Cerebral inflammation and disorders

Question 1

Define meningitis

Answer 1

inflammation of the meninges caused by viral or bacterial infection

Question 2

define encephalitis

Answer 2

inflammation of the brain caused by infection or autoimmune mechanisms

Question 3

what is Cerebral vasculitis?

Answer 3

inflammation of the blood vessel walls (sometimes called angitis)

Question 4

What is myelitis?

Answer 4

infection of the spinal cord

Question 5

what is encephalomelitis?

Answer 5

infection of the spinal cord and brain

Question 6

What is the blood brain barrier (BBB)?

Answer 6

protective mechanism that helps maintain a stable environment for the brain creating an immune protected space

Question 7

how vascularised is the CNS?

Answer 7

very densely vascularised, no neurone is more than 100micrometers from a capillary

Question 8

How is the blood brain barrier formed?

Answer 8

formed from capillaries and extensive tight junctions at the endothelial cell-cell contacts, astrocytes help to maintain the structure

Question 9

What are the advantages of the BBB?

Answer 9

blood borne infectious agents have reduced entry into the CNS tissue, specific transporters must be used to transport substances in and out of the brain

Question 10

Outline what can happen if theres a disruption of the BBB?

Answer 10

Contents of blood can move into the parenchyma causing the glial cells to react, astrocytes retract which breaks down the barrier further resulting in a membrane basement change, this leads to disruption of collagen and sclerosis of vessels

Question 11

Breakdown of the BBB evokes ____

Answer 11

a lot of cellular reaction

Question 12

Outline the symptoms associated with encephalitis

Answer 12

initial flu-like symptoms (fever, pyrexia) and headache. subsequent: confusion/ disorientation, seizures, changes in behaviour, difficulty speaking, weakness or loss of movement and loss of consciousness

Question 13

Most causes of Encephalitis are of what origin?

Answer 13

viral infection

Question 14

List the most common viral infections which cause Encephalitis

Answer 14

Herpes simplex, measles, chickenpox, rubella,

Question 15

other than those of viral infection origin, what are other causes of Encephalitis?

Answer 15

mosquito, tick, or other insect bites, bacterial and fungal infections, trauma, autoimmune mechanisms e.g MS

Question 16

How is encephalitis treated?

Answer 16

depends on underlying cause but can include: antivirals, steroids, antbiotics/fungals, analgesics, anti-convulsants, ventilation

Question 17

How is cerebral inflammation diagnosed?

Answer 17

neurological examination, scans (MRI, CT), lumbar puncture, EEG, blood tests

Question 18

what would a lumbar puncture show in a patient with Meningitis?

Answer 18

low glucose and elevated WBC count

Question 19

what diagnostic tests can be done to confirm Encephalitis?

Answer 19

MRI, EEG, spinal tap, blood tests

Question 20

What is Multiple Sclerosis (MS)?

Answer 20

autoimmune demyelinating disease of the CNS, can cause encephalitis

Question 21

Relapses of MS are related to____

Answer 21

inflammatory activity

Question 22

progression of MS is related to ____

Answer 22

neurodegeneration (axonal loss)

Question 23

what are the four aspects of the pathology of MS?

Answer 23

inflammation, demyelination, axonal loss, neurodegeneration

Question 24

What would show on a positive MRI of MS?

Answer 24

pre-ventricular white matter changes, this will progress over time

Question 25

describe the pattern of MS

Answer 25

a random disorder that affects the white matter anywhere in the CNS, symptoms vary between patients

Question 26

What is perivascular cuffing?

Answer 26

inflammation around a blood vessel

Question 27

outline the mechanism of inflammation seen in MS

Answer 27

perivascular cuffing causes infiltration of immune cells which cross BBB, this mainly includes CD3 Tcells and CD20 Bcells leading to leptomeningeal inflammation

Question 28

what is the risk of permanent impairment associated with meningitis?

Answer 28

20%

Question 29

The majority of causes of meningitis are of what origin?

Answer 29

bacterial

Question 30

What are the bacterial causes of meningitis?

Answer 30

Meningococcal (neisseria meningitides), pneumococcal (strep. pneumoniae), haemophilus influenzae type B, streptococcal

Question 31

What is the main cause of meningitis in newborns?

Answer 31

streptococcal infection

Question 32

Other than those of bacterial origin, what are the causes of meningitis?

Answer 32

Viral (rare but life threatening), fungal

Question 33

Outline the symptoms of meningitis

Answer 33

sudden fever, sudden headache, nausea and vomiting, double vision, drowsiness, photophobia, stiff neck, rashes

Question 34

what are some of the long term effects of meningitis?

Answer 34

recurrent seizures, problems with memory and concentration, coordination problems, dizziness, speech problems, deafness, headaches, weakness, visual problems, movement and balance problems, learning difficulties

Question 35

are seizures more commonly seen in meningitis or encephalitis?

Answer 35

often occur in encephalitis

Question 36

Are focal neurological findings (weakness, visual disturbance, aphasia) a hallmark feature of meningitis or encephalitis?

Answer 36

encephalitis, however half of patients with meningitis develop focal findings

Question 37

What is an infection of the spinal cord known as?

Answer 37

Myelitis

Question 38

What diagnostic tests can be performed to investigate encephalitis and meningitis?

Answer 38

Neurological examination, CT, MRI, lumbar puncture (CSF is usually clear and colourless; low glucose in bacterial meningitis; raised white blood cell counts are a sign of inflammation), blood, urine analysis.

Question 39

What are some of the long term effects of meningitis?

Answer 39

Long term learning disabilities, memory loss, poor concentration, clumsiness/co-ordination problems, headaches, deafness/hearing problems/tinnitus/dizziness/loss of balance, epilepsy, weakness/paralysis/spasms, speech problems, visual problems.