Download - Infecciones Snc
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Neonatos Strepto B, E coli, Listeria
Ninios Meningococo, Neumococo
Adolescentes Meningococo
Adultos Neumococo
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ETIOLOGIA BACTERIANA BK VIRAL
Aspecto Turbio Claro u opalescente
Claro
Proteina +++ ++ +
Glucosa --- -- Normal o -
Cloruro Normal - Normal
Células Neutrofilos Linfocitos Linfocitos
Aspecto Cristal de Roca
Tension Decub. Lat 100-150 mmH20
Cloruros 720 mg/100ml
Glucosa 45-80 mg/100ml
Proteinas 14-45 mg/100ml
R Pandy Negativa
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Gadolinium-enhanced MRI scans demonstrate discreteleft frontal (A) and right parieto-occipital (B) lesions in thispatient with EBV-associated primary CNS lymphoma. This 81year-old male had myasthenia gravis with long-term azathioprinetherapy but no other immunosuppression.
B. K. Kleinschmidt-DeMasters and D. H. Gilden: Expanding Spectrum of Herpesvirus Infections Brain Pathology 11: 440-451(2001)
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B. K. Kleinschmidt-DeMasters and D. H. Gilden: Expanding Spectrum of Herpesvirus Infections Brain Pathology 11: 440-451(2001)
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CRISE D’EPILESIE
Toutes les parasitoses,mais principalement : - paludisme
- cysticercose- filariose- bilharziose- hydatidose- paragonimose- toxocarose
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HydatidoseKyste Cysticersose
Paragonimose
Abcès Amibiase
Hydrocéphalie Cysticercose
PROCESSUS EXPANSIF INTRACRANIENet
HYPERTENSION INTRACRANIENNE
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SYNDROME MEDULLAIRE
- Epidurite Filariose (Dracunculus medinensis)
- Arachnoïdite kystique CysticercoseCénurose
- MyéliteBilharziose
- Syndrome du cône terminal
- Myéloradiculite Gnathostomose
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Premiers signes dépendent de la porte d'entrée :
porte d'entrée conjonctivale (complexe ophtalmoganglionnaire) = signe de Romaña = oedème bipalpébral
unilatéral indolore + adénopathies
régionales
MALADIE DE CHAGAS
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CALCIFICATIONS
Toxoplasmose
Cysticercose
Paragonimose
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Mycobacterium tuberculosis pulmonary alveoli hematogenous dissemination 3 weeks
CNS
Primary tubercle encapsulated
grows and ruptures if reactivation
meningitisarteritistuberculoma or abscessarachnoiditis - myelitis
TBETBEEvolution de l’affectionEvolution de l’affection
PathogénèsePathogénèse
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TBTBMéningiteMéningite
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TBTBArtériteArtérite
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TBTBTuberculomeTuberculome
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TBTBTuberculomeTuberculome
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TBTBTuberculomeTuberculome
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TBTBArachnoïdite - MyéliteArachnoïdite - Myélite
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Syndrome méningéParalysie des nerfs crâniensAVC : monoplégie, hémiplégieConvulsionsManifestations encéphalitiques (confusion mentale)Syndrome démentielHIC, syndrome tumoral, hydrocéphalieSyndrome médullaire et polyneuropathies
TB / HIVTB / HIVManifestations cliniquesManifestations cliniques
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Les manifestations traduisant l’atteinte HIV sont l’association :- d’une très importante altération de l’état général (perte de poids)- de lésions buccales (+++)- de signes cutanés (éruption, herpès)- d’un syndrome de Kaposi- d’une anémie avec leucopénie
TB / HIVTB / HIVManifestations cliniquesManifestations cliniques
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Les manifestations traduisant la TB nerveusedominent le tableau clinique
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Manifestations cliniquesAnomalies biologiques sont presque identiquesTraitement dans les deux affectionsDevenirMortalité
TB / HIVTB / HIVAtteintes nerveusesAtteintes nerveuses
M. tuberculosis; M. avium; M. fortuitum
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Compte-tenu de la fréquence de la co-infectionSi TB : recherche systématique HIVSi HIV : recherche systématique TB
Diagnostic de HIV est facile par la recherche desanticorps anti-HIV
Apparition 1 à 2 mois après contaminationTests sont simples, rapides et sensiblesEIA (immuno-enzymatique)Dosage ARN viral
TB / HIVTB / HIVDiagnostic HIVDiagnostic HIV
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Reconnaître la méningite est facile
Affirmer la TB est plus difficile- BK sont difficile à trouver- ELISA, mais manque de spécificité et de sensibilité- PCR - Culture- Enzyme Adenosine Deaminase (ADA)
Nécessité de différencier parmiles autres méningites opportunistes
TB / HIVTB / HIVDiagnostic TBDiagnostic TB
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ADA Cellules ProtéinesGlucose
g/l mg/dl
Méningo-encéphalite TB 9,15 302 1.57 20.9
Méningo-encéphalite cryptococcose 3,6 5 0.82 40.3
Méningo-encéphalite toxoplasmose 5,7 18 1.06 45.2(test : encre de chine)
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TB / HIVTB / HIVDiagnostic (LCR)Diagnostic (LCR)
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In basal cisterns and sylvian fissures:iso or hyperdense imagesintense enhancement after i.v. contrast
deep lenticulo striate territory Infarcts MCA
cortico-sub-cortical territory
Hydrocephalus
Ependymitis: linear enhancement of the ependymal surface
Associated tuberculomasin parenchymain meninges and sylvian fissures
TB / HIVTB / HIVDiagnostic TB (CT et MRI)Diagnostic TB (CT et MRI)
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Isoniazide 10-12 mg/kg/day hepato and neurotoxicity
Rifampin 10 mg/kg/day 600 mg renal and hepatotoxicity
Pyrazinamide 30 mg/kg/day hepatotoxicity
Ethambutol 15 mg/kg/day optic neuritis
Streptomycin 1 g/day ; 20 mg/kg/day ototoxicity
TREATMENT (1)TREATMENT (1)
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Management
2 - 3 or 4 drugs ?choice ?2 - 6 -12 - 18 - 24 months ?WHO recommendations INH, RMP, PZA, EMB 2 months
+ INH, RMP 7 months
TREATMENT (2)TREATMENT (2)
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If side effects, resistance, poor response, intolerance:
PAS, Ethionamide, Cycloserine
Amino-glycoside(Kanamycin, Amikacin, Capreomycin)
Quinolone (Ofloxacin)
TREATMENT (3)TREATMENT (3)
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