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Anatomic Pathology > CNS Infections > Flashcards

CNS Infections Flashcards

1
Q

Most common route of spread of CNS infections include?

A

Hematogenous spread (arterial)

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2
Q

Routes of spread of CNS infection

A

Hematogenous - (Arterial)
Direct implantation (Traumatic)
Local extension - (Established infection or air sinus)
Axonal transport - (Rabies, herpes zoster)

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3
Q

Based on etiology and clinical evolution of illness, infectious meningitis is broadly classified into?

A
  • Acute Pyogenic meningitis (bacterial)
  • Aseptic meningitis (Acute, Subacute Viral)
  • Chronic meningitis (Tuberculosis, spirochetal and cryptococcal )
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4
Q

Aseptic (Viral) meningitis is most commonly caused by?

A

Enterovirus causes leptomeningeal inflammation (pain and arachnoid mater)

  • self limiting, low mortality, treat symptomatically
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5
Q

Type of inflammatory cells seen in Aseptic meningitis ?

A
  • Lymphocytic infiltration

Clinical manifestation: Fever, meningioma irritation, depressed consciousness

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6
Q

Causes of Acute purulent meningitis in NEONATES ?

A

Neonates;
*Group B strep, E. coli

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7
Q

Causes of Acute purulent meningitis in Infants and children?

A
  • Streptococcus Pneumoniae
  • Haemophilus influenzae (reduced with immunization)
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8
Q

Causes of Acute purulent meningitis in Adolecents and young adults ?

A
  • Neisseria meningitidis
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9
Q

Causes of Acute purulent Meningitis in Elderly?

A
  • Listeria monocytogenes
  • Streptococcus pneumoniae
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10
Q

Microscopic view of Acute purulent meningitis ??

A

Neutrophilic infiltration of the leptomeninges, extending variably to the cortex

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11
Q

Gross findings in Acute purulent meningitis?

A
  • Opaque Leptomeninges
  • Engorged meninges vessels
  • Purulent exudates
  • Diffused cerebral edema: Flattened and widened gyri with narrowed sulcus
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12
Q

Clinical presentation of Acute purulent meningitis?

A

Headache
Fever
Nuchal rigidity
photophobia
Irritability
Cloudy sensorium
Coma and death
Sequelae due to purulent exudate and fibrosis
- Hydrocephalus and cranial nerve impairment (neural deafness)

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13
Q

Bacteria with affinity for the base of the brain?

A
  • Mycobacterium tuberculosis
  • Cryptococcus species
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14
Q

Mycobacteria meningoencephalitis is caused by??

A
  • Mycobacterium tuberculosis
  • Atypical bacteria
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15
Q

Mycobacteria meningoencephalitis features

A
  • usually involves the basal surface of the brain
  • tuberculoma within the brain and dura mater
  • common in aids patients
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16
Q

Which microbacterium is associated with AIDS Patients?

A

Mycobacterium avium intracellulare (MAI)

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17
Q

Normal CSF values in humans?

A

WBCs - < 5 lymphocytes cells
/uL
Glucose - 45-85 ug/dL (50 -70% glycemia)
Proteins - 15 - 45 mg/dl
Pressure - 70 - 80mmH20

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18
Q

CSF findings in Bacterial meningitis

A

WBCs - up to 90,000 neutrophils cells/uL
Glucose- < 45ug/dL (Decreased)
Proteins - > 50 mg/dL (increased)
Pressure - markedly elevated

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19
Q

CSF findings in Aseptic (viral) meningitis

A

WBCs - 100 - 1000cells/uL (lymphocytes)
Glucose - 45 - 85 ug/dL (Normal)
Protein - > 50mg/dL (increased)
Pressure - slightly elevated

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20
Q

cSF findings in Granulomatous meningitis (mycobacterial/fungal)

A

WBCs -100 - 1000 cells/uL
Glucose - < 45ug/dL (decreased)
Protein - > 50mg/dL
Pressure - moderately elevated

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21
Q

Protein is normal is one what type of meningitis ?

A

Aseptic (viral meningitis)

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22
Q

Common features of Viral encephalitides ?

A
  • Perivascular cuffs of lymphocytes
  • Microglial nodules
  • Neuron loss
  • Neuronophagia
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23
Q

Specific forms of viral encephalitides ?

A
  • Arthropod borne
  • Herpes simplex type 1 - hemorrhagic necrosis
  • Rabies - Negri bodies
  • HIV
  • Progressive multifocal leucoencephalopathy
24
Q

Negri bodies are found in purkinje and and hippocampal of what form of viral encephalitides?

A

Rabies

25
Q

Cowdry bodies are seen where?

A

In Herpes simplex type 1; They are hemorrhagic necrosis of the temporal lobes

26
Q

Arthropod born viral encephalitides?

A
  • St Louis
  • California
  • Eastern and western equine
  • Venezuelan
27
Q

The diagnostic histologic findings in rabies?

A

Negri bodies in a purkinje or hippocampal cell

28
Q

What part of the brain is involved in HIV and what complex does it form?

A

Cerebral involvement
- AID-Demetia complex

29
Q

Histopathology of HIV encephalitides ?

A

Microglial nodules and diagnostic Myltinucleated giant cells

30
Q

Spinal involvement in HIV leads to ?

A

Vascular myelopathy

(Similar to VB12 deficiency - associated with subacute combined degeneration)

31
Q

What virus is associated with Progressive multifocal leukoencephalopathy (pML) ?

