1b Cerebral Inflammation

Question 1

What is meningitis?

Answer 1

Inflammation of the meninges caused by viral or bacterial infection

Question 2

What is encephalitis?

Answer 2

inflammation of the brain caused by infection or autoimmune mechanisms

Question 3

What is cerebral vasculitis?

Answer 3

inflammation of blood vessel walls (sometimes called angiitis)

Question 4

What was the evidence which suggested the presence of the blood brain barrier?

Answer 4

In the late 19th and early 20th centuries, it was noted that dyes, and other tracers, injected intravenously, accumulated in most tissues, but were excluded from most areas of the CNS.
This suggested the existence of a Blood-Brain Barrier.

Question 5

What term is used to describe the blood supply of the CNS?

Answer 5

Dense Vascularisation

Question 6

No neurone is more than how far from a capillar?

Answer 6

100 micrometers

Question 7

What cells form the blood brain barrier?

Answer 7

Endothelial cells and astrocytes

Question 8

What do BB capillaries have at the endothelial cell-cell contacts?

Answer 8

Extensive tight junctions

Question 9

What do the tight junctions of the BBB allow?

Answer 9

massively reduced solute and fluid leak across the capillary wall

Question 10

What is the benefit of the BBB?

Answer 10

The BBB can then control the exchange of these substances using specific membrane transporters to transport into and out of the CNS (influx and efflux transporters).

Blood borne infections then have reduced entry into the CNS tissue

Question 11

Describe the series of events which occurs when the BBB is disrupted?

Answer 11

1. Endothelial layer disruption
2. Fibringoen leakage
3. Astrocytes retract their end feet in response
4. Then inflammatory cells can more to the area

Question 12

What are the initial symptoms of encephalitis?

Answer 12

flu-like with pyrexia (high body temperature) and headache

Question 13

What are the symptoms of encephalitis which are experienced within a few days / weeks?

Answer 13

confusion or disorientation
seizures or fits
changes in personality and behaviour
difficulty speaking
weakness or loss of movement
loss of consciousness

Question 14

What are the most common viral causes of encephalitis?

Answer 14

Herpes Simplex
Measles
Varicella (chickenpox)
Rubella (German measles)

Question 15

What is encephalitis most commonly caused by?

Answer 15

Viral infections

Question 16

What are the other non-viral causes of encephalitis?

Answer 16

Mosquito, tick and other insect bites
Bacterial and fungal infections
Trauma
Autoimmune

Question 17

What treatments could be used for encephalitis?

Answer 17

Anti-virals eg acyclovir
Steroids - anti-inflammatory
Antibiotics / antifungals
Analgesics
Ventilation

Question 18

What term is used to describe the classic presentation of MS?

Answer 18

Relapsing-remitting

Question 19

What is MS?

Answer 19

Autoimmune attack on the oligodendrocytes causing demyelination (the myelinating cells of the CNS) which impairs normal transmission

Question 20

What are the relapses of MS linked to?

Answer 20

Inflammatory activity

Question 21

What happens to the axons over time in MS?

Answer 21

there is progressive, residual loss of axons

Question 22

What is the progression of MS linked to?

Answer 22

Neurodegenration

Question 23

What is the cellular pathology of MS?

Answer 23

Inflammation
Demyelination
Axonal Loss
Neurodegenration

Question 24

What would be seen on a MRI scan of a patient with MS?

Answer 24

Whitening of the inner matter of the brain indicating a loss of myelination of the axons

Question 25

Which cells are recruited to the area in MS?

Answer 25

Perivascular immune cell infiltration (CD3 T cells and CD20 B cells)

Question 26

What is meningitis?

Answer 26

Irritation, inflammation and swelling of the meninges

Question 27

What are the four bacterial causes of meningitis?

Answer 27

Meningococcal
Pneumococcal
Haemophilus Influenzae type b (Hib)
Streptococcal

Question 28

Which is the most common bacteria to cause meningitis in the UK?

Answer 28

Meningococcal

Question 29

Which is the most common bacteria to cause meningitis in new born babies?

Answer 29

Streptococcal

Question 30

What is MS pathology characterised by?

Answer 30

MS pathology is characterised by perivascular and leptomeningeal inflammation

Question 31

What are the other causes of meningitis?

Answer 31

Viral - rarely life threatening
Fungal

Question 32

Why do the symptoms of MS vary between patient to patient?

Answer 32

Symptoms vary because the amount and location of damage to the nervous system is different in each person with MS

Question 33

Which symptom is unique to meningitis and not encephalitis?

Answer 33

Photophobia

Question 34

What are the hallmark features of encephalitis?

Answer 34

fever, seizures, change in behaviour, and confusion and disorientation.

Question 35

What are the hallmark features of meningitis?

Answer 35

sudden fever, severe headache, nausea or vomiting, double vision, drowsiness, sensitivity to bright light, and a stiff neck, rash (not always).

Question 36

What are the usual glucose levels in bacterial meningitis?

Answer 36

Low glucose

Question 37

What are the common treatment options which are used for encephalitis and meningitis?

Answer 37

antibiotics, antivirals, corticosteroids and immune suppressors

Question 38

What are the other causes of meningitis?

Answer 38

Viral - rarely life threatening
Fungal