病毒性脑炎诊断的困惑讲义课件.ppt

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2、port. Journal of Medical Case Reports 2008, 2:387,病毒感染破坏脑组织的同时波及病灶中的血管，一般只表现为出血坏死性炎症反应，如损害较大动脉，则会发生蛛网膜下隙出血和脑实质血肿。,Neuropathology of viral infections. Handbook of Clinical Neurology, Vol. 123 (3rd series),2014.,诊断的困惑,病毒性脑炎的诊断依据,感染性脑炎,自身免疫性脑炎,感染性脑炎,自身免疫性脑炎,自身免疫性脑炎的诊断条件,确诊,鉴别,病原学检测,病毒一览,Epidemiology of

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10、128.,脑脊液PCR 的敏感性及特异性均超过95%，有研究建议在治疗2周后，再次进行脑脊液PCR检查，如果结果仍为阳性，则需要继续抗病毒治疗。研究显示，PCR在神经系统症状出现3-7日后的阳性率最高，第二周病毒DNA减少至3050%，15天后减少至25%。,Case definitions, diagnostic algorithms, and priorities in encephalitis: consensus statement of the international encephalitis consortium. Clin Infect Dis.2013;57:1114-11

11、28.Diagnosis of herpes simplex encephalitis: application of PCR to CSF from brain-biopsied patients and correlation with disease. J Infect Dis 1995;171:857-863.,RT-PCR以敏感性高、特异性高、污染少、可定量等优点著称。PCR在部分确诊的脑炎患者中呈阴性结果，因此对于具有典型脑炎临床及影像学特征的患者，不要因为此阴性结果而排除病毒性脑炎诊断。,European consensus on viral encephalitis. Lanc

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