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BRS YR2 > Cerebral Inflammation and Disorders > Flashcards

Cerebral Inflammation and Disorders Flashcards

1
Q

What is the definition of meningitis?

A

Inflammation of the meninges caused by viral or bacterial infection

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2
Q

What is the definition of encephalitis?

A

Inflammation of the brain caused by infection or autoimmune mechanisms

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3
Q

What is the definition of cerebral vasculitis?

A

Inflammation of blood vessel walls (angiitis)

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4
Q

What is the definition of myelitis?

A

Inflammation of the spinal cord

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5
Q

What causes the blood brain barrier?

A
  • dense vascularisation of the CNS
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6
Q

What forms the blood brain barrier (BBB)?

A

extensive tight junctions at the endothelial cell-cell contacts, massively reducing the fluid leak across capillary walls

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7
Q

What does the BBB do?

A

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

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8
Q

What is the site of problems in the blood brain barrier?

A
  • Perivascular space
  • promotes drainage of solutes in diseases such as Alzheimer’s
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9
Q

What happens in BBB disruption?

A
  • endothelial layer disruption
  • blood components leak into the brain (fibrinogen)
  • astrocytes withdraw end feet from the vessel wall
  • further compromising the BBB
  • collagen buildup leading to hardening of the vessel wall
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10
Q

What are the initial symptoms of encephalitis?

A
  • flu-like
  • pyrexia (fever)
  • headache
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11
Q

What are the subsequent symptoms of encephalitis?

A
  • confusion
  • seizures/fits
  • personality/behaviour changes
  • difficulty speaking
  • weakness/loss of movement
  • loss of consciousness
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12
Q

What are the causes of encephalitis?

A 
MOST COMMON:
- herpes simplex
- measles
- varicella
- rubella
OTHER:
- insect bites
- bacteria/fungal infections
- trauma 
- autoimmune
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13
Q

How to treat encephalitis?

A

dependent on the cause, but may include:

  • antivirals e.g. acyclovir
  • steroids
  • antibiotics/antifungals
  • analgesics
  • anti-convulsants
  • ventilation
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14
Q

How does COVID-19 affect the brain?

A
  • appears to cause acute inflammatory vasculitis
  • doesn’t affect brain tissue
  • either perivascular or vascular
  • causes small haemorrhages
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15
Q

What is Multiple Sclerosis?

A
  • autoimmune demyelinating disease of the CNS
  • relapses linked to inflammatory activity
  • progression is linked to neurodegeneration
  • neurological deficit, relapses and remits but steadily progresses
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16
Q

What is the cellular pathology of MS?

A
  • inflammation
  • demyelination
  • axonal loss
  • neurodegeneration
17
Q

How would you look for evidence of demyelination

A

MRI scan

18
Q

Why do MS symptoms vary?

A

the amount and location of damage to the nervous system varies from person to person

19
Q

What are the two courses of symptoms for MS?

A
  • relapsing-remitting
  • secondary progression
20
Q

What inflammation is involved in MS?

A

perivascular immune cell infiltration

  • CD3 T-cells
  • CD20 B-cells
21
Q

What are the causes of meningitis?

A 
bacterial:
- meningococcal (most common cause in the UK)
- pneumococcal
- haemophilus Influenza type B
- streptococcal (new-born)
other:
- viral (rarely life threatening)
- fungal
22
Q

What is the pathophysiology of meningitis?

A
  • pathogens from the nasopharynx or upper airways enter the CNS
  • bateria release toxins causing neuronal damage and cell death
  • the antigens/toxins trigger an immune response and immune cells damage nerves
  • inflammatory cascade leads to cerebral oedema
  • intracranial pressure rises
23
Q

How do you confirm a diagnosis of meningitis?

A

CSF sample, lumbar puncture

24
Q

How does antibiotics pass the BBB?

A

high dose, IV antibiotics does pass through the BBB

25
Q

What is an infection of the spinal cord known as?

A

Myelitis

26
Q

What types of infections tend to cause encephalitis?

A

Virus

27
Q

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

A
  • physical examination
  • lumbar puncture, with subsequent cultures + glucose test
  • Brain scan (CT+MRI)
  • bloods
  • urine analysis
28
Q

What are some of the long term effects of meningitis?

A
  • seizures
  • visual disturbances
  • behavioural changes
  • confusion
  • amnesia
  • excessive fatigue
  • hearing loss (biggest cause in children)
  • aphasia
  • learning disabilities
  • memory loss
  • poor concentration
  • clumisness/co-ordination problems
  • headaches
  • weakness
  • speech problems
29
Q

Which is more severe, bacterial or viral meningitis?

A

bacterial, 1 in 10 die from it

30
Q

What are the hallmarks of encephalitis?

A
  • seizures
  • fever
  • behaviour changes
  • confusion and disorientation
  • aphasia
  • visual disturbances
31
Q

Why is encephalitis more likely to be viral?

A

Because viruses are able to pass through the blood-brain barrier

32
Q

What are the hallmark features of meningitis?

A
  • sudden fever
  • severe headache
  • nausea/vomiting
  • double vision
  • drowsiness
  • light sensitivity
  • stiff neck
  • distinctive rash
33
Q

What would you treat meningitis with?

A
  • broad spectrum antibiotics
  • analgesia
  • steroids
  • anti-inflammatories
  • anti-pyretics
34
Q

What is the structure of the capillaries that make up the BBB? DELETE

A
  • extensive tight junctions at the endothelial cell-cell contacts
  • massively reduced solute and fluid leak across the capillary wall
35
Q

Describe the vascularisation of the CNS in the BBB?

A

no neuron is more than 100 micrometers from a capillary

36
Q

Why is the tight control of the BBB beneficial?

A

blood-borne infections have reduced entry to CNS tissue

37
Q

What is the structure of the capillaries of the BBB?

A
  • endothelial layer
  • collagen layer
  • astrocytes with end feet on vessel wall
38
Q

What is an infection of both the spinal cord and brain known as?

A

encephalomyelitis

39
Q

How can you tell the difference between meningitis and encephalitis?

A

Encephalitis has:

  • photophobia
  • seizures
  • neurologic findings (weakness, aphasia, behviour change)

BRS YR2 (67 decks)

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