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CNS infections Flashcards

1
Q

What is meningitis

A

Infection of meninges and cerebrospinal fluid space

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2
Q

What is encephalitis

A

Infection of brain parenchyma

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3
Q

What is meningoencephalitis

A

Infection of the brain and Meninges

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4
Q

Main route of infection of the meninges and csf

A

Hematogenous most common
Direct in plantation from trauma lumbar puncture corneal transplant etc.
Local extension from sinuses
Peripheral and cranial nerves from viruses

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5
Q

Classification of meningitis

A

Acute pyogenic meningitis - bacterial purulent
acute aseptic meningitis- viral lymphocytes
chronic meningitis- bacterial , fungal

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6
Q

Main part of the brain affected by pachymeningitis

A

Dura

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7
Q

Main cause of acute pyigenic meningitis in each age group

A

Neonates E. coli Group B streptococcus
Infant and young children influenza
Older children and adolescents and young adults and meningitidis
Elderly network pneumococci

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8
Q

Route of transmission of a cute pyogenic meningitis

A

Hematogenous
bacteria from airways
Direct trauma
Basal fracture or brain surgery

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9
Q

Macro Morphology of acute pyogenic meningitis

A 
Brain swollen 
congested Meninges 
clouded meninges 
Purulent exudate accumulation on convexity’s or basal
Ventriculitis
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10
Q

Micro morphology of acute pyogenic meningitis

A

Acute inflammatory exhibit exudatein subarachnoid space and within Pia and arachnoid matter

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11
Q

Lumbar puncture findings in acute pyogenic meningitis

A 
Cerebrospinal fluid cloudy 
increased pressure 
increased cell polymorphs 
increaesed protein
Decreased glucose
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12
Q

Symptoms and signs of a cute pyogenic meningitis

A 
General malaise 
Fever
meningeal irritation 
agitation 
irritability 
headaches 
clouded sensorium 
photophobia 
stiff neck 
Kernig’s sign
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13
Q

Complication of a cute pyogenic meningitis

A

Adhesion from fibroblastic proliferation -> constrict cranial nerves , obliterates subarachnoid space -> cause hydrocephalus, deafness ,blindness

Arteritis and pheblitis -> thrombosis and micro infarct-> intracerebral abscess and convulsions

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14
Q

Main causes of aseptic meningitis

A

Viral 70%

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15
Q

Viruses types involved in aseptic meningitis

A

Enteroviruses -echo ,Coxsackie
EBV
herpes simplex
mumps

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16
Q

Cerebrospinal fluid findings in viral aseptic meningitis

A

Increased lymphocytes
increased protein
sugar content normal
negative culture bacteria and fungi

