眩晕与中枢神经系统感染及免疫性疾病课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,-,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,-,*,眩晕与中枢神经系统感染及免疫性疾病,1,-,2,-,急性小脑炎,(Acute Cerebellitis),3,-,4,-,5,-,Contactin-associated protein-2 antibodies in nonparaneoplastic Cerebellar ataxia. J Neurol Neurosurg Psychiatry. 2012; 83(4):437440.,6,-,7,-,8,-,9,-,10,-,Sudden death from fulminant acute cerebellitis.Pediatr Neurosurg 2001; 35:248.,11,-,小脑脓肿,(Cerebellar Abscess),由中耳炎引发的耳源性脑脓肿多数以眩晕为首发症状，受累结构主要包括：迷路及小脑。,12,-,13,-,14,-,15,-,16,-,17,-,18,-,脑囊虫病,(Cerebrocysticercosis),19,-,20,-,21,-,实质型囊虫,囊泡样病灶,单个囊,阿苯达唑,15mg/kg/d X 3,或吡喹酮每次,30mg/kg,，共三次，每次间隔,2,小时,罕用激素、,轻到中度感染,阿苯达唑,15mg/kg/d X 1,周,吡喹酮每次,30mg/kg/dX 15,日,必要时激素治疗,重度感染,阿苯达唑,15mg/kg/d X 1,周,需要治疗全程应用激素,胶样病灶,单个囊,阿苯达唑,15mg/kg/d X 3,或吡喹酮每次,30mg/kg,，共三次，每次间隔,2,小时,罕用激素,轻到中度感染,阿苯达唑,15mg/kg/d X 1,周,通常治疗全程应用激素,囊虫性脑炎,禁用驱虫药，激素与渗透性利尿剂缓解脑水肿，部分患者去骨瓣减压,颗粒样或,钙化病灶,单个或多个,不必驱虫治疗，复发性癫痫及钙化病灶周围水肿患者可应用激素治疗,Neurocysticercosis. The Neurohospitalist2014, Vol. 4(4) 205-212,22,-,实质外型囊虫,半球凸面小囊,单囊或多囊,阿苯达唑,15mg/kg/d X 1,周,必要时应用激素,侧裂及脑脊液池大囊,葡萄样多囊,阿苯达唑,15-30mg/kg/d X 15-30d,需要治疗全程应用激素,其他形态,脑积水,不必驱虫治疗，脑室分流,脑室囊虫,内镜取虫,侧脑室小病灶可用阿苯达唑,伴脑室炎患者可行脑室分流,血管炎和慢性蛛网膜炎,不必驱虫治疗，需要激素治疗,脊髓囊虫,手术取虫,23,-,多发性硬化,(Multiple Sclerosis MS),Vertigo in MS: utility of positional and particle repositioning maneuvers. Neurology.2000,55:1566-1569.,24,-,在,MS,患者中，,68%,的患者可以发现脑干脱髓鞘改变，,30%,出现小脑病变，还有部分患者同时出现脑干和小脑病变，这些都是造成患者眩晕的病理基础。,A prospective study of patients with brain MRI showing incidental t2 hyperintensities addressed asmultiple sclerosis: a lot of work to do before treating. Neurol Ther.2014 Dec 13;3(2):123-32.,25,-,Bickerstaff,型脑干脑炎,(Bickerstaff Brainstem Encephalitis, BBE),26,-,27,-,28,-,29,-,治 疗,30,-,31,-,32,-,前庭神经元炎,(VestibularNeuronitis),33,-,34,-,