Cerebral inflammation & disorders

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

Question 4

what does the histology of meningitis look like?

Answer 4

infiltration of subarachnoid space by WBCs, pussy exudate

Question 5

what does the histology of viral encephalitis look like?

Answer 5

perivascular cuffing

Question 6

how vascularised is the brain?

Answer 6

no neuron is more than 100micrometers from a capillary

Question 7

how does the BBB form?

Answer 7

BBB capillaries have extensive tight junctions at endothelial cell-cell contacts, nothing can freely diffuse

Question 8

what happens if the BBB is broken?

Answer 8

blood leaks into brain, astrocytes attempt to clear blood borne products by retracting end feet (leaving BBB undefended)

Question 9

what may happen long term if the BBB is chronically disrupted?

Answer 9

fibrosis in brain vessels, small vessel disease

Question 10

what are the initial symptoms of encephalitis?

Answer 10

flu like with pyrexia and headache

Question 11

what are the overall symptoms of encephalitis?

Answer 11

confusion/disorientation
seizures
depending on lobe affected:
changes in personality/behaviour
difficulty speaking
weakness or loss of movement
loss of consciousness 
catatonicity

Question 12

what are the viral causes of encephalitis?

Answer 12

herpex simplex
measles
varicella
rubella

Question 13

what are the non-viral causes of encephalitis?

Answer 13

mosquito/insect bites
bacterial or fungal infections - untreated meningitis
trauma
autoimmune

Question 14

how is encephalitis treated?

Answer 14

depends on underlying cause
antivirals/antibiotics/antifungals
steroids
analgesics
anti-convulsants (often prophylactically)
ventilation

Question 15

what is multiple sclerosis?

Answer 15

demyelinating autoimmune disease of the CNS

relapsing and remitting - 1st resolves spontaneously

Question 16

what is the cellular pathology of multiple sclerosis?

Answer 16

inflammation
demyelination & axonal loss (larger grey areas)
neurodegeneration

Question 17

what are the bacterial causes of meningitis?

Answer 17

meningococcal (most common)
pneumococcal
haemophilus influenzae type B
streptococcal (main cause in newborns)

Question 18

what are the causes of meningitis?

Answer 18

bacteria
viruses (rarely life threatening)
fungi

Question 19

how is meningitis diagnosed?

Answer 19

lumbar puncture for CSF sample

Question 20

what are the hallmarks of meningitis?

Answer 20

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

Question 21

what are some long term effects of meningitis?

Answer 21

disabilities
memory loss
coordination loss
behaviour changes
paralysis/weakness
speech coord issues
visual defects

Question 22

what diagnostic tests are useful for suspected encephalitis or meningitis?

Answer 22

lumbar puncture - raised WCC, pink colour
low csf glucose in bacterial men
CT/MRI
neurological assessment