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17
Q

Findings of chemical aseptic meningitis

A

Increased polymorphs
increased Protein
normal sugar
no organism

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18
Q

Morphology of aseptic meningitis

A

Swollen brain

moderate to mild lymphocytic infiltration of meninges

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19
Q

Main causes of brain abscess

A

Direct implantation of organism during trauma surgery ,needle biopsy ,

local extension from Adjacent Foli like sinusitis, otitis

hematogenous from heart valve septic emboli from endocarditis like abscesses

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20
Q

Organisms involved in brain abscess

A

staphylococcus
Streptococcus
Anaerobes

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21
Q

Symptoms and signs of brain abscess

A

Progressive focal deficits

raised intracranial pressure

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22
Q

CSF findings of brain abscess

A

Increased pressure leukocyte pleocytosis
increased protein
normal sugar

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23
Q

MacroMorphology of Brain abscess

A

Discrete lesions

central liqueFactive necrosis surrounded by fibrous and edema

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24
Q

Complication of brain abscess

A

Rupture

Increased intracranial pressure causing herniation

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25
What is subdural empyema
Collection of pus in the subdural space from spread of bacterial or fungal infection of skull, bones or air sinuses
26
Complication in subdural empyema
Space occupying lesion _> thrombophlebitis of bridging veins crossing subdural space -> venous occlusion ->infarction of brain
27
Clinical symptoms of subdural empyema
Fever headache neck stiffness focal neurologic deficit’s
28
Csf findings in subDural empyema
cerebrospinal fluid under pressure increase White cell increased proteins normal glucose
29
Main association to extradural abscess
Osteomyelitis of skull bones after otitis ,sinusitis ,trauma ,surgery
30
Form of chronic meningoencephalitis seen in adults with HIV
Tuberculous meningitis
31
How does tuberculous get to the brain
hematogenously spread from primary focus usually in the lung
32
Microscopic presentation of tuberculous meningitis
Granuloma that gets in sub arachnoid space Shaggy necrotic yellowish exudate at the base of the brain Arachnoid fibrosis
33
Why is there a cranial nerve palsies in tuberculous meningitis
Arachnoid fibrosis and compression of cranial nerves and brainstem
34
Why is there a Hydrocephalus in tuberculous meningitis
Due to obliteration of subarachnoid space
35
Presentation of tuberculosis meningitis
``` cranial nerve palsies Hydrocephalus obstructive hydrocephalus vasculitis parenchymal granulomas tuberculosis abscesses tuberculosis cerebritis Pachymeningitis spinal cord infection ```
36
Clinical presentation of tuberculous meningitis
Malaise headache mental confusion vomiting
37
CSF findings of tuberculosis meningitis
Pleocytosis - mononuclear or mixture of mononuclear and polymorphs increased protein levels glucose is reduced or normal
38
Micro morphology of tuberculous meningitis
Subarachnoid space gelatinous or fibrous exudates discrete whitish granules scattered over meninges tuberculosis granulomas with central caseation
39
What is tuberculoma
Well circumscribe intraparenchymal mess associated with meningitis central caseation necrosis surrounded by granuloma sometimes calcification
40
Percentage of cases of syphilis leading to neurosyphilis
30%
41
Route of spread of syphilis
Hematogenous
42
Stage of syphilis with neurosyphilis
Second stage
43
Stage of syphilis in meningovascular syphilis or parenchymal syphilis
3 stage
44
Meningovascular syphilis micro morphology
Lymphocytes and Plasma cell infiltration in meninges
45
Complications of Meningovascular
Scarring leading to nerve compression and hydrocephalus | Obliterative endarteritis-> parenchymal infarction -> stroke
46
Tissue invaded in paretic neuro syphilis
Parenchyma
47
Morphology of paretic neuro syphilis
Loss of neurons Hyperplastic neuroglia Peribascular inflammatory infiltrate
48
Clinical presentation 15years after trepanoma infection
Progressive dementia Mood alteration Delusion General paresis of insane
49
What’s tabes dorsalis
Locomotor ataxia from spinal corD involvement in infection with syphylis
50
Damage occurring in tabes dorsalis
Dorsal root damage | Loss of myelin axon
51
Clinical presentation of tabes dorsalis
``` Ataxia - Impaired joint position Loss of pain sensation Lightening pains in limbs Loss of deep tendon reflexes Urinary retention Argyll Robertson pupils ```
52
Most common fungal infection of brain in ´HIV
Cryptococcus
53
Cryptococcus Brain morphology
Soap bubble appearance | no inflammation
54
In which patient do you have brain fungal infection called mucormycosis
Diabetics with dka | Immunocompromised
55
Common parasitic infection of brain
Toxoplasmosis Plasmodium Cysticercosis - tænia solium
