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急性病毒性脑炎与感染后脑脊髓炎代表两种不同类型的急性脑炎,两者临床表现相似,病死率约为20～30%,50%以上的幸存者有神经性后遗症。然而,两者的致病机理却显然不同。以日本乙型脑炎为例,急性病毒性脑炎是一种灰质损伤性疾病。病毒经吸血节肢动物叮咬传播给人,在皮下局部组织增殖后,播散入血,形成病毒血症。血流中的病毒经脑毛细血管侵犯中枢神经系统(CNS),在CNS内,病毒可能在细胞外传播,亦可能经树突和轴突在细胞间传播。病毒选择性地侵犯神经元,损伤腻干及深部神终核。病毒抗原多局限于神经元内,单一或成堆。晚期患者病毒抗原多局限于巨噬细胞内。参加炎症反应的细胞还有T细胞和B细胞。患者椎管内是否有早期IgM抗体形成,对日本乙型脑炎
Acute viral encephalitis and post-infection encephalomyelitis represent two different types of acute encephalitis, with similar clinical manifestations and a mortality of about 20-30%. More than 50% of survivors have neurological sequelae. However, the pathogenesis of the two is clearly different. In Japan, Japanese encephalitis, for example, acute viral encephalitis is a gray matter injury. The virus spread by vampire arthropod bites to people, after the subcutaneous local tissue proliferation, disseminated into the blood, the formation of viremia. The virus in the bloodstream invades the central nervous system (CNS) via the brain capillaries. Within the CNS, the virus may travel extracellularly and may also travel between cells via dendrites and axons. Viruses selectively infringe on neurons, dampness, dryness and deep epidermis. More viral antigen confined to neurons, single or piles. Advanced patients with viral antigens and more confined to macrophages. T cells and B cells are also involved in the inflammatory response. Does the patient have early IgM antibody formation in the spinal canal against Japanese encephalitis