病毒性脑炎诊断的困惑演示ppt课件.pptx

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1、.,1,病毒性脑炎诊断的困惑,.,2,脑出血,炎症,病毒性脑炎,.,3,病毒性脑炎引发的脑出血,Herpes zoster encephalitis presenting as multiple cerebral hemorrhages a rare presentation:a case report.Journal of Medical Case Reports 2013,7:155,.,4,Herpes simplex 1 encephalitis presenting as a brain haemorrhage with normal cerebrospinal fluid anal

2、ysis:a case report.Journal of Medical Case Reports 2008,2:387,.,5,单纯疱疹病毒性脑炎合并出血性脑卒中1例报告.新医学,2007,11(38)752-753.,.,6,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.,.,7,诊断的困惑,.,8,病毒性脑炎的诊断依据,.,9

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10、,viii.,Nipah病毒脑炎,.,35,实验室诊断手段,Case definitions,diagnostic algorithms,and priorities in encephalitis:consensus statement of the international encephalitis consortium.Clin Infect Dis.2013;57:1114-1128.,.,36,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

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12、orrelation with disease.J Infect Dis 1995;171:857-863.,.,37,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.Lancet,1997,349:299300.DevelopmentandField Testingof a Real-Time PCR Assay for Caprine Arthritis-Encephali

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