56
Route of spread of viral encephalitis
Hematogenous | Peripheral nervesn
57
Types of p primary enceophalitis
Acute viral infections Persistent viral infections Slow viral infections
58
Why is there CNS damage in encephalitis due to virus
Direct destruction of tissues ( slow viruses. ) Cell lysis by immune rxns Immune complex in vessel walls autoimmunity to myelin
59
Csf finding in viral encephalitis
Increased mononuclear cells Normal glucose Raised or normal protein
60
What is tropism in viral encephalitis
The fact that many viruses are site specific so infect specific part of brisn
61
Area of Brain infected by heroes zoster
Dorsal root ganglion
62
Area of Brain infected by polio
Anterior horn cell
63
Area of Brain infected by papova virus
Oligodendrocytes
64
Area of Brain infected by rabies
Neurones
65
Area of Brain infected by hsv2
All cells | Inferior frontal m temporal lobe
66
Virus infection that can lead to post encephalitic Parkinsonism
Influenza
67
Virus infection that can lead to congenital malformations
Rubella
68
Histology of viral infections
Peri vascular mononuclear infiltrate Glial nodules with microglial and lymphocytes Neuronophagia - macrophages cluster around dead neurons Intranuclear and intracytoplasmic inclusions Cowdry A - intranuclear eosinophilic inclusion with hyaline of granular appearance with halo Cowdry B - small round indistinct intranuclear inclusion
69
Virus that cause the most encephalitis and spread to spread person
Enteroviruses
70
Polio manifestation in CNS
Large motor neurones in spinal cord and brainstem -> Lower motor neurons paralysis
71
Polio micro morphology
neurones loss Gliosis loss AStrocytes loss Neurogenic atrophy of muscle
72
Causes of death in polio I
Respiratory muscle paralysis | Myocarditis
73
Coxsackie virus presentation in the CNS
Meningoencephalitis | myocarditis
74
Mumps CNS presentation
Mild transient meningitis
75
Ganglion affected by herpes type one
Trigeminal ganglion
76
CNS Presentation of herpes virus 1
``` Focal neurologic deficit bizarre behavior seizures impaired sensorium coma ```
77
Microscopy morphology of herpes virus one
hemorrhaging necrosis l edema Cowdry a inclusions
78
Effective treatment of herpes virus one
Acyclovir
79
Ganglia with herpesvirus 2
Sacral ganglia
80
CNS presentation of herpes virus 2
Necrotizing encephalitis in AIDS patients encephalitis in 50% newborns severe meningitis ,necrotizing encephalitis
81
Ganglia with varicella zoster
Dorsal root ganglia
82
Can can you have encephalitis with varicella zoster
Rarely
83
Presentation of CMV
``` Syndrome of microcephaly Periventricular calcification hepatosplenomegaly Purpura Pneumonitis choroidoretinitis ```
84
Animals involved in rabies bite
Animal like dog cat fox bat
85
Incubation period of rabies
1-3 months
86
symptoms of rabies
Headache fever malaise | Progression to profound sensitivity , pain, convulsions photophobia ,coma and death
87
Rabies morphology
Edematous brain | congested brain with neuronal degeneration especially in basal ganglia ,midbrain ,and the floor of the fourth ventricle
88
What is the diagnostic criteria in micro morphology of rabies
Negri bodies(70% cases) - Intracytoplasmic multiple rounds to oval eosinophilic inclusions
89
What can cause persistent viral encephalitis
Chronic viral infection like in measles
90
CNS presentation of measles
``` Intellectual deterioration personality change involuntary movements gait disturbances eventual death in months to 2 to 3 years ```
91
Immunoglobin presents highly in measles
IgG
92
Morphology of measles
Granular firm brain perivascular and parenchymal infiltration by inflammatory cells inclusion bodies mostly in oligodendrocytes but also neurons and astrocytes neuronophagia Nerve cell loss Dense fibrillary gliosis
93
Why can’t measles virus be cleared and therefore spreads in the brain
Because csf do not have M proteins antibodies so produce defective virus
94
Type of encephalitis in in persistent viral encephalitis
Sub acute sclerosing panencephalitis
95
Virus involved in slow virus infection causing progressive multifocal leukoencephalopathy
JC virus of Popovaviruses
96
JC virus infect which cell of the CNS
Oligodendrocytes
97
Patience affected by JC virus
Immuno compromised patients
98
Morphology of JC virus
Multifocal lesions in cerebrum cerebellum and spinal cord white matter foci of demyelination lipid laden macrophages cystic areas sometimes in progression enlarged oligodendrocyte nuclei with glassy amphophilic viral inclusions bizarre giant astrocytes
99
Percentage of patients with eight presenting with CNS involvement
60
100
Syndromes CNS in HIV
Acute aseptic meningitis and encephalitis subacute encephalitis Vacuolar myelopathy peripheral neuropathy
101
Percentage of HIV patients with aseptic meningitis
10
102
What is the cause of 2/3 of aids patients developing dementia
Subacute encephalitis also Cold aids dementia
103
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Neurology (31 decks)

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