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Term 5: Neuro > 6/24- Infections of the Nervous System I > Flashcards

6/24- Infections of the Nervous System I Flashcards

1
Q

What kind of inflammatory reaction is seen in infections: bacterial?

A

Polymorphonuclear cells

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2
Q

What kind of inflammatory reaction is seen in infections: mycobacterial?

A

Granulomatous

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3
Q

What kind of inflammatory reaction is seen in infections: fungal?

A

Granulomatous

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4
Q

What kind of inflammatory reaction is seen in infections: viral?

A

Lymphocytic

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5
Q

What kind of inflammatory reaction is seen in infections: protozoal?

A

Lymphocytic

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6
Q

What kind of inflammatory reaction is seen in infections: metazoal?

A

Eosinophils

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7
Q

What kind of inflammatory reaction is seen in infections: Prion?

A

No inflammation

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8
Q

What is this?

A

Empyema- surface collection of pus

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9
Q

What is this?

A

Meningitis- subarachnoid pus

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10
Q

What is this?

A

Abcesses- parenchymal collection of pus

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11
Q

What is this?

A

Granuloma

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12
Q

What is this? Cause/characteristics?

A

Convexity meningitis

  • More likely to be bacterial (polymorphonuclear)
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13
Q

What is this?

A

Basilar meningitis

  • Morel likely to be fungal or TB (granulomatous)
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14
Q

What infections commonly cause convexity meningitis?

A

Bacterial

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15
Q

What infections commonly cause basilar meningitis?

A

Fungal and TB

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16
Q

What are the main causes of bacterial meningitis in neonates?

A
  • Group B strep
  • E. coli
  • Listeria
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17
Q

What are the main causes of bacterial meningitis in childhood?

A
  • Meningococcus
  • Pneumococcus
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18
Q

What are the main causes of bacterial meningitis in adolescence?

A

Meningococcus

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19
Q

What are the main causes of bacterial meningitis in adults?

A

Pneumococcus

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20
Q

What etiology of bacterial meningits has been dramatically lessened due to vaccines?

A

H. influenza

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21
Q

Which agent may be used in bioterrorism in regards to meningitis? Characteristics? Diagonsis?

A

Inhalational anthrax with systemic dissemination may produce severe hemorrhagic meningitis

  • Dx: Gram(+) bacilli in CSF
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22
Q

How is bacterial meningitis diagnosed?

A

Lumbar puncture

  • Polys
  • Low glucose (consumed by PMNs)
  • High protein
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23
Q

What is this?

A

Bacterial Meningitis

  • Left layers are dura
  • Box is around subarachnoid space
  • See mostly polys
  • PMN inflammation -> bacterial meningitis
24
Q

Where do brain abscesses occur?

A

In the brain parenchyma

Often occurs as direct extension from a sinusitis or mastoiditis

  • Frontal, temporal, or cerebellar as direct extension
25
Q

Brain abscesses may mimic what?

A

Brain tumor

26
Q

What are the most common causes of brain abscesses?

A

Suppurative bronchopulmonary infections with hematogenous spread (#1 cause)

  • Deep, particularly in MCA distribution
  • Multiple at gray-white junction when hematogenous

Often occurs from sinusitis or mastoiditis with direct extension

  • Frontal, temporal, or cerebellar

Penetrating or surgical wounds

27
Q

What is a common characteristic of bacteria that typically cause abscesses?

A

Micro/anaerobes

  • Hard to grow/culture
28
Q

T/F: May have multiple brain abscesses

A

True; multiple in 15-20%

29
Q

What is seen on imaging for brain abscess?

A
  • Smooth ring enhancing mass
  • Purulent material within (smoother ring points to abscess rather than neoplasm, but there may be exceptions)
30
Q

What is this?

A

Brain abscess with smooth ring enhancing mass

31
Q

What are the zones of a classic brain abscess (4)?

A

1. Central necrosis with acute inflammatory cells

2. Granulation tissue (contrast-enhancing on imaging; neovascularization?)

3. Fibrous “capsule” (proliferating fibroblasts with abundant collagen deposition)

4. Reactive astrogliosis and edema

32
Q

Label the picture

A
33
Q

What are common characteristics of mycobacterial infection meningitis?

A

Tuberculous meningitis

  • Basilar
  • Thick exudate
  • Involvement of CNs (and CSF foramina)
  • Chronic
  • Tends to be slower-paced than bacteria
34
Q

What does the CSF look like in mycobacterial-caused meningitis (tuberculous meningitis)?

