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
2
Q
meningoencephalitis
A
-inflammation of the meninges and brain parenchyma
3
Q
infectious meningitis classified as?
A
- acute pyogenic (bacterial)
- aseptic (viral)
- chronic (TB, spirochetal, cryptococcal)
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
5
Q
Acute pyogenic (bacterial) meningitis spinal tap
A
- cloudy/purulent CSF
- increased pressure?
- neutrophils
- increased protein conentration
- reduced glucose content
6
Q
Waterhouse-Friederichsen syndrome
A
- meningitis associated septicimia- hemorrhagic infarction of adrenal glands, cutaneous petechiae
- meningococcal and pneumococcal meningitis
7
Q
chronic adhesive arachnoiditis
A
- in pneumococcal meningitis
- capsular polysaccharide of organism produces a gelatinous exudate that promotes arachnoid fibrosis
8
Q
Brain abcess caused by?
A
- localized focus of necrosis of brain tissue with inflammation
- caused by bacterial infection
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
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
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
12
Q
extradural empyema- caused by?
A
- extradural abcess
- associated with osteomyelitis
- arise from an adjacent focus of infection (sinusitis, surgical procedure)
13
Q
chronic bacterial meningoencephalitis caused by?
A
- mycobacterium tuberculosis
- treponema pallidum
- borrelia
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
15
Q
neurosyphillis major patterns?
A
- meningovascular neuroshyphilis
- paretic neurosyphilis
- tabes dorsalis
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
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
HIV encephalitis- morphology
-chronic reaction- microgilal nodules with multinucleated giant cells
26
PML (progressive multifocal leukoencephalopathy)
- encephalopathy caused by JC polyomavirus
- infects oligodendrocytes- demyelination
- in immunocompromised patients
- primary infection-asymptomatic
- reaction of virus in immunosuppression setting
- neurologic symptoms
27
PML morphology
- parenchymal damage of cerebral cortex
| - lesions- loss of neurons, proliferation of microglia, gliosis, iron deposits
28
tabes dorsalis
- 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
neuroborreliosis (lyme disease)
- caused by spirochete- Borrelia burgdorferi (ixodes tick)
- involvement of NS
- neurologic symptoms- aseptic meningitis, facial n palsies, polyneuropathies, encephalopathy
30
arthropod-borne viral encephalitis--symptoms, CSF?
- arboviruses
- generalized neurological deficits
- focal signs- reflex asymmetry, ocular palsies
- CSF- colorless, elevated pressure, elevated protein, normal glucose
31
HSV type 1 symptoms
- 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
HSV 1 morphology
cowdry type A intranuclear inclusion bodies in neurons and glia
33
varicella zoster virus (herpes zoster)
- after cutaneous infection- latent phase within sensory neurons of dorsal root or trigeminal ganglia
- react in adults-- painful, vesicular skin eruption in dermatome
34
CMV occurs in?
- fetuses, immunocompromised
| - infection in utero outcome- periventricular necrosis- brain destruction, microcephaly, periventricular calcification
35
SSPE (subacute sclerosing panencephalitis)--symptoms, morphology
- 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
fungal meningoencephalitis- most common
-candida albicans, mucor species, aspergillus fumigatus, cryptococcus neoformans
37
3 main forms of injury in fungal infection in CNS
- chronic meningitis
- vasculitis (mucormycosis, aspergillosis)- invade BV walls- vascular thrombosis, infarction- hemorrhagic
- parenchymal invasion (granulomas or abcesses)
38
cryptococcal meningitis
- in AIDS patients
| - may be fulminant and fatal in 2 weeks or can evolve over months
39
cerebral toxoplasmosis morphology
- 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
cerebral amebiasis
- fatal necrotizing encephalitis- Naegleria infection
| - chronic granulomatous meningoencephalitis- Acanthamoeba infection
41
cerebral malaria
- progressive encephalitis
- plasmodium falciparum infection
- vascular dysfunction--reduced cerebral blood flow--ataxia, seizures, coma
