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NS2 Test 2 > Chapter 28 part 3 > Flashcards

Chapter 28 part 3 Flashcards

1
Q

Acute meningitis

A

-inflammatory process of leptomeninges (pia and arachnoid mater) and CSF within the subarachnoid space, usually caused by infection

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2
Q

meningoencephalitis

A

-inflammation of the meninges and brain parenchyma

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3
Q

infectious meningitis classified as?

A
  • acute pyogenic (bacterial)
  • aseptic (viral)
  • chronic (TB, spirochetal, cryptococcal)
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4
Q

acute pyogenic (bacterial) meningitis–neonates, adolescents, older patients

A
  • neonates: E coli, Group B strep
  • adolescents: Neisseria meningitidis
  • older patients: strep pneumoniae, L. monocytogenes
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5
Q

Acute pyogenic (bacterial) meningitis spinal tap

A
  • cloudy/purulent CSF
  • increased pressure?
  • neutrophils
  • increased protein conentration
  • reduced glucose content
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6
Q

Waterhouse-Friederichsen syndrome

A
  • meningitis associated septicimia- hemorrhagic infarction of adrenal glands, cutaneous petechiae
  • meningococcal and pneumococcal meningitis
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7
Q

chronic adhesive arachnoiditis

A
  • in pneumococcal meningitis

- capsular polysaccharide of organism produces a gelatinous exudate that promotes arachnoid fibrosis

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8
Q

Brain abcess caused by?

A
  • localized focus of necrosis of brain tissue with inflammation
  • caused by bacterial infection
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9
Q

brain abscess predisposing conditions

A
  • acute bacterial endocarditis, congenital heart disease (R to l shunting), chronic pulmonary sepsis, immunosuppression
  • streptococci and stahylococci- most common in non-immunosuppressed patients
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10
Q

brain abcess- patients presents with? CSF?

A
  • progressive focal neurologic deficits
  • increased intracranial pressure
  • CSF- high white cell count, increased protein count, glucose normal
  • can lead to fatal herniation
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11
Q

subdural empyema caused by?

A
  • bacterial infection of skull bones or air sinuses-can spread to subdural space
  • thrombophlebitis of bridging veins-venous occlusion and infarction
  • pts-febrile, headache, neck stiffness
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12
Q

extradural empyema- caused by?

A
  • extradural abcess
  • associated with osteomyelitis
  • arise from an adjacent focus of infection (sinusitis, surgical procedure)
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13
Q

chronic bacterial meningoencephalitis caused by?

A
  • mycobacterium tuberculosis
  • treponema pallidum
  • borrelia
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14
Q

chronic bacterial meningoencephalitis- serious complications

A
  • arachnoid fibrosis- causes hydrocephalus
  • oliterative endarteritis- arterial occlusion and infarction
  • nerve roots when involving the spinal cord subarachnoid space
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15
Q

neurosyphillis major patterns?

A
  • meningovascular neuroshyphilis
  • paretic neurosyphilis
  • tabes dorsalis
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16
Q

meningovascular neursyphilis

A
  • chronic meningitis involving the base of brain
  • associated with obliterative endarteritis
  • cerebral gummas (plasma cell-right mass lesions)- may occur in meninges
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17
Q

paretic neurosyphillis

A
  • caused by invasion of brain by T pallidum
  • insidious, progressive cognitive impairment associated with mood alterations and eventually severe dementia (general paresis of the insane)
  • localizes in periventricular subependymal regions of brain- producing hemorrhagic necrotizing ventriculoencephalitis and choroid plexitis
  • can attack lower spinal cord and roots- painful radiculoneuritis
18
Q

poliomyelitis

A
  • mild gastroenteritis
  • can invade the NS in a small fraction of vulnerable population
  • mononuclear cell perivascular cuffs and neuronophagia of anterior horn motor neurons of spinal cord
  • anterior horn motor neurons of spinal cord- loss of neurons and gliosis, inflammation, atrophy of anterior spinal roots, neurogenic atrophy of denervated m
19
Q

poliomyelitis clinical features

A
  • motor neurons of spinal cord- flaccid paralysis associated with m wasting and hyporeflexia
  • severe respiratory compromise if diaphragm affected
20
Q

postpolio syndrome

A
  • 25-35 years after resolution of initial illness

- progressive weakness associated with decreased muscle mass and pain

21
Q

rabies- diagnostic histologic finding?

A

-negri bodies- cytoplasmic, round to oval, eosinophilic inclusions–in pyramidal neurons of hippocampus and purkinje cells of cerebellum

22
Q

Rabies clinincal features

A
  • virus enters CNS by asc along peripheral nerves from wound site
  • incubation period- 1-3 months
  • begins with nonspecific symptoms (malaise, headache, fever), local paresthesias around wound–diagnostic!!
  • later- CNS excitability- slightest touch is painful, violent motor responses
  • contracture of pharyngeal m- foaming at mouth
  • flaccid paralysis
  • mania and stupor periods-progress to coma, death from respiratory failure
23
Q

HIV acute, chronic phases

A
  • acute- mild lymphocytic meningitis, perivascular inflammation, myelin loss
  • chronic- encephalitis
  • only microglia express CD4 coreceptors and CCR5/CXCR4
24
Q

IRIS (immune reconstitution inflammatory syndrome)

A
  • in patients with AIDS after treatment
  • deterioration after starting therapy
  • inflammatory response while on antiretroviral therapy
25
Q

HIV encephalitis- morphology

A

-chronic reaction- microgilal nodules with multinucleated giant cells

26
Q

PML (progressive multifocal leukoencephalopathy)

A
  • encephalopathy caused by JC polyomavirus
  • infects oligodendrocytes- demyelination
  • in immunocompromised patients
  • primary infection-asymptomatic
  • reaction of virus in immunosuppression setting
  • neurologic symptoms
27
Q

PML morphology

A
  • parenchymal damage of cerebral cortex

- lesions- loss of neurons, proliferation of microglia, gliosis, iron deposits

28
Q

tabes dorsalis

A
  • damage to sensory axons in dorsal roots
  • impaired joint position sense and ataxia; loss of pain sensation, leading to skin and joint damage (charcot joints)
  • sensory disturbances–lightning pains, absense of DTRs
  • loss of axons and myelin in dorsal roots, pallor and atrophy in dorsal columns of spinal cord
29
Q

neuroborreliosis (lyme disease)

A
  • caused by spirochete- Borrelia burgdorferi (ixodes tick)
  • involvement of NS
  • neurologic symptoms- aseptic meningitis, facial n palsies, polyneuropathies, encephalopathy
30
Q

arthropod-borne viral encephalitis–symptoms, CSF?

A
  • arboviruses
  • generalized neurological deficits
  • focal signs- reflex asymmetry, ocular palsies
  • CSF- colorless, elevated pressure, elevated protein, normal glucose
31
Q

HSV type 1 symptoms

A
  • most common in children, young adults
  • typical symptoms- alteration in mood, memory, behavior
  • some patients-subacute course–weakness, lethargy, ataxia, seizures over 4-6 weeks
32
Q

HSV 1 morphology

A

cowdry type A intranuclear inclusion bodies in neurons and glia

33
Q

varicella zoster virus (herpes zoster)

A
  • after cutaneous infection- latent phase within sensory neurons of dorsal root or trigeminal ganglia
  • react in adults– painful, vesicular skin eruption in dermatome
34
Q

CMV occurs in?

A
  • fetuses, immunocompromised

- infection in utero outcome- periventricular necrosis- brain destruction, microcephaly, periventricular calcification

35
Q

SSPE (subacute sclerosing panencephalitis)–symptoms, morphology

A
  • rare progressive clinical syndrome- cognitive decline, spasticity of limbs, seizures
  • children, young adults- months/years after infection with measles
  • stems from infection of CNS by altered measles virus
  • gliosis and myelin degeneration, viral inclusions, inflammation of white and gray matter, neurofirbillary tangles
36
Q

fungal meningoencephalitis- most common

A

-candida albicans, mucor species, aspergillus fumigatus, cryptococcus neoformans

37
Q

3 main forms of injury in fungal infection in CNS

A
  • chronic meningitis
  • vasculitis (mucormycosis, aspergillosis)- invade BV walls- vascular thrombosis, infarction- hemorrhagic
  • parenchymal invasion (granulomas or abcesses)
38
Q

cryptococcal meningitis

A
  • in AIDS patients

- may be fulminant and fatal in 2 weeks or can evolve over months

39
Q

cerebral toxoplasmosis morphology

A
  • in pts with HIIV
  • toxoplsma gondii infection
  • brain abcess
  • central necrosis, petechial hemorrhages, inflammation, macrophages, vascular proliferation
  • after treatment, lesions of coagulative necrosis surrounded by macrophages
  • cysts and free tachyzoites adjacent to lesions
40
Q

cerebral amebiasis

A
  • fatal necrotizing encephalitis- Naegleria infection

- chronic granulomatous meningoencephalitis- Acanthamoeba infection

41
Q

cerebral malaria

A
  • progressive encephalitis
  • plasmodium falciparum infection
  • vascular dysfunction–reduced cerebral blood flow–ataxia, seizures, coma

NS2 Test 2 (16 decks)

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