Generally arterial - lucid interval - most commonly squamous temporal fracture

Typically venous or parasagittal mass lesion - acute and chronic (osmotic/re-bleeding) - age, coagulopathy, generally traumatic - microscopic dating helpful for forensics

- return to play controversy; second impact syndrome - 300x increase for repeat concussion - danger of acute brain injury are more acute between ages 10-18

Diffuse axonal injury - accumulation of beta-amyloid precursor protein - small hemorrhages of deep cortex and corpus callosum

Trauma vector is parallel with straightened c spine resulting in multiple failure points -

- tuberculosis infxn in vertebrae - can result in vertebral collapse, cord compression or humpback (gibbus)

- candida - aspergillus - crypto neoform. - coccidioides imm.

Cns Trauma/cns Infxn Flashcards by Jordan Jacobsen

Epidural hematoma

Generally arterial

lucid interval
most commonly squamous temporal fracture

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SCALP

Skin, connective tissue, aponeurosis, loose ct, pericranium

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Subdural hematoma

Typically venous or parasagittal mass lesion

acute and chronic (osmotic/re-bleeding)
age, coagulopathy, generally traumatic
microscopic dating helpful for forensics

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Subarachnoid

Bridging veins

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Concussion

return to play controversy; second impact syndrome
300x increase for repeat concussion
danger of acute brain injury are more acute between ages 10-18

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Contusion hemorrhages: types and histology

Coup and contra-coup

primary and 180
illustrates deep vascular compromise
cerebral cortical contusion plaques

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Parenchymal secondary to intercranial hemorrhage: cause

Related to amphetamine and cocaine use

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Parenchymal hemorrhage with multiple petechial hemorrhages of white matter

Secondary to fractures of long bones containing marrow resulting in systemic that embolize

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“Shaken baby”

Diffuse axonal injury

accumulation of beta-amyloid precursor protein
small hemorrhages of deep cortex and corpus callosum

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Cervical injuries

Upper - often fatal
Lower - quadri/paraplegia
- corticosteroids = bad

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Axial loading

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Bacterial meningitis

Inflammation of arachnoid and pia (leptomeninges) and CSF

- most commonly staph and strep

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CSF findings in bacterial meningitis

Cloudy appearance

Increased neutrophils, decreased glucose, increased protein

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Mechanisms of infection in meningitis

direct implantation
spread from adjacent site (like mastoid air cells)
hematogenous

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Brain abscess formation

5-10% mortality

- includes vasogenic edema (increased ICP)

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Tuberculous meningitis

commonly spread via hematogenous spread
basilar exudate
once common in children
sudden unexpected death
arachnoid fibrosis -> hydrocephalus
obliteritive endarteitis -> vascular occlusion and infarct

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Potts disease

tuberculosis infxn in vertebrae

- can result in vertebral collapse, cord compression or humpback (gibbus)

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CNS fungal infxns

candida
aspergillus
crypto neoform.
coccidioides imm.

Candida

common saprophyte
may infect IV caths, prosthetic valves
granulomatous response

Aspergillus infxn

Usually pulmonary origin
vasophillic
45 branching hyphae
immunoenzymatic microplate assay

Cryptococcus neoformans: epidemiology and testing

most common mycotic CNS infxn
immunocompromised: 50 % apparently immunocompetant
latex agglutination test
NOT usually mass lesion

CNS enteroviruses

- Echo and coxsackie A/B are most common 
     ~ fecal oral
     ~ crowding 
- polio
     ~ neurotrophic

CNS arbo viruses

dengue: increasing in US
eastern equine (30% mortality)
western equine
St. Louis: high mortality in elderly
California: treehole mosquito
west Nile

West Nile virus: contraction

contract able through Mosquitos, transfusion, organ transplantation and transplacental routes

Herpes viruses

HSV-1: oral mucosal, encephalitis causing in adults ~ highly fatal, PCR diagnosis, cowdry type A inclusions ~ trt with acyclovir HSV-2: spread to in birth canal infant -> meningitis HHV-6: often fatal in infants, transplants Varicella: ind DRG, can spread to brain

CMV

- typically subclinical - infection seen with giant cells and cowdry type A inclusions - typically immunocomp and infants

Progressive multifocal leukoencephalopathy

- immunocomp - acidophilic nuclear inclusions - astrocytes with bizarre nuclei - caused by papovirus

Prions: diseases, histology

- self replicating malignant proteins - CJD, vCJD, kuru (and animal variants) - spongiform encephalopathy ~ spongiosis ~ Astrocytosis ~ lack of inflammation - transmitted through transplants, transfusions, incited instruments

Neurosyphillis

- Manifestation of tertiary syphilis - rates lowering except in MSM - meningial syphillis, tabes dorsalis, parenchymal syphillis and congenital syphillis all part in parcel

Neuroborreliosis

- neuro Lyme disease - Ixodes transmission - cutaneous erythema migrans, serologic confirmation - potential neuro (confusion et al)

Toxoplasmosis: acquired, congenital

- congenital (transplacental) and acquired ~ congenital: mostly mild; can involve chorioretinitis, retardation ~ acquired: lymphadenitis, lymphadenopathy (may look like lymphoma) mostly in immunocomp (necrotizing encephalitis)

Neuropathology of AIDS infxns

- encephalopathy/encephalitis: sub cortical dementia - toxoplasmosis - CMV - cryptococcosis - lymphoma: mainly B cell, assoc. with EBV; high grade, aggressive

Obliteritive endarteitis/ arachnoid fibrosis

Tuberculous meningitis

Lucid interval

- period of time of lucidity following onset of epidural bleed

Loss of consciousness or duration of concussion symptoms greater than 15 minutes

- return to play

Uncal herniation

Generally associated with hemiparesis and CN III palsy | - progression produces kernohans notch phenomena

kernohans notch phenomena

Uncus herniate to contralateral sup. cerebral peduncle | - this of course results in ipsilateral hemiparesis

Normal ICP

~ 15 mmHg

Treatment of ICP (per blueprints)

- elevate the head - hyperventilation to PCO2 of 25 mmHg - barbiturates (phenolbarb) - drainage of CSF - hypertonic saline/mannitol

Cytotoxic vs. vasogenic edema

Cytotoxic: minutes to hours, may be reversible Vasogenic: hours - days, considered irreversible

Cerebral amyloid angiography, HTN, berry aneurysm

Two primary causes of intraparenchymal hemorrhages in CVD | - hypertensive hemorrhage most often effects basal ganglia and thalamus

Charcot-Bouchard aneurysm

- non saccular, formed from multiple other smaller aneurysms

Subarachnoid hemorrhage

- sudden onset of severe headache without focal signs | - results in increased ICP -> reduces profusion -> brain death

Fusiform aneurysm

- Dilation due to atherosclerosis most commonly found in the basilar artery