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Chronic meningitis. Perform careful general, systemic, and neurologic examinations, looking especially for a BCG vaccination scarPerform careful general, systemic, and neurologic examinations, looking especially for a BCG vaccination scar, lymphadenopathy, papilledema and tuberculomas during funduscopy, and meningismus. The presentation of chronic tuberculous meningitis may be acute, but the classic presentation is subacute and spans weeks. Patients generally have a prodrome of fever of varying degrees, malaise, and intermittent headaches. Patients often develop central nerve palsies (III, IV, V, VI, and VII), suggesting basilar meningeal involvement. Clinical staging of tuberculous meningitis is based on neurologic status, as follows:
The median incubation period before the appearance of symptoms in chronic syphilitic meningitis is 21 days (range 3-90 d), during which time spirochetemia develops. Three stages of disease are described, and involvement of the CNS can occur during any of these stages. Syphilitic meningitis usually occurs during the primary or secondary stage, complicating 0.3-2.4% of primary infections during the first 2 years. Its presentation is similar to other types of aseptic meningitis, with headache, nausea, vomiting, and meningismus. Meningovascular syphilis occurs later in the course of untreated syphilis, and the symptoms are dominated by focal syphilitic arteritis (ie, focal neurologic symptoms associated with signs of meningeal irritation) that spans weeks to months and results in stroke and irreversible damage if left untreated. Patients with HIV have an increased risk of accelerated progression. Although rare during stage I of Lyme disease, CNS involvement (with meningitis) may occur in Lyme disease-associated chronic meningitis and is characterized by the concurrent appearance of erythema migrans at the site of the tick bite. More commonly, aseptic meningitis syndrome occurs 2-10 weeks following the erythema migrans rash. This represents stage 2 of Lyme disease, or the borrelial hematogenous dissemination stage. Headache is the most common symptom of Lyme disease–associated chronic meningitis, with photophobia, nausea, and neck stiffness occurring less frequently. Symptoms of somnolence, emotional lability, and impaired memory and concentration may occur. Facial nerve palsy is the most common cranial nerve deficit. These symptoms of meningitis usually fluctuate and may last for months if left untreated. Infection with C neoformans is characterized by the gradual onset of symptoms, the most common of which is headache. Coccidioidal meningitis is the most serious form of dissemination, and it usually is fatal if left untreated. These patients may present with headache, vomiting, and altered mental function associated with pleocytosis, elevated protein levels, and decreased glucose levels. Eosinophils may be a prominent finding in the CSF. Patients infected with B dermatitidis may present with an abscess or fulminant meningitis, while patients infected with H capsulatum may present with headache, cranial nerve deficits, or changes in mental status months prior to diagnosis. Дата добавления: 2015-09-18 | Просмотры: 634 | Нарушение авторских прав |