?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