A
  • Related to JC virus - A polyomavirus
  • causes pML in immunocompromised patients (especially AIDS)
32
Q

PML histopathology ?

A
  • Demyelination
  • lymphohistiocytic infiltrates
  • Astrogliosis (bizarre shaped Astrocytes)
  • oligodendrocytes (enlarged intranuclear inclusions)
33
Q

Subacute Sclerosing panencephalitis is a rare complication of?

A

Measles (Rubeola) virus infection

persistent immune resistant measles virus causes slow-virus encephalitis

A child who had measles before age 2
* 6-15yrs later, presents with progressing mental deterioration with siezures*
fatal in 1-2 years once it develops

34
Q

Most frequent agents causing Fungal meningoencephalitides?

A
  • Candida
  • Aspergillous
  • Cryptococcus
  • Mucor species

Aspergillus** and **mucor** have a marked tropism for **blood vessels
(Vasculitis, hemorrhage)

35
Q

Cryptococcus cause what type of CNS pathology ?

A

Diffuse meningoencephalitis; invasion of the brain through virchow-robin space and soap-bubble lesions

36
Q

Soap-bubbles lesions are associated with what type of infection?

A

Cryptococcus meningoencephalitis

37
Q

Infections frequent in aids patient??

A
  • pML
  • Toxoplasmosis
38
Q

Characteristic findings in toxoplasmosis ?

A

Central abscess with central necrosis and chronic inflammation

39
Q

Neurosyphilis is a manifestation of what stage of syphilis ??

A
  • Tertiary syphilis
  • 10% of individuals with untreated syphilis
40
Q

Major pattern of CNS involvement in neurosyphilis are;

A

1) Meningovascular neuropsyphilis
2) paretic neurosyphilis
3) Tabes dorsalis

41
Q

Meningo-vascular neurosyphilis is associated with ?

A
  • Obliterating endarteritis - heubner arteritis
  • perivascular plasma lymphocytic infiltrates
  • cerebral gummas
42
Q

General paresis of the insane is associated with what pattern of neurosyphilis ?

A
  • Paretic neurosyphilis

insidious but progressive of grandeur that terminate in severe dementia

43
Q

Paretic neurosyphilisostly affects what part of the cerebral cortex?

A

The frontal lobe

  • loss of neurons
  • proliferation of microglia
  • gliosis
  • iron deposits
44
Q

What structures are damaged in tabes dorsalis ?

A

Damage to the sensory axons or the dorsal roots

Microscopy:
Loss of both axons and myelin in the dorsal roots, pallor and atrophy in the dorsal columns of the spinal cord.

  • locomotor ataxia: impaired joint position sense and ataxia
  • Charcot joints: loss of pain sensation leading to skin and joint damage
  • Lightening pain
  • Absent deep tendon reflexes
45
Q

Predisposing factors to cerebral abscess?

A
  • Acute bacterial endocarditis
  • Cyanotic’ heart disease
  • Chronic pulmonary abscess
  • Mastoiditis, paranasal sinusitis, acute otitis, open fracture, previous neurosurgery
46
Q

MRI/CT appearance of cerebral abscess ?

A

Ring enhancing lesion

signs of increased intracranial pressure

47
Q

Examples of a prion disease?

A
  • Cruetz feldt Jakob disease (CJD)
  • Kuru disease
  • scrapie (sheep is host)
  • Gerst Mann straussler disease
  • Fatal familial insomnia
48
Q

CRuetZfeldt Jakob disease results in what change ?

A

Spongiform change

fine vacuolization of the neutrophil in the gray mater (especially cortex)
Large membrane bound vacuoles within the neuronal processes
Associated with neuronal loss and astrogliosis

49
Q

What are Kuru plaques ?

A

Deposits of amyloid of altered prp proteins. Seen using PAS stain

50
Q

ECG changes in CJD?

A

Bilateral synchronous periodic epileptiform discharges (BIPEDs)?

  • Death withing 6-12 months
  • genetic predisposition
51
Q

Memory loss with Startle myoclonus is associated with what prion disease?

A

CJD

52
Q

Prion disease are generally associated with what CNS disease ?

A

Subacute spongiform encephalopathy SSE

53
Q

What grieve is associated with kuru disease?

A

New Guine; consuming infected cattle brains

54
Q

Scrapie is gotten from?

A

Sheep, scrapping their wool off on fences

55
Q

Characteristic findings in several CNS infections

A

1) Viral encephalitis - Microglial modules, perivascular cuffs, neuronal loss, neuronophagia
2) Rabies - Negri bodies
3) HIV - Microglial nodules with multinucleated giant cells
4) Neurosyphilis - cerebral gummers
5) Cryptoccocus, aspergillosis and candida in Fungal meningoencephalitides - bubble lessions
6) JC virus in PML - Demyelination, lymphohistiocytic infiltrates, astrogliosis and oligodendroglial inclusions
7) CRuetZfeldt Jakob disease prion - Subacute spongiform encephalopathy (SSE)
8) Rubeola virus; Subacute sclerosing panencephalitis (SSPE)
9) Cerebral abscess; Ring enhancing lesions on MRI
10) Toxoplasmosis - ring enhancing lesion
11) Herpes simplex virus 1 - Cowdry bodies Hemorrhagic necrosis of temporal lobes.
12) Polo virus - affects the anterior horn

Anatomic Pathology (12 decks)

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