Neurology in the tropics

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神経系の整理

CNS

• brain
  • cortex
  • subcortex
  • cerebellum
  • brainstem
• base of brain
  • cranial nerves
  • meninges
• spinal cord
  • root

... PNS

• peripheral nerves

病原体による神経疾患

各病原体がどの神経臓器に特異的に感染・障害するのか整理する

例：cryptococcusは第6脳神経特異的

症候学による整理

• 意識障害・意識変容を生ずる病原体
• 特定の脳神経を障害する病原体
• 麻痺を生ずる病原体
• 痙攣を生ずる病原体
• 神経筋接合部を障害する病原体

診断のプロセス

1. 病変はどこか？
2. 何が起きているのか？

• focal deficit
  • CNS focal deficit
    • minites - vascular stroke
    • hours - fulminant infection
    • days - infection
    • weeks - tumor
• paraplegia
  • spinal cord diseases
    • traumatic
    • non-traumatic
      • infections - TB, schistosomiasis, CMV, HIV
      • inflammation - autoimmune myelitis
      • tumors - spinal tumors/metastasis
      • degeneration - slipped disc, spinal canal stenosis
• altered mental status
  • traumatic (head)
  • non-traumatic (head)
    • dog bite, animal bite
    • infection
      • HIV based/non-HIV based
      • malaria
    • vascular
      • SAH
  • first absolutely check blood glucose especially in children
• seizures
  • differentiate true seizures from mimicers
    • epileptic seizure? syncope? psychogenic?

How to perform a Lumbar Puncture

low resource environmentでの意思決定

Cerebral herniationのリスクがあってもlumbar punctureをしなければ治療方針が立てられない重症CNS感染で，LPなしですべての病原体をカバーする治療をしては薬剤ストックがなくなるような環境では，LPによる突然死のリスクを本人家族に背負ってもらってでもLPしなければならない．