Encephalitis — a brain substance inflammation. The term "encephalitis" designate infectious, allergic, infectious and allergic and toxic damages of a brain. Distinguish primary (tick-borne, Japanese mosquito, Ekonomo's encephalitis) and secondary (clumsy, influenzal, vaccine-challenged) encephalitis. In case of encephalitis of any etiology complex therapy is necessary. As a rule, it includes etiotropny treatment (antiviral, antibacterial, antiallergic), dehydration, infusional therapy, anti-inflammatory treatment, vascular and neurotyre-tread therapy, symptomatic treatment. The patients who had encephalitis also need recovery treatment.
Encephalitis — a brain substance inflammation. The term "encephalitis" designate infectious, allergic, infectious and allergic and toxic damages of a brain.
Classification of encephalitis reflects etiologichesky factors, the related clinical manifestations and features of a current. On terms of emergence distinguish primary encephalitis (virus, microbic and rikketsiozny) and secondary encephalitis (post-exanthematic, vaccine-challenged, bacterial and parasitic, demiyeliniziruyushchy). On a tep of development and the course of a disease — supersharp, sharp, subsharp, chronic, recidivous. On defeat localization — cortical, subcrustal, stvolovy, with damage of a cerebellum. On prevalence — leykoentsefalit (with defeat of white substance), polyencephalitis (with defeat of gray substance) and pan-encephalitis. On morphological features — necrotic and hemorrhagic.
On weight of a course of a disease allocate encephalitis of average weight, heavy and extremely heavy. On possible complications — brain hypostasis, dislocation of a brain, a brain coma, an epileptic syndrome, . And also to possible outcomes of a disease — recovery, a vegetative state, rough focal symptoms. Besides, depending on primary localization encephalitis divides on stem, cerebellar, mezentsefalny and dientsefalny.
Tick-borne encephalitis (spring and summer)
The disease causes the filtering neyrotropny virus of tick-borne encephalitis. Carriers of a virus and its tank in the nature — ixodic pincers. Getting into a human body through a sting of a tick or alimentarno (consumption of raw milk of the infected cows and goats), the virus gets into nervous system gematogenno. Duration of the incubatory period of the disease which developed as a result of a sting of a tick makes from 1 to 30 days (in certain cases up to 60 days), in case of alimentary infection — from 4 days to 1 week. At microscopy of a brain and covers find their hyperaemia, infiltrates from poly-and mononuclear cages, mesodermal and gliozny reactions. Localization of inflammatory and degenerate changes of neurons is the share mainly of medulla kernels, forward horns of cervical segments of a spinal cord, the bridge of a brain, bark of a big brain.
The sharp debut which is shown in the form of temperature increase of a body to 39-40 degrees, the aching waist, calves pains is typical for a clinical picture of all forms of tick-borne encephalitis. In the first days of a disease pronounced all-brain symptoms (vomiting, a headache), consciousness violation are noted, mental disorders (nonsense, acoustical and sound hallucinations, a depression) were in certain cases observed. Allocate several clinical forms of tick-borne encephalitis: poliomiyelitichesky, meningealny, entsefalitichesky, feverish, poliradikulonevritichesky, and also two-wave viral encephalomeningitis. Their distinction consists in prevalence and expressiveness of these or those neurologic symptoms.
In diagnosing of tick-borne encephalitis data of the anamnesis (stay in the endemic center, a sting of a tick, the patient's profession, the use of goat milk or cheese) are of great importance. Let's note that only 0,5-5,0% of all pincers are carriers of viruses therefore not each disease which arose after a sting of a tick — encephalitis. Verification of the diagnosis "tick-borne encephalitis" is carried out by means of reactions of binding of a complement, neutralization and braking of hemagglutination. A certain diagnostic value has allocation of a virus in blood and a likvor; in blood increase in SOE, is defined, and at a likvor research — lymphocytic and increase in protein up to 1 g/l. Tick-borne encephalitis needs to be differentiated from a typhus, various forms of serous meningitis, sharp poliomyelitis.
Japanese mosquito encephalitis
The disease is caused by a neyrotropny virus which carriers are the mosquitoes capable to transovarialny transfer of a virus. The incubatory period proceeds from 5 to 14 days. The Japanese mosquito encephalitis debuts suddenly, from sharp temperature increase of a body (up to 39-40 degrees), vomiting, an intensive headache. Besides, considerable expressiveness of the general infectious symptoms (tachycardia, bradycardia, hyperaemia of the person, herpetic rashes, dryness of language) is typical for a clinical picture of the Japanese mosquito encephalitis. Allocate several forms of the Japanese mosquito encephalitis: meningealny, convulsive, bulbarny, gemiparetichesky, hyperkinetic and lethargic. Their distinction consists in prevalence of this or that syndrome.
