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Aseptic meningitis
definition: When the CSF culture was negative.
CSF:
pressure mmh2o: normal or slightly elevated. leukocytes : PMN early mononuclear later.rarly >1000Protein mg /dl:20-100Glucose mg/dl: generally normal may be depressed to40. (15-20%) Entroviruse recoverd by CSF culture or PCRHSV by PCR.
CSF
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Aseptic meningitis
Refer principally to viral meningitis.
Other infection.( Lyme disease,syphlis,TB)
Parameningeal infection:(brain abscess, epidural abscess,venus sinus empyema)
Chemical (NSAID,anti-inflamatory, IVig) Autoimmune disorders
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Encephalitis
Inflammatory of brain parenchyma lead to cerebral dysfunction .
May be diffuse , or localized
1. Acute 2. Post infection encephalomyelitis3. Chronic degenerative ,slow viral infection.
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Encephalitis
it has 2 mechanism.
1. Direct infection. 2. Immune mediated response in the CNS that begins
several days after the extraneural manifestation of infection .
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Encephalitis
Viruses are the principal causes of acute infection encephlitis.
Metabolic. Toxic. Neoplastic disorder. HIV is an important cause of enceplalitis more
commonly insidious in onset.
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ADEM ( Acute disseminated encephalomyelitis)
ADEM abrupt development. mutiple neurologic signs related to an inflammatory
and demyelinating disorder of brain and spinal cord .
Childhood viral infection. ( measles , chickenpox, or vaccination) Resembles to MS. Relapses occurred in 14% within in 1 year .
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Clinical manifestation encephalitis
Prodrome of nonspecific symptoms.(cough, sore throat, fever, headache, abdominal
complaint)
Progressive lethargy, behavioral change, neurologic deficits.
Seizures are common. Maculopapular rash. Coma, transverse myelitis, Polio- like illness, periferal
neuropathy.
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Laboratory
CSF shows:
lymphocytic pleocytosis.Slight elevatin protein.Normal glucose.The CSF occasionally may be normal. In HSV protein and RBC increased . Extreme elevated of protien and reduction of glucose(TB, carcinomatoseis, cryptococcal infection)
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Laboratory
EEG: temporal lobe characteristic HSV
infection .
Serologic studies.(arbovirus, EBV, mycoplasma, cat-scratch, Lyme)
culture stool and CSF ,nasopharyngeal. PCR test for HSV,entrovirus and other virus. The cause of encephalitis In 1/3 of cases is
undetermined.
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Laboratory
Brain biopsy may be necessary for definitive diagnosis.
1. in patients with focal neurologic finding2. Severe encephalopathy with no clinical improvement
if diagnosis is obscure.3. HSV,rabis encephalitis ,prion related disease (kuru,
jakob) diagnosed with culture of brain biopsy.4. Identify arbovirus, entrovirus, TB, fungal infection .5. Non infection illness ( primary CNS
vasculopathies ,malignancies)
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Differential diagnosis
Diagnosis established with :
Neurologic signs. epidemiology, evidence of infection in CSF, EEG, brain imaging
brain biopsy diagnostic but seldom performed.
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Treatment
There is no specific therapy exception of HSV and HIV. Treatment is supportive
(siezure, electerolyte abnormality, airway monitoring, increased ICP
ADEM:high-dose IV corticosteroids.
IV acyclovir is choice for HSV. M,pneumonia may be trated with doxycycline,
erythromycin, azithromycin, clarithromycin??
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complication
Symptoms resolve over several days to 2-3 weeks. Recover without sequelae in 2/3 before dischrge from
hospital. neurologic sequelae(spasticity,cognitive impairment,
weakness, ataxia, seizure. ( gradually recover some or all) death. Mortality is 5%
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Thanks…
But it’s not the end !!