitis, fungal enteritis, ischemic colitis, rotavirus enteritis, chronic ulcerative colitis, pseudomembranous colitis, acute hemorrhagic necrotic enteritis.
Fourth, hemorrhoids: patients who stay in bed for a long time, if they do not pay attention to change position frequently, it is easy to develop hemorrhoids in the posterior occipital and lumbar vertebrae.
Acne: decubitus, also known as pressure sores, is a long-term compression of the body that blocks blood circulation, causing blisters, ulcers or gangrene due to ischemia of the skin and subcutaneous tissue. The prevention method is to avoid local long-term compression. To turn over regularly, it is best to turn over every 2 hours to 3 hours. Frequently massage the compression site, if necessary, use a steam pad or a sponge pad to cushion the compression site, especially the tail. When moving the patient, behave lightly to avoid pushing and pulling the patient. Always change the sheets and keep the sheets clean, flat and dry. After defecation, remove the urine and urine in time, scrub with warm water to avoid local irritation, to prevent acne.
Symptom
Symptoms of cerebral symptoms Common symptoms Weak body pain, headache, nausea, vomiting, consciousness, meningeal irritation
1, systemic toxic symptoms
Fever, headache, body pain, nausea, vomiting, fatigue. A small number of patients with bleeding rash and myocarditis.
2, nervous system symptoms
Awareness disorder, meningeal irritation. There may be flaccid paralysis of the neck muscles and scapular muscles, so that the head can sag and the arms can not be lifted and shaken. Cranial nerves and lower limbs are rare. 2 to 3 weeks can be recovered, about half of the muscles are atrophied. Mild symptoms can have no obvious neurological symptoms.
Because of the location of the lesions and the severity of the lesions, the performance is varied. Diffuse encephalitis often has general malaise, and soon coma, convulsions, and fever; brainstem encephalitis often has facial nerve spasm, cough, difficulty swallowing, limb numbness, weakness, and (or) oculomotor nerves Paralysis, pseudo-ball paralysis and other performances. Pseudo-neoplastic encephalitis often has headache, vomiting, poor physical activity or paralysis, aphasia, mental symptoms, and intracranial hypertension. At the same time pay attention to the primary symptoms, such as mumps virus encephalitis with parotid swelling; herpes virus encephalitis when the skin has herpes, Cox's virus and Echo virus encephalitis may have rash, myocarditis, hand, foot and mouth disease, etc. If the lesion involves the meninges (meningoencephalitis), meningeal irritation signs are positive.
Examine
Examination of encephalitis
1. Neurological examination:
Whether there are visual impairment, optic disc edema, eye muscle spasm, hearing loss, dysphagia, limb paralysis, pathological reflex, muscle tone change, ataxia, involuntary movement (tremor, dance-like movement, hand and foot movement), sensory disturbance , defecation, incontinence and meningeal irritation.
2. Auxiliary inspection:
(1) General examination: blood, urine routine, erythrocyte sedimentation rate, cerebrospinal fluid pressure, routine, biochemical, cytological, immunoglobulin (IgG, IgA, IgM) determination and blood mixed rosette rate determination.
(2) Electrophysiological examination: EEG, brain-induced (visual, auditory, somatosensory) potentials.
(3) Imaging examination: brain CT or MRI examination.
(4) Immunological examination of viral infection: Detection of herpes simplex virus in blood and cerebrospinal fluid by enzyme-linked immunosorbent assay or polymerase chain reaction method. Two sera were used for complement binding test, hemagglutination inhibition test, adenovirus immunofluorescence test, and polio neutralization test for epidemic encephalitis, adenovirus, measles virus, polio, influenza virus, and the like.
(5) Brain biopsy: immunofluorescence, histopathological examination.
Diagnosis
Diagnosis and diagnosis of encephalitis
According to different viruses, the route of infection, the season of good hair and the age of good hair are different. Due to the severity of the lesions and the severity of the lesions, the performance is varied, combined with examination and clinical manifestations for diagnosis.
