I. Diagnostic points.
1, mostly acute or subacute onset, peaking a few days or weeks after the disease.
2, there are often fever and other symptoms of systemic infection, increased blood white blood cell count, increased sedimentation.
3, neurological damage symptoms: can involve the brain, spinal cord or cerebrospinal membrane. Most of the damage is diffuse.
4.Cerebrospinal fluid examination: Most of them are the basis for confirming the diagnosis. Specific or non-specific inflammatory changes may be found, and evidence of infection by viruses, bacteria, fungi, parasites, spirochetes, etc. may be found.
5.Electroencephalography: It has auxiliary diagnostic value for inflammatory brain damage, and can distinguish diffuse or limited damage.
6.Imaging examination (CT, MR): may show the location, scope and nature of lesions, but cannot replace cerebrospinal fluid examination.
II. Diagnosis and treatment process.
(a) Diagnosis and early management.
1.Discovery of suspected cases: fever, headache, neuropsychiatric symptoms, meningeal irritation signs, etc. Those with proposed diagnosis of CNS infection need to be hospitalized.
2.Emergencies such as high fever, convulsions, delirium, coma, unstable vital signs, etc. First resuscitate life and treat symptomatically. If bacterial infection is suspected, give empirical antibacterial drug treatment.
3. Do lumbar puncture as early as possible, send cerebrospinal fluid for routine, cytological and specific examination, preferably for bacterial culture or drug sensitivity test, and do pathogenic examination as far as possible. One cerebrospinal fluid examination cannot confirm the diagnosis, changes in condition, observation of treatment effect, intrathecal medication, etc. repeated lumbar punctures are required.
4.Other auxiliary tests: routine blood, blood sedimentation, EEG, etc. According to the condition and differential diagnosis need to do brain CT, MR scan.
5, etiology tracing: such as septic meningitis can be caused by cardiopulmonary and other visceral infections, cranial vertebrae and other septic foci or through cranial fractures and neurosurgery, which need to be combined with medical history and other related auxiliary examinations to confirm the diagnosis; tuberculous meningitis needs to find extracerebral tuberculosis (such as lung) infection foci.
(ii) Analysis of findings and specific treatment.
1, cerebrospinal fluid is normal or slightly non-specific abnormal: may be mild viral encephalitis, meningitis, post-infection demyelinating brain, non-viral infection of aseptic meningitis, etc.; may also be atypical changes of a certain infection, need to be combined with medical history, the evolution of the disease and review of cerebrospinal fluid to further confirm the diagnosis.
2, cerebrospinal fluid abnormalities consistent with viral changes: antiviral treatment.
3, cerebrospinal fluid abnormalities consistent with tuberculosis changes: anti-tuberculosis treatment.
4.Cerebrospinal fluid abnormalities consistent with septic changes: antibacterial drug treatment.
5.Cerebrospinal fluid abnormalities consistent with new cryptococcal infection: antifungal treatment.
6.Cerebrospinal fluid abnormalities cannot be diagnosed or cannot exclude certain infections such as tuberculous meningitis, and cerebrospinal fluid needs to be rechecked recently.
(c) General treatment.
1.Observation of vital signs, regular measurement of temperature, pulse, respiration, blood pressure, and attention to cardiopulmonary conditions.
2. Systemic nutritional support therapy: pay attention to water and electrolyte balance, give nutritious and easily digestible food; usually intravenous fluids are needed, and enteral or parenteral nutrition can be given according to the condition.
3, coma or delirium, should strengthen care, prevention of bedsores, pneumonia, urinary tract infection, etc.
4. Symptomatic treatment: Anti-epileptic drugs should be given to those with convulsions; antipyretics or physical cooling should be given to those with high fever;
5, prevention and control of cerebral edema: keep the airway open to prevent cerebral hypoxia. Drugs can be given 20% mannitol, tachyphylaxis, glycerol fructose or glycerol saline, dexamethasone, etc.
If there are septic lesions in the adjacent organs of the head, the lesions need to be removed to eliminate the source of infection.