A
  • Lymphocytes
  • Increased protein
  • Decreased glucose
  • Increased pressure
  • Send for culture
35
Q

What is this?

A

Cortical TB granuloma

36
Q

What is this? When would it typically be seen?

A

Granulomatous inflammation

  • Multinucleate giant cells (can be seen in any granulomatous inflmn, not just TB)
  • Lymphocytes
  • Plasma cells

This suggests mycobacteria (TB) or fungal infections

37
Q

What kind of necrosis is associated with TB?

A

Caseous necrosis

38
Q

What is this?

A

TB seen on acid fast stain (bacilli)

39
Q

What are the two types of fungi (and common fungi within them) causing meningitis?

A

Yeast

  • Cryptococcus
  • Coccidioiomycosis
  • Histoplasmosis
  • Blastomycosis (uncommon)

Hyphae

(tend to involve BV walls -> infarction -> tissue substrate for growth of fungi)

  • Aspergillosis
  • Mucormycosis
40
Q

What is the most common cause of fungal meningitis?

In AIDS population?

A

Cryptococcus

  • Even moreso in AIDS pts
  • Seeing cryptococcal meningitis is an indicator for AIDS
41
Q

Source and characteristics of Cryptococcus?

A
  • Found in pigeon droppings (C. neoformans)
  • “Soap bubble” cysts in parenchyma (intra-axial microabscesses; glistening)
  • “Tear drop” (narrow-based) budding yeast seen with india ink and mucicarmine
  • Encapsulated (polysaccharide)-thick, slimy; cloaks from immune response
42
Q

What is this?

A

Multiple cryptococcal microabscesses

  • Clear like “soap bubbles”
  • Shiny b/c encapuslated
43
Q

What is this?

A

Narrow-budding yeast of cryptococcus

44
Q

What is this?

A

Thick capsule of cryptococcus

45
Q

What are common characteristics of Histoplasmosis? Location, diseases caused, histology…

A
  • Common pulmonary infection in Ohio, Mississippi, and Missouri Valleys
  • OBLIGATE intracellular (intracytoplasmic) yeasts; very small (2-5 um) in cytoplasm of macrophages
  • Calcified granulomas- usually benign and self-limited
  • Disseminated disease does occur in infants and immunosuppressed
46
Q

What is this?

A

Multiple granulomata seen in Histoplasmosis

  • Thought before that these were brain mets
47
Q

What is this?

A

Touch prep of masses from last scan

  • Can see macrophages with tiny little dots in cytoplasm; Histoplasmosis
48
Q

What is this?

A

Tiny yeast forms inside of macrophages seen in Histoplasmosis

49
Q

Characteristics of Aspergillosis? Commonly infects who? Histology?

A
  • Common, lethal infection in immunosuppressed
  • Hemorrhagic due to angioinvasive nature
  • Septate, true branching at 45’ uniform diameter
  • Sets up in lung and can spread hematogenously to the brain
  • Tends to occur in SW (CA, AZ, W TX); aerosolized by earthquakes
50
Q

Characteristics of Rhinocerebral mucormycosis?

A
  • Poorly controlled diabetics or immunocompromised
  • Moor likely to have fever and elevation in peripheral white count
  • Tends to progress a little more slowly than straight up stroke
  • Angioinasive large non-septate hyphae
  • Non-uniform and branching; 90’
51
Q

What is this?

A

Aspergillosis cerebritis

  • Can’t be sealed off by brain
  • Hemorrhagic, dusty, and discolored
52
Q

What is this?

A

Aspergillosis cerebritis (GMS stain)

  • Septate, true branching at 45’ uniform diameter
53
Q

What is this?

A

(LEFT) Sphenoid bone in mucomycosis

  • Can see hypothalamus at the top of the pic
  • Cavernous sinus (normal) and open carotid artery on right
  • Clogged carotid a. on left due to mucor

(RIGHT) Inside of sphenoid sinus

  • Black discoloration is infarcted mucosa due to mucor growing in BVs supplying this area
54
Q

What is this?

A

Mucor

55
Q

What is this?

A

Mucormycosis

  • Can see hyphal forms in lumen of vessel and invading wall
  • Can impede flow and cause infarct
56
Q

Characteristics of Candidiasis: form, affected populations, symptoms, histology?

A
  • Hyphae and yeast forms
  • Commonly in immunocompromised hosts; the very ill
  • Ubiquitous in environment
  • # 1 fungal infxn of CNS found at autopsy
  • Microabscesses
  • PAS/GMS positive

Term 5: Neuro (24 decks)

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