眩暈與中樞神經(jīng)系統(tǒng)感染及免疫性疾病PPT精選文檔

1、1眩暈與中樞神經(jīng)系統(tǒng)感染眩暈與中樞神經(jīng)系統(tǒng)感染及免疫性疾病及免疫性疾病23急性小腦炎急性小腦炎 (Acute Cerebellitis)(Acute Cerebellitis)456Contactin-associated protein-2 antibodies in nonparaneoplastic Cerebellar ataxia. J Neurol Neurosurg Psychiatry. 2012; 83(4):437440.7891011Sudden death from fulminant acute cerebellitis.Pediatr Neurosurg 2001;

2、 35:248.12小腦膿腫小腦膿腫(Cerebellar Abscess)(Cerebellar Abscess)由中耳炎引發(fā)的耳源性腦膿腫多數(shù)以眩暈為首發(fā)癥狀，受累結(jié)構(gòu)主要包括：迷路及小腦。13141516171819腦囊蟲(chóng)病腦囊蟲(chóng)病(Cerebrocysticercosis)(Cerebrocysticercosis)202122實(shí)質(zhì)型囊蟲(chóng)實(shí)質(zhì)型囊蟲(chóng)囊泡樣病灶囊泡樣病灶單個(gè)囊單個(gè)囊阿苯達(dá)唑阿苯達(dá)唑15mg/kg/d X 315mg/kg/d X 3或吡喹酮每次或吡喹酮每次30mg/kg30mg/kg，共三次，每次間隔，共三次，每次間隔2 2小時(shí)小時(shí)罕用激素、罕用激素、輕到中度感染輕到中度

3、感染阿苯達(dá)唑阿苯達(dá)唑15mg/kg/d X 115mg/kg/d X 1周周吡喹酮每次吡喹酮每次30mg/kg/dX 1530mg/kg/dX 15日日必要時(shí)激素治療必要時(shí)激素治療重度感染重度感染阿苯達(dá)唑阿苯達(dá)唑15mg/kg/d X 115mg/kg/d X 1周周需要治療全程應(yīng)用激素需要治療全程應(yīng)用激素膠樣病灶膠樣病灶單個(gè)囊單個(gè)囊阿苯達(dá)唑阿苯達(dá)唑15mg/kg/d X 315mg/kg/d X 3或吡喹酮每次或吡喹酮每次30mg/kg30mg/kg，共三次，每次間隔，共三次，每次間隔2 2小時(shí)小時(shí)罕用激素罕用激素輕到中度感染輕到中度感染阿苯達(dá)唑阿苯達(dá)唑15mg/kg/d X 115mg/k

4、g/d X 1周周通常治療全程應(yīng)用激素通常治療全程應(yīng)用激素囊蟲(chóng)性腦炎囊蟲(chóng)性腦炎禁用驅(qū)蟲(chóng)藥，激素與滲透性利尿劑緩解腦水禁用驅(qū)蟲(chóng)藥，激素與滲透性利尿劑緩解腦水腫，部分患者去骨瓣減壓腫，部分患者去骨瓣減壓顆粒樣或顆粒樣或鈣化病灶鈣化病灶單個(gè)或多個(gè)單個(gè)或多個(gè)不必驅(qū)蟲(chóng)治療，復(fù)發(fā)性癲癇及鈣化病灶周圍不必驅(qū)蟲(chóng)治療，復(fù)發(fā)性癲癇及鈣化病灶周圍水腫患者可應(yīng)用激素治療水腫患者可應(yīng)用激素治療Neurocysticercosis. The Neurohospitalist2014, Vol. 4(4) 205-21223實(shí)質(zhì)外型囊蟲(chóng)實(shí)質(zhì)外型囊蟲(chóng)半球凸面小囊半球凸面小囊單囊或多囊單囊或多囊阿苯達(dá)唑阿苯達(dá)唑15mg/kg/

5、d X 115mg/kg/d X 1周周必要時(shí)應(yīng)用激素必要時(shí)應(yīng)用激素側(cè)裂及腦脊液池大囊側(cè)裂及腦脊液池大囊葡萄樣多囊葡萄樣多囊阿苯達(dá)唑阿苯達(dá)唑15-30mg/kg/d X 15-30d15-30mg/kg/d X 15-30d需要治療全程應(yīng)用激素需要治療全程應(yīng)用激素其他形態(tài)其他形態(tài)腦積水腦積水不必驅(qū)蟲(chóng)治療，腦室分流不必驅(qū)蟲(chóng)治療，腦室分流腦室囊蟲(chóng)腦室囊蟲(chóng)內(nèi)鏡取蟲(chóng)內(nèi)鏡取蟲(chóng)側(cè)腦室小病灶可用阿苯達(dá)唑側(cè)腦室小病灶可用阿苯達(dá)唑伴腦室炎患者可行腦室分流伴腦室炎患者可行腦室分流血管炎和慢性血管炎和慢性蛛網(wǎng)膜炎蛛網(wǎng)膜炎不必驅(qū)蟲(chóng)治療，需要激素治療不必驅(qū)蟲(chóng)治療，需要激素治療脊髓囊蟲(chóng)脊髓囊蟲(chóng)手術(shù)取蟲(chóng)手術(shù)取蟲(chóng)24多發(fā)性硬

6、化多發(fā)性硬化(Multiple Sclerosis MS)(Multiple Sclerosis MS)Vertigo in MS: utility of positional and particle repositioning maneuvers. Neurology.2000,55:1566-1569.25在MS患者中，68%的患者可以發(fā)現(xiàn)腦干脫髓鞘改變，30%出現(xiàn)小腦病變，還有部分患者同時(shí)出現(xiàn)腦干和小腦病變，這些都是造成患者眩暈的病理基礎(chǔ)。A prospective study of patients with brain MRI showing incidental t2 hyperintensities addressed as multiple sclerosis: a lot of work to do before treating. Neurol Ther. 2014 Dec 13;3(2):123-32. 26 Bickerstaff Bickerstaff型腦