1. Acute viral encephalitis:
(1) Symptoms of infection: such as fever, general malaise, myalgia, sore throat, can be from several to several weeks, and in some cases, sudden fever, white blood cells normal or increased to (15 ~ 30) × 109 / L.
(2) meningeal irritation and cerebrospinal fluid changes: cerebrospinal fluid pressure is normal or increased, white blood cells increased to (10 ~ 500) × 106 / L, a few can reach (1000 ~ 1500) × 106 / L, mainly lymphocytes. Early neutrophils of encephalitis caused by arboviruses are the main components. The sugar is normal or slightly higher, and a few can be reduced. The protein can be slightly increased to 0.5-1 g/L, and there can be red blood cells in the cerebrospinal fluid of herpes simplex virus encephalitis. In a small number of cases of acute viral encephalitis, the cerebrospinal fluid can be completely normal.
(3) localized or diffuse encephalitis symptoms: mental symptoms, paralysis, coma and other disturbances of consciousness, convulsions, aphasia, strong grip, sucking reflexes, hemiplegia. Asymmetry of sputum reflex, pathological reflex positive. The brain has cerebral nerve palsy and autonomic nervous system dysfunction. Cerebellar damage can be caused by nystagmus, ataxia, and rotation.
(4) Related signs of primary lesions: such as measles, chickenpox, mumps or infectious mononucleosis. Some cases are characterized by psychiatric symptoms or high intracranial pressure symptoms, such as lesions mainly in the brain stem called brain stem encephalitis. Different types of viral encephalitis can also have their special performance.
2. Lentiviral encephalitis and encephalopathy:
Known are: subacute sclerosing panencephalitis, progressive multifocal leukoencephalitis, cortical striatal spinal degeneration, Kuru disease.
The characteristics of lentiviral infection are: the incubation period of infection and disease is long, from months to years or even decades. Subacute or chronic onset. The patient has an immunodeficiency, mainly a cellular immune deficiency. The central nervous system lesions are more diffuse and multifocal.
3. Several other viral encephalitis:
(1) Mumps virus encephalitis: The virus directly invades the brain, most of which manifest as meningitis symptoms, and may also have hemiplegia, quadriplegia, vision loss, deafness, and aphasia. Mumps and brain inflammation occur simultaneously or sequentially, and the general diagnosis is not difficult. Those without mumps can determine the diagnosis by serum immunological examination. The prognosis of symptomatic treatment is good.
(2) Herpes zoster encephalitis: rare, individual cases of meningitis and encephalitis after the emergence of trunk or head and herpes. Treatment with general viral encephalitis.
(3) cytomegalovirus encephalitis: mostly fetal and neonatal infections, occasionally seen in children and adults. Most of them show microcephaly malformation, periventricular and intracerebral calcification, hydrocephalus. Adults can present with acute polyneuritis. Any baby with microcephaly, especially with choroidal colitis, retinal calcification, cataract, optic atrophy, should be suspected of this disease. Specific antibodies can be found in 44% of children. Try to use adenosine treatment.
(4) Progressive rubella encephalitis: refers to the mother with rubella during pregnancy, the encephalitis that occurs within 14 years of age after birth, is a lentivirus infection. Symptoms are progressive, and may include epilepsy, deafness, and dementia. Or manifest a variety of brain developmental malformations. Congenital rubella symptoms of cerebral inflammation are mild, no special treatment is required, and the prognosis is good. Viral isolation and serum immunoassays during infection can confirm the diagnosis.
(5) Infectious mononucleosis (EB virus) encephalitis: occurs in the case of systemic diseases, and occasionally occurs before blood and visceral symptoms. There may be convulsions, aphasia, hyperactivity, cranial nerve damage, cerebellar ataxia, and paraplegia. A typical blood picture and heterophil can determine the diagnosis.