Course of a disease, as a rule, heavy. Within the first 3-5 days there is an increase of symptoms, high temperature of a body remains for 10-14 days and decreases lytically. The lethal outcome most often (to 70% of cases) is observed in the first week of a disease. Approach of death is possible also in later terms of a disease as result of the joined complications (for example, hypostasis of lungs). Seasonality of a disease and epidemiological data are of great importance for diagnosis of the Japanese mosquito encephalitis. Verification of the diagnosis is carried out by means of reactions of binding of a complement and neutralization, antibodies are defined on the second week of a disease.
Epidemic lethargic encephalitis of Ekonomo (encephalitis And)
The disease malokontagiozno, now in a typical form does not meet. The causative agent of epidemic encephalitis of Ekonomo is not found to this day. Clinically and patomorfologichesk the disease can be divided into two stages — sharp, having inflammatory character, and chronic for which typically progressive and degenerate current. The classical form of epidemic lethargic encephalitis in a sharp stage debuts from rise in body temperature up to 39 degrees, moderate headaches, vomiting, feeling of the general weakness. Fever lasts about two weeks. At this time there are neurologic symptoms: pathological drowsiness (is more rare — other sleep disorders), defeat of kernels of glazodvigatelny nerves (sometimes ). The extrapyramidal symptoms typical for a chronic stage of epidemic encephalitis of Ekonomo are quite often observed also at a sharp stage of a disease. They can be shown in the form of giperkinez (, a look spasm, ) and an akinetiko-rigidny syndrome (an amimia, , a rigidnost of muscles).
In certain cases the sharp stage of epidemic encephalitis of Ekonomo can be followed by the expressed psychogenic frustration (visual and/or acoustical hallucinations, change of perception of coloring and a form of surrounding objects). At a sharp stage of a disease in a likvor at most of patients reveal (mostly lymphocytic), small increase in level of glucose and protein; in blood — the increased level of lymphocytes, eosinophils. The sharp stage of epidemic encephalitis of Ekonomo can last from 3-4 days to 4 months after which perhaps absolute recovery. The sharp stage passes into 40-50% of cases in chronic with preservation of residual symptoms (persistent sleeplessness, a depression, easy , insufficiency of convergence).
The main clinical manifestation of a chronic stage of epidemic encephalitis of Ekonomo is the syndrome of parkinsonism along with which also endocrine frustration can develop (infantility, not diabetes, violations of a menstrual cycle, a kakheksiya, obesity). Diagnosis of epidemic encephalitis in a sharp stage is quite difficult. During this period diagnosing can be based only on various forms of a sleep disorder which are followed by psychotouch disorders, and symptoms of defeat of kernels of glazodvigatelny nerves. Special attention should be paid to emergence of the above-stated symptoms against the background of the increased body temperature. Diagnostics of a chronic stage of epidemic encephalitis of Ekonomo is less difficult and is based on a characteristic syndrome of parkinsonism, endocrine violations of the central genesis, changes of mentality.
The disease is caused by viruses of flu A1, A2, A3 and V. Voznikayet as a flu complication. Pathogenetic mechanisms of influenzal encephalitis — the distsirkulyatorny phenomena in a brain and neurotoxicosis. Defeats of nervous system are inevitable at any form of flu when they are shown in the form of a headache, muscular pains, drowsiness, an adinamiya, etc. However in case of development of influenzal encephalitis the health of the patient sharply worsens, there are all-brain symptoms (dizziness, vomiting). In a likvor find moderate increase in protein and small (when carrying out a lyumbalny puncture the likvor follows under elevated pressure).
In some cases at a sharp stage of influenzal encephalitis severe defeat in the form of hemorrhagic influenzal encephalitis which debuts sharp rise in body temperature, a fever and violation of consciousness (developed up to a coma). In a likvor find blood traces. A current of such form of influenzal encephalitis extremely heavy therefore the lethal outcome comes quite often, and in case of a positive outcome of a disease the expressed neurologic frustration remain.
Treats infectious and allergic encephalitis. Develops sharply, for 4-5 day after emergence of rash at measles when body temperature, as a rule, was already normalized, note its new sharp rise to 39-40 degrees. In most cases there are expressed disorders of consciousness, a hallucination, psychomotor excitement, generalizirovanny spasms, koordinatorny violations, giperkineza, paresis of extremities and violation of functions of bodies of a small pelvis. At a research of a likvor define the increased protein content, . The course of clumsy encephalitis extremely heavy, a lethality reaches 25%.
