tailieunhanh - Thieme Mumenthaler, Neurology - part 2

mãn tính viêm màng não. Bệnh nhân là một phụ nữ 49 tuổi. Các sinh vật gây bệnh không thể được xác định. một T1-weighted coronal MRI với độ tương phản. b trục T1-weighted MRI với độ tương phản. Lưu ý việc tăng cường tương phản bất thường trong các màng não. | Infectious Diseases of the Brain and Meninges 85 Fig. b Chronic meningitis. The patient is a 49-year-old woman. The pathogenic organism could not be identified. a Coronal T1-weighted MRI with contrast. b Axial T1-weighted MRI with contrast. Note the abnormal contrast enhancement in the meninges. Fig. b Acute bacterial meningitis. The patient is a 10-year-old boy. a Coronal T1-weighted MRI with contrast demonstrates sphenoid sinusitis arrows spreading in the epidural space under the left temporal lobe and causing meningitis by direct extension with involvement of the temporal lobe arrowheads . b T1-weighted MRI with contrast in a coronal section posterior to a shows a probable epidural empyema over the left temporal lobe arrowheads . There is also extensive signal change in the left thalamus probably due to an arterial infarction as a complication of meningitis. Mumenthaler Neurology 2004 Thieme All rights reserved. Usage subject to terms and conditions of license. 86 2 Diseases Mainly Affecting the Brain and its Coverings Prognosis The prognosis of acute bacterial meningitis depends on the pathogenic organism the severity of the infection concomitant illnesses the state of the immune system and the type of treatment and time at which it is instituted. Mortality is highest in the newborn over 50 . Meningitis accompanied by meningococcal sepsis also confers a high mortality because it is frequently complicated by bilateral adrenal hemorrhage and subsequent circulatory collapse Waterhouse-Friderichsen syndrome . The mortality of other forms of meningitis is approximately 20 1014 . Surviving patients often suffer from permanent sequelae including deafness malre-sorptive hydrocephalus epilepsy and intellectual deficits particularly in children. Treatment Fig. 777a If a lumbar puncture cannot be performed immediately because of clinical signs of intracranial hypertension blind parenteral antimicrobial treatment should be initiated at once as a few .