CNS Infections part 2 Flashcards
Aseptic Meningitis
Viral
With Aseptic (viral) Meningitis, there is usually no organism recognized. What class of viruses is usually to blame?
Enteroviruses
What histological findings will be seen with Aseptic (viral) Meningitis?
Perivascular lymphocytic cuffs and microglial nodules
Herpes Simplex Virus - 1 affects children and young adults. What will be seen on the brain and where?
Necrosis and hemorrhage
= Inferior and medial temporal lobes
Necrosis and hemorrhage on the inferior and medial temporal lobes may indicate what infection?
HSV-1
herpes simplex
What intranuclear inclusions will be seen in neurons and glia with HSV-1?
Cowdry type A
Who does Herpes Simplex Virus - 2 affect?
Children born via vaginal delivery to infected mothers
= Encephalitis
Herpes Zoster’s latent phase is usually in?
Trigeminal Ganglia or sensory neurons
Once Herpes Zoster is reactivated, what occurs and what are the symptoms?
Shingles
= Painful vesicles following dermatome
What is Postherpetic Neuralgia Syndrome?
- seen with shingles/herpes zoster)
= Painful sensation following NON-painful stimuli
Describe what occurs if a fetus is infected with Cytomegalovirus in utero?
- Periventricular necrosis
- Brain destruction
- Microcephaly and calcification
Describe what occurs if a fetus is infected with Cytomegalovirus in utero?
- Periventricular Necrosis
- Brain destruction
- Microcephaly and calcification
What does Poliomyelitis affect and thus what are the symptoms?
Anterior horn of motor neurons
= Flaccid paralysis, muscle wasting, etc.
What will atrophy in the anterior horn of the motor neurons with Poliomyelitis?
Atrophy of the white columns
What is Post-Polio Syndrome?
25-35 years after illness resolved there will be weakness and pain that is progressive
What is the incubation period for Rabies?
1-3 months
What is diagnostic of Rabies at the wound site?
Local paresthesias around the initial wound
What shape is the Rabies virus and what inclusions will be seen?
Bullet shaped
Negri bodies
What are the symptoms of Rabies infection?
- CNS hyperexcitability, convulsions
- Flaccid paralysis
- Hydrophobia
If HIV is causing Chronic Aseptic Meningitis, what cells will be present?
Multinucleated giant cells
With HIV, what is there an increased incidence of?
Primary CNS lymphoma
What virus causes Progressive Multifocal Leukoencephalopathy?
JC polyomavirus
What does JC polyomavirus cause?
Progressive Multifocal Leukoencephalopathy (PML)
With PML, what does the JC polyomavirus do?
Demyelinates oligodendrocytes
What changes (3) in the brain will be seen with JC polyomavirus causing PML?
Demyelinates oligodendrocytes
Lipid-laden macrophages
Decreased # of axons
What virus causes Subacute Sclerosing Panencephalitis?
Paramyxovirus
What does Paramyxovirus cause?
Subacute Sclerosing Panencephalitis
What are the symptoms of infection with Paramyxovirus and what does it follow?
Cognitive decline, limb spasticity and seizures following measles infection
What are the 3 histologic manifestations of Subacute Sclerosing Panencephalitis (paramyxovirus)?
- Widespread gliosis
- Myelin degeneration
- Neurofibrillary tangles
Fungal Meningoencephalitis occurs in the immunosuppressed. What are the 2 main pathogens?
Mucormycosis
Cryptococcus Neoformans
What is infection with Mucormycosis associated with?
DIABETES
What will be seen microscopically with infection with Cryptococcus Neoformans?
Cryptococcal soap bubbles
What protozoa causes brain abscesses?
Toxoplasmosis Gondii
Where are the brain abscesses with Toxoplasmosis Gondii?
- Grey-white matter junction
- Deep grey nuclei
What types of lesions will be seen with Toxoplasmosis Gondii?
Ring enhancing lesions
With Toxoplasmosis Gondii protozoal infection, what occurs centrally in the brain abscess?
Central necrosis
Vascular proliferation
Petechial hemorrhages
With Toxoplasmosis Gondii protozoal infection, what is seen at the periphery of the central necrosis?
Free tachyzoites
Encysted bradyzoites
What are the 2 Prion Diseases?
Creutzfeldt Jakob Disease
Fatal Familial Insomnia
What are the 2 Prion Diseases?
Creutzfeldt Jakob Disease
Fatal Familial Insomnia
Prion diseases involve a buildup of abnormal proteins. What does this result in and what histo change is usually seen?
Result = rapidly progressive disorders
** SPONGIFORM CHANGE - intracellular vacuoles!
Spongiform change (intracellular vacuoles) is seen with what diseases?
Prion diseases
What are the symptoms of Creutzfeldt-Jakob Disease?
In 70s, rapid dementia and myoclonus (involuntary jerking)
What are the symptoms of Creutzfeldt Jakob Disease and what is there little evidence of?
Rapid dementia and myoclonus (involuntary jerking)
– little evidence of brain atrophy
How is VCJD in the UK different that regular Creutzfeldt Jakob Disease?
Slower progression, exposure to bovine (cow) brains
What 3 things are seen with a Kuru plaque?
Protein
PAS
Congo red
What are the symptoms of Fatal Familial Insomnia?
Sleep disturbances –> ataxia, stupor, coma
What is the survival rate for Fatal Familial Insomnia?
Less than 3 years
What amino acid is substituted and where with Fatal Familial Insomnia?
Aspartate subbed at codon 129