Can arise after introduction of vaccines ADS and AKDS, at antirabichesky inoculations, and also after a clumsy vaccine (most often). Postvaktsignalny encephalitis develops sharply, debuting from sharp temperature increase of a body (up to 40 degrees), vomiting, a headache, violations of consciousness and generalizirovanny spasms. Defeat of extrapyramidal system is followed by emergence of giperkinez and violations of coordination of the movement. At a likvor research (follows under elevated pressure) define small lymphocytic and slight increase of level of protein and glucose. Feature of a course of encephalitis at antirabichesky inoculations — a disease debut in the form of the sharp entsefalomiyelopoliradikulonevrit which sometimes is quickly progressing capable to lead to death as a result of bulbarny frustration.
Treatment of encephalitis
Neurologists apply several types of therapies to treatment of encephalitis. Pathogenetic therapy includes several directions:
- dehydration and fight against brain hypostasis ( 10-20% solution intravenously on 1–1,5 g/kg; furosemide intravenously or intramuscularly 20-40 mg; acetazoleamide);
- desensitization (, , );
- hormonal therapy — has the dehydrating, anti-inflammatory, desensibilizing effect, and also protects bark of adrenal glands from functional exhaustion (Prednisolonum to 10 mg/kg/days by method pulse therapy within 4-5 days; dexamethasone intravenously or intramuscularly 16 mg/days on 4 mg every 6 hours);
- microcirculation improvement (isotonic solution of a dextran intravenously kapelno;
- antigipoksant (ethylmethylhydroxypyridine , etc.);
- maintenance of a homeostasis and water and electrolytic balance (parenteral and enteroalimentation, dextrose, dextran, potassium chloride);
- vasoprotectives ( + + , , , etc.);
- treatment of cardiovascular frustration (warm glycosides, vazopressor, camphor, , glucocorticoids);
- breath normalization (preservation of passability of airways, hyperbaric oxygenation, oxygenotherapy, if necessary trakheostomiya or intubation, IVL;
- restoration of metabolism of a brain (vitamins, polypeptides of a cerebral cortex of the cattle, piracetam, etc.);
- anti-inflammatory medicines (salycylates, ibuprofen, etc.)
Etiotropny therapy of viral encephalitis assumes use of antiviral medicines — the nukleaz detaining reproduction of a virus. Appoint interferon alfa-2, in hard cases in combination with ribaviriny. At RNA and DNA-viral encephalitis application of a tiloron is effective. Corticosteroids (methylprednisolonum) apply by a method pulse therapy to 10 mg/kg intravenously within 3 days.
Symptomatic therapy in turn assumes several directions: antikonvulsantny and antipiretichesky treatment, therapy of a deliriozny syndrome. Apply diazepam to knocking over of the epileptic status (5-10 mg intravenously on dextrose solution), 1% solution of a tiopental of sodium intravenously, phenobarbital, , an inhalation anesthesia. Apply to decrease in body temperature lytic mixes, 2 ml of 50% of solution of metamizol of sodium, , an ibuprofen. In therapy of a deliriozny syndrome purpose of magnesium of sulfate, acetazoleamide, lytic mixes is expedient. To normalization of consciousness apply metabolic medicines, biostimulators, to normalization of mentality — antidepressants, tranquilizers.
Recovery therapy also includes several components: treatment of parkinsonism (medicines of a levodopa, holinolitika, miorelaksant; stereotaksichesky operations are shown only at increase of a rigidnost and inefficiency of drug treatment); treatment of giperkinez (metabolic medicines, neuroleptics, tranquilizers); treatment of kozhevnikovsky epilepsy (antikonvulsant, neuroleptics, tranquilizers); treatment of paresis (power proofreaders, the medicines stimulating metabolism in a brain and muscular tissue, physiotherapy exercises, physical therapy, massage); treatment of neuroendocrine frustration (the metabolic medicines, tranquilizers desensibilizing medicines, neuroleptics).
Prevention of encephalitis
The preventive measures capable whenever possible to prevent infection with tick-borne and mosquito encephalitis, are preventive vaccination of the people living and/or working in zones of possible infection. Standard vaccination against tick-borne encephalitis includes 3 inoculations and gives resistant immunity for 3 years. Prevention of secondary encephalitis means timely diagnosis and adequate therapy of infectious diseases.