最后审阅: 13 四月 2021
最后更新: 15 四月 2021

小结

定义

病史和体格检查

关键诊断因素

  • 头痛
  • 颈项强直
  • 发热
  • 精神状态改变
  • 呕吐
  • 意识模糊
  • 畏光
  • 癫痫发作
  • 危险因素

其他诊断因素

  • 局灶性神经系统体征
  • 眼球运动异常
  • 面神经麻痹
  • 平衡问题/听力障碍
  • 皮疹
  • 视神经乳头水肿
  • 克尼格氏征
  • 布鲁津斯基征

危险因素

  • 高龄
  • 拥挤
  • 接触致病菌
  • 导致免疫功能低下的疾病
  • 颅骨结构缺陷/脑室-腹腔分流术
  • 耳蜗植入物
  • 镰状细胞病
  • 邻近部位感染

诊断性检查

首要检查

  • 血培养
  • 血清肺炎球菌和脑膜炎球菌 PCR
  • 血糖
  • FBC 和分类计数
  • 血清尿素、肌酐和电解质
  • 静脉血气
  • 肝功能检查 (LFT)
  • 凝血筛查(凝血酶原时间、INR、活化 PTT、纤维蛋白原、纤维蛋白降解产物
  • 血清 HIV
  • 血清降钙素原(procalcitonin, PCT
  • 血清 CRP(如果无法进行 PCT
  • 脑脊液(Cerebrospinal Fluid, CSF)蛋白
  • 脑脊液乳酸
  • CSF 葡萄糖
  • CSF 显微镜检查、革兰染色、培养和药敏试验
  • 脑脊液细胞计数
  • 肺炎球菌 CSF 聚合酶链反应(polymerase chain reaction, PCR)

需考虑的检查

  • 神经影像
  • 应用 CSF PCR 检测结核病
  • 通过 CSF PCR 检测 1 型和 2 型单纯疱疹病毒(herpes simplex virus, HSV)以及水痘带状疱疹病毒
  • 采集 CSF、粪便和咽拭子进行肠道病毒 PCR

治疗流程

撰稿人

Flight Doctor

Greater Sydney Area

Helicopter Emergency Medical Service

New South Wales

Australia

利益声明

AA declares that he has no competing interests.

ST4 Emergency Medicine Doctor

Royal London Hospital

Physician Response Unit Clinical Fellow

London

UK

利益声明

AC declares that she has no competing interests.

BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work is retained in parts of the content:

A. Marceline Tutu van Furth, MD, PhD, MBA

Professor in Pediatric Infectious Diseases

Vrije Universiteit Medical Center

Amsterdam

The Netherlands

Disclosures: AMTvF declares that she has no competing interests.

Omaima El Tahir, MD

PhD Candidate

Pediatric Infectious Diseases and Immunogenetics

Vrije Universiteit Medical Center

Amsterdam

The Netherlands

Disclosures: OET declares that she has no competing interests.

同行评议者展开全部内容

Acute Hospital Sub Dean (Cornwall)

Honorary Clinical Senior Lecturer

Consultant Emergency Physician

The Knowledge Spa

Royal Cornwall Hospital

Truro

UK

利益声明

RT declares that he has no competing interests.

Section Editor, BMJ Best Practice

利益声明

CP declares that she has no competing interests.

Head of Editorial, BMJ Best Practice

利益声明

AE declares that she has no competing interests.

Lead Section Editor, BMJ Best Practice

利益声明

RW declares that she has no competing interests.

Comorbidities Editor, BMJ Best Practice

利益声明

JC declares that she has no competing interests.

Drug Editor, BMJ Best Practice

利益声明

IC declares that she has no competing interests.

Drug Editor, BMJ Best Practice

利益声明

AM declares that he has no competing interests.

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