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ENCEFALITE ACUTE

Def: atingerea encefal consecutiv


?x loc a ag inf-polioencefalita/
?rr imunologice loc postinf-leucoencefalite
Asoc n proportii var disfunctia SNC: tulb de const, crize conv, deficit neurologi
c
Asoc frecv meningitei limfocitare
evol severa/ autolim, frecv sechelarit imp
Denumiri: panencef, encefalomielita (+M spin), meningoencef (leptomeninge, creie
r, maduva)
FIZPAT
Rar=x v la niv neuron/celule gliale: VHS1, 2-la nn, EBV, CMV, enterov, HIV, aden
ov, v rabic
Frecv: postinf, ca rr imun-inflam ? demielinizare perivenoasa
invazia SNC pe cale sg/ de-a lungul nn motori, senz (VZV, VHS, rabia). Sediul in
it de patr, x, poate fi resp, dig, tsc-prin inoc: togav, flaviv, rickettsi, x n e
pit vasc, gg, Spl. Dupa invazie, se x si det lez endot vasc, infarctiz, edeme cu
apar cl a sdr piramidal, extrapir, cerebelos, mielitic etc
n f mediate imun: pe I plan = demieliniz apoi infiltrat cu Mo
Encef tardive: luni/ ani dupa inf v-PESS, b Kuru, Creutzfeld-Jakob
Sdr Reye: f partic. Edem cerebr neinflam + hepatopat ac
CLINIC
Sdr mening: fo, cefalee, redoarea cefei, fotofobie, varsaturi, bradic, Kernig, B
rudzinski
Sdr inf: fo, mialgii, semne spec ag pat
Tulb st de const (cortex cerebral): obnubilare?coma (val progn f: profunzime, du
rata), uneori precedate de tulb de comportament -agit, halucin, obnubil
Crize conv: generaliz/focaliz; progn nefav- status grand mal/crize subintrante
Deficit motor: mono/hemiplegie, paralizii nn cran, mielite/misc aN-distonii, mio
clonii, tremor
Sdr priramid: pareze, paraplegii spastice, HROT, Babinski
Extrapir: tremor parkinsonian, hipertonie
Hipotal: Hfo, diabet insipid
Cerebel: ataxie, dismetrie, nistagmus
Lob temporal: halucin, afazie, bizarerii
?
Lez mielita: paralizie flasca, aROT/ mielita transv-lez motorii, senz, s
fincteriene
EX COMPLEMENTARE
PL = indisp, exclude o meningita purulenta; pleiocitoza, Lycitoza (10-200/ mm3),
alb?, inct, moderata/LCR = N
CT cran cu subst contrast- exclude abces, epansam subdural, tromboflebite, hemor
; la cteva zile-hipodensit focala, frecv temporal-herpes/ hipodens subs albe n enc
ef postinf
RMN: mai sensibila, evid anomalii precoce
EEG: activit cerebr cu unde lente, unde ? /? ample, monomorfe, generaliz, asp de
descarcari periodice de unde lente sugestive pt encefalita herpetica
IFN n LCR: ?precoce n herpes/alte encefalite herpetice- 30%
IgM n LCR, ser- dg precoce
? Ac specifici n dinamica
Culturi v, PCR din LCR (BK, toxo)
DIAGNOSTIC +
Dg epidemiologic, clinic, laborator
DD: come metab (uremie, DZ), intox medic, Tm cerebr, tromboflebite cerebr, supur
endocran, abces cerebral, empiem subdural, hemor cerebr, vascularite sistemice
(LES, periarterita nodoasa) hglic, HCa, hNa, psihoze
Evol: primare-deces 20-70% f:etio, vrsta, f clin, vindec +/- sehele n 30%: tulb co
mp, emot, scade perfor sc, profes, retard psihomot, epilepsie, pareza/paralizii
FORME ETIOLOGICE
Prioni
V: herpes, enterov, rujeolic, rubeolic, urlian, gripa, rabia, fo hemoragice, arb

ov (TBE, fo v Rift, West Nile, encefalita japoneza), choriomeningita Ly


Bact: BK, L monocytogenes, brucella, Borellia, treponeme, leptospire, Mycoplasma
, Chlamydia, legionella, ricketsii -R prowazekii, ricketsii
Parazit-micoze: plasmodium falciparum, Naegleria Cryptococcus neoformans, Toxopl
, Trypanosoma, Toxocara, Trichinella, Echinococcus, Cisticercus
ENCEFALITE CU TERAPIE SPECIFICA
Encefalita herpetica: n orice suspiciune trat trebuie initiat la pacientii cu:
Fo 39-40 oC, tulb de comportament, halucinatii, tulb mnezice, crize conv repetit
iv +
Meningoencefalita cu ?IFN n LCR, activit EEG variabila la debut, lez hipodense fr
onto-temporale uni/bilat la RMN/ tardiv pe CT
PCR HSV (+) n LCR
Listerioza evol cu encefalita cu localiz frecv de trunchi cerebral- nn cranieni;
LCR- Ly, prot? glico?/LCR = N; hemoculturi, culturi LCR =N
Trat: ampi/amoxi 200mg/kgc/zi+cotrimoxazol
TBC- trat specific
Paludism-Pl falciparum- frecv cu LCR =N, suspicionata ptr voiaj recent, fo, mani
f neuro? chinina iv
B Lyme- evol cr la dist de manif cut
Sifilis
Bruceloza
TRAT
Etiologic: acyclovir n susp de inf herpetica;
Se poate asocia ABterapie:
- la adult, n susp de listerioza/
-Susp de mycopl: fluorochinolona
Izolare, monitorizarea funct vitale
Ig teg, muc, dieta parenter, sonda nazog
Reech HE, AB, IOT,
Trat anticonvulsivant
Combat edem cerebral: restrictie hidrica, depletive cerebr- manitol, G Htona
Corticoterapie-imune, AINS
Monitoriz pres intracran- extradural