Cerebral inflammation and disorders

Question 1

What is meningitis?

Answer 1

Inflammation of meninges caused by viral or bacterial infection
generally at the arachnoid

Question 2

What is encephalitis?

Answer 2

Inflammation of brain from infection or autoimmune

Question 3

What is cerebral vasculitis?
(angiitis)

Answer 3

Inflammation of blood vessel walls

Question 4

What was the evidence for the existence of the BBB?

Answer 4

Dyes injected into mice were present in most organs (as everything receives blood supply) but not in the brain

Question 5

What is the structural formation of the blood brain barrier?

Answer 5

BBB capillaries have tight junctions between cells - limit solute and fluid leak from capillaries. Outside capillaries are perivascular cells (astrocytes) which are involved in filtration

Question 6

What is the function of the blood brain barrier?

Answer 6

Controls exchange of substances using influx and efflux transporters

Question 7

Explain how endothelial layer disruption causes disruption to the blood brain barrier

Answer 7

Endothelial layer disruption leads to leakage of blood components (including fibrinogen). This triggers astrogliosis (proliferation of astrocytes) and astrocytic end feet change (where astrocytes wrap around blood vessels)
thickening of collagen
- to try and repair the damage

Question 8

Why is the brain described as being immunologically different?

Answer 8

Resistant to blood borne diseases due to the presence of the BBB

Question 9

What are initial symptoms of encephalitis?

Answer 9

Flu-like symptoms: pyrexia (high body temp), headache

Question 10

What are some consequent symptoms of encephalitis?
hours,days,week

Answer 10

confusion, seizures, personality changes, difficulty speaking, weakness, loss of consciousness

Question 11

What is the most common causes of encephalitis?

Answer 11

Viral - Her Majesty’s ViRus aka HMVR:
Herpes simplex,
Measles,
Varicella (chicken pox),
Rubella

Question 12

What are other causes of encephalitis?

Answer 12

Bacterial/fungal infections, insect bites, trauma, autoimmune

Question 13

What are the treatments for encephalitis?

Answer 13

Antiviral (acylovir)/
Antibacterial/Antifungal,
Steroids (anti-inflammatory), swelling can caused raised intracranial pressure
Anticonvulsants (prophylactic measure),
Analgesia

Question 14

What is MS?

Answer 14

Autoimmune, inflammatory, degenerative disease due to demyelination of CNS

Question 15

Describe the progression of MS with regards to neurological deficit

Answer 15

Initially relapsing-remitting, peaks of deficit which return to normal, however due to axon loss will eventually lead to secondary progression which is linear degeneration

Question 16

Describe the progression of MS with regards to inflammation

Answer 16

Initially relapsing-remitting, however in secondary progression inflammation decreases gradually (this is due to degeneration becoming independent of inflammation)

Question 17

How are relapses of MS associated with inflammation

Answer 17

Inflammatory spikes match up with relapses, which indicates increased inflammatory activity is their cause.

Question 18

What are the 4 key cellular pathology features of MS?

Answer 18

Inflammation, demyelination, axonal loss, neurodegeneration

Question 19

Features of MS seen on an MRI scan

Answer 19

White areas around the ventricles, usually due to demyelination
(increasing large perivascular lesions)

Question 20

What will demyelination of the spinal cord usually lead to?

Answer 20

Motor issues particularly with mobility

Question 21

What inflammatory cells are involved in MS?

Answer 21

CD3 T cells, CD8 T cells, CD20 B cells

Question 22

What is perivascular cuffing

Answer 22

Immune cell infiltration (CD3,CD8,CD20)
originated in the bloodstream, broken through BBB and are surrounding the blood vessels

Question 23

Why is meningitis a large issue?

Answer 23

High mortality rate, leaves 1 in 5 with impairment

Question 24

What are the main causes of meningitis?

Answer 24

Bacterial infections: HMPS: Her Majesty’s ProkaryoteS: Haemophilus Influenza type b (Hib),
Meningococcal (most common in UK),
Pneumococcal,
Streptococcal (most common in newborns)

Question 25

What are the other causes of meningitis?

Answer 25

Viral (rarely life threatening) and Fungal Infections

Question 26

Why are MS symptoms difficult to predict

Answer 26

Random nature of demyelination

Question 27

What is myelitis?

Answer 27

Inflammation of spinal cord

Question 28

What are the main symptoms of meningitis?

Answer 28

sudden fever, headache, nausea, double vision, photophobia, rash, stiff neck

Question 29

What diagnostic tests do you do for meningitis and encephalitis?

Answer 29

CT, MRI, Lumbar Puncture (low glucose in meningitis), Blood, Urine Analysis

Question 30

What treatments are used for meningitis and encephalitis?

Answer 30

Antibiotics, Antivirals, Corticosteroids, Immunosuppressants

Question 31

What are long term effects of meningitis?

Answer 31

Learning disabilities, memory loss, dizziness, hearing loss, spasms