Aseptic meningitis o definition When the CSF culture

Aseptic meningitis o definition: When the CSF culture was negative. o CSF: CSF pressure mmh 2 o: normal or slightly elevated. leukocytes : PMN early mononuclear later. rarly >1000 Protein mg /dl: 20 -100 Glucose mg/dl: generally normal may be depressed to 40. (15 -20%) Entroviruse recoverd by CSF culture or PCR HSV by PCR.

Aseptic meningitis o Refer principally to viral meningitis. o Other infection. ( Lyme disease, syphlis, TB) o Parameningeal infection: (brain abscess, epidural abscess, venus sinus empyema) o Chemical (NSAID, anti-inflamatory, IVig) o Autoimmune disorders

Encephalitis Inflammatory of brain parenchyma lead to cerebral dysfunction. o May be diffuse , or localized 1. 2. 3. Acute Post infection encephalomyelitis Chronic degenerative , slow viral infection.

Encephalitis o 1. 2. it has 2 mechanism. Direct infection. Immune mediated response in the CNS that begins several days after the extraneural manifestation of infection.

Encephalitis o Viruses are the principal causes of acute infection encephlitis. o Metabolic. o Toxic. o Neoplastic disorder. o HIV is an important cause of enceplalitis more commonly insidious in onset.

ADEM ( Acute disseminated encephalomyelitis) o ADEM abrupt development. o mutiple neurologic signs related to an inflammatory and demyelinating disorder of brain and spinal cord. o Childhood viral infection. ( measles , chickenpox, or vaccination) o Resembles to MS. o Relapses occurred in 14% within in 1 year.

Clinical manifestation encephalitis o Prodrome of nonspecific symptoms. (cough, sore throat, fever, headache, abdominal complaint) o Progressive lethargy, behavioral change, neurologic deficits. o Seizures are common. o Maculopapular rash. o Coma, transverse myelitis, Polio- like illness, periferal neuropathy.

Laboratory o CSF shows: lymphocytic pleocytosis. Slight elevatin protein. Normal glucose. The CSF occasionally may be normal. o In HSV protein and RBC increased. o Extreme elevated of protien and reduction of glucose (TB, carcinomatoseis, cryptococcal infection)

Laboratory o EEG: temporal lobe characteristic HSV infection. o Serologic studies. (arbovirus, EBV, mycoplasma, cat-scratch, Lyme) o culture stool and CSF , nasopharyngeal. o PCR test for HSV, entrovirus and other virus. o The cause of encephalitis In 1/3 of cases is undetermined.

Laboratory o 1. 2. 3. 4. 5. Brain biopsy may be necessary for definitive diagnosis. in patients with focal neurologic finding Severe encephalopathy with no clinical improvement if diagnosis is obscure. HSV, rabis encephalitis , prion related disease (kuru, jakob) diagnosed with culture of brain biopsy. Identify arbovirus, entrovirus, TB, fungal infection. Non infection illness ( primary CNS vasculopathies , malignancies)

Differential diagnosis o Diagnosis established with : o Neurologic signs. epidemiology, evidence of infection in CSF, EEG, brain imaging o brain biopsy diagnostic but seldom performed.

Treatment o There is no specific therapy exception of HSV and HIV. Treatment is supportive (siezure, electerolyte abnormality, airway monitoring, increased ICP o ADEM: high-dose IV corticosteroids. o IV acyclovir is choice for HSV. o M, pneumonia may be trated with doxycycline, erythromycin, azithromycin, clarithromycin? ?

complication o Symptoms resolve over several days to 2 -3 weeks. o Recover without sequelae in 2/3 before dischrge from hospital. o neurologic sequelae(spasticity, cognitive impairment, weakness, ataxia, seizure. ( gradually recover some or all) o death. o Mortality is 5%