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Imaging approach to neuroinfections Flashcards

1
Q

What are several outbreaks found in this century?

A

Encephalitis

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2
Q

What is Encephalitis?

A

Infection or inflammation of the brain parenchyma

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3
Q

What is endemic in some countries?

A

Tuberculosis

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4
Q

What is an infection where children are born with no brain parenchyma?

A

Zika virus

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5
Q

What is an example of a zika virus?

A

Ebola

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6
Q

Where is there a common cause of neurological morbidity?

A

Endemic areas

e.g. South East Asia

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7
Q

Where is it common for focal epilepsy to occur?

A

South East Asia

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8
Q

What is an example of focal epilepsy?

A
  1. Tuberculosis

2. Cysticercosis

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9
Q

What is an example of urbanisation and encroachment on natural environment, ease of world travel and climate change?

A

Mosquito-borne diseases

  • Malaria
  • Dengue
  • Viral encephalitides
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10
Q

What is an example of immunosuppressed and immunodeficient states?

A
  1. Post-transplant
  2. Chemotherapy
  3. Disease modifying therapy
  4. Recreational drug use HIV
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11
Q

What does BBB keep?

A

Brain and spinal cord safe from other pathogens

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12
Q

What brings down all of the immune system?

A

HIV

vulnerable to pathogens

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13
Q

What can be treated with immunotherapy?

A

Multiple Sclerosis

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14
Q

What are huge problems?

A

Immunotherapy and immunodeficient states

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15
Q

What is a prion?

A

Transmissible virus and protein particles

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16
Q

What is an example of disease transmission that prions can cause?

A

CJD

Affects elderly - Rapid deterioration and death

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17
Q

What used to be called mad cow disease?

A

CJD

No treatment

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18
Q

What are barriers to infection?

A
  1. Mechanical and physiological barriers
  2. Between parenchyma and the skin
  3. physical barriers
  4. Dura mater
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19
Q

What are several layers that give rise to protection from the scalp?

A
  1. Skin
  2. Tissues
  3. Bone
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20
Q

What is more important than the skull?

A

Dura mater

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21
Q

What sits across the brain surface?

A

Arachnoid

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22
Q

What is found within the nervous tissue?

A

Astrocytes

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23
Q

What are brain and spinal cord called?

A

Sancturary

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24
Q

What is found in the heart?

A

Bugs

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25
What can happen around the sinuses? Give examples.
1. Infections - Mastoid area - nasal sinus
26
What is absent in CSF?
Soluble anticryptocococcal factors
27
What protects against the host inflammatory response?
Polysaccharide capsule
28
What destroys BBB?
Bacterial lipopolysaccharides | They have invasiveness into the CNS
29
What is an example of a bacterium that has different mechanisms?
Listeria
30
What has a protective coating?
Fungus
31
What is vasculitis and infarcts?
Brain damage from bacterial toxins and immune responses
32
What are antigens?
1. Bacteria | 2. Viruses
33
When is there a response?
When the body recognises the foreign antigens
34
What are examples of manifestations that goes from outside to inside?
1. Meningeal 2. Calvarial 3. Ventricular 4. Parenchyma's
35
What are examples of meningeal CNS infections?
1. Leptomeningeal 2. Pachymeningeal 3. Arachnoiditis 4. Effusions 5. Empyema
36
What is example of calvarial CNS infections?
Osteomyelitis
37
What are examples of ventricular CNS infections?
1. Choroid plexitis 2. Hydrocephalus 3. Pneumocephalus 4. Ventriculitis
38
What is it called when the ventricles are blocked?
Hydrocephalus
39
What are extra-axial complications?
1. Meningeal 2. Calvarial 3. Ventricular Found on the surface of the brain
40
What are found inside the brain parenchyma?
Parenchymal lesions | These are intra-axial lesions/manifestations
41
When is it called encephalitis?
When it involves the grey matter
42
When is it called a myelitis?
When it involves the spinal cord
43
When is it called an abscess?
If it forms a puss shaped