1. INFECTIOUS DISEASES OF CENTRAL NERVOUS SYSTEM

2. INFECTIOUS INFLAMMATORY DISEASES OF CENTRAL NERVOUS SYSTEM Subacute sclerosing leukoencephalitis (demyelinating leuko- and panencephalitis) Arachnoiditis of brain Meningitis Encephalitis Poliomyelitis Myelitis

3. MENINGITIS

4. CLASSIFICATION OF MENINGITIS

5. By etiology Bacterial Viral Primary Secondary By pathogenesis

6. By the character of inflammatory process and changes in liquor Purulent Serous Serous-fibrinogenous Hemorrhagic

7. By clinical course Fulminant Acute Chronic Subacute

8. By localization of the process Basal Convexital light By degree of severity medium severe extremely severe

9. Clinical signs of meningitis

10. – fever – high body temperature – leucocytosis in blood with shift of the formula to the left, – erythrocyte sedimentation rate (EST) Syndrome of infectious disease I

11. Meningeal symptoms 1. General hyperesthesia and hyperesthesia of organs of senses 2. Reactive pain phenomena: – Bechterew’s zygomatic symptom – feeling of pain when you press on eyeballs, points of outlet of branches of trigeminal, occipital nerves 3. Muscular tonic tensions: – rigidity of occipital muscles, long muscles of the back – Kernig’s symptoms, Brudzinski’s upper , media, lower symptoms Meningeal syndrome II

12. – headache – vomiting – spasms – psychomotor excitement – impairment of consciousness Meningeal syndrome General brain symptoms II

13. Purulent meningitis Neutrophilic pleocytosis ( thousands of cells per 1 mm 3 ) Lymphocytic pleocytosis ( tens or hundreds of cells per 1 mm 3 ) Detection of pathogenic factor Syndrome of inflammatory changes in liquor Serous meningitis III

14. Pathogenesis of meningitis

15. Ways of infection of membrane Open craniocerebral trauma , which is combined with liquoria Perineural or lymphogenous spread of pathogenes in case of presence of purulent infection (sinusitis, otitis etc) Hematogenous spread from primary sources of infection

16. Pathogenesis Inflammation and edema of brain membranes (and adjacent brain tissue) Discirculation in brain and membranes vessels Hypersecretion of liquor and delay of its resorption High intracranial pressure and hydrocephalus Damage of membranes and roots of cranial and spinal nerves

20. PNEUMOCCOCAL MENINGITIS ( adults get this disease more often )

23. STAPHYLO-, STREPTOCOCCAL MENINGITIS

26. SEROUS MENINGITIS Acute lymphocytic choriomeningitis Parotitic Caused by Coxsackie viruses

29. ARACHNOIDITIS

31. CLASSIFICATION OF ARACHNOIDITIS

32. By morphologic changes adhesive cystic

33. By localization of posterior cranial fossa of cerebellopontine angle cerebral spinal convexital basal optico-chiasmic

35. Clinical peculiarities of some cerebral arachnoiditis

36. Convexital arachnoiditis – jacksonian epileptic attacks – asymmetry of reflexes, more rarely paresis of limbs – conductive sensory impairments

37. Optico-chiasmic – headaches in forehead area, eye-sockets/orbits, bridge of nose – loss of eyesight – bitemporal hemianopsia or concentric narrowing of eyesight fields – bitemporal atrophy of discs of optic nerves ( more rarely congestive) – anosmia – sleep disorders, changes of carbohydrate-salt metabolism

38. Of posterior cranial fossa – general cranial symptoms prevail – pains in back of the head – vomiting – vertigo – anosmia – congestive disks of optic nerves

39. Of cerebellopontine angle – Tinnitus (ear noise) – loss of hearing – unsteadiness, vertigo – paresis of mimic muscles – trigeminal neuralgia – slight pyramidal lesions

42. ENCEPHALITIS

46. Secondary • parainfectious (in case of measles, rubella, epimic parotitis, chicken pox, flu) • postvaccinal, serum • caused by microbes, rickettsia, toxoplasma

48. General cerebral: Headache, vomiting, spasms, psychomotor disorders, impairment of consciousness General infectious : High temperature, inflammatory changes inj blood, catarrhal phenomena of upper respiratory tracts and gastrointestinal tract, focal : ( depend on localization of the process ) Clinical manifestations of encephalitis

49. Chronic stage : Parkinsonian syndrome Acute stage : High body temperature, pathologic sleepiness, oculomotor disorders, vegetative, vestibular, psychic impairments Epidemic encephalitis

50. Stage of recovering Stage of reconalescence Period of residual effects ( permanent atrophic paresises, Kojewnikoff’s epilepsy) Acute stage • The first period of fever: weakness, headache, pain in muscles, meningeal syndrome; • the second period of fever: peripheral paresises of muscles of arms and neck, bulbar syndrome Tick-borne(vernal) encephalitis

51. Ethiology . HSV of 1 and 2 type Pathogenesis . Central nervous system gets infected by virus through olfactory bulbs or ganglions of trigeminal nerve. Virus spreads hematogenicly or by perineural areas. Provocateurs of virus manifestation are: intercurrent diseases, prscription of cytostatics, HIV infection etc. It gets to central nervous sytem hematogenicly if hemaencephalitic barrier (HEB) is impaired (by perineural fissures – herpes zoster) Herpetic encephalitis

52. Herpetic encephalitis Pathomorphology - is characterized by hemorrhagic changes in nerval tissue with appearance of focuses of distruction, with further developing of cysts, mainly in grey sunstance (frontal, temporal, parietal lobes)

53. Clinical picture of herpetic encephalitis 1 . Early stage of clinical course Meningeal type – in 50 % • fever • general infectious effects • severe headache • impairment of consciousness Cortical type –in 20% of cases • non adequate behaviour • disorientation • elements of amnesia In 5-7 days - fever

54. Clinical picture of herpetic encephalitis 1. Early stage of clinical course Stroke-like type – in 10% of cases • sudden generalized spasms • loss of consciousness (up to coma) • fever Brainstem type – in 5% cases • diplopia • disarthria • dysphonia • alternating hemiaparesis

55. Clinical picture of herpetic encephalitis • general cranial and liquor-hypetensive symptoms • lesion of cranial nerves • paresis of limbs • huperkinesias, episyndrome • severe impairments of higher cortical functions (aphasia, apraxia, hallucinations, loss of intellect, bulbar syndrome)

58. This is toxico-infectious lesion of nervous sytem, which is developping on peack of the flu Grippal enecephalitis (secondary) pathomorphology - ▪ swelling of brain ▪ small hemorrhages, diapedic hemorrhages ▪ perivascular infiltrations

59. Grippal encephalitis (secondary) Clinical picture – marked general cerebellar symptoms – meningeal symptom with domination of rigidity of occipital muscles – cerebral symptoms: aphasia. Oculomotor impairments, lesion of V ІІ, ІІІ, ІХ-ХІІ pairs of cranial nerves, pyramidal insufficiency – changes in eye ground: congestion, sometimes neuritis, loss of acuty of eye-sight – Liquor : bloody, xanthochromic, transparent

60. Grippal encephalitis (secondary Treatment – bed rest – calcium drugs – antihistaminic – antiviral – desintoxicating In case of absence of focal sisns, but with presence of asthenic, cephalgic, general cerebellar and hypertensive syndromes, grippal encephalopathy is diagnosed

61. Thank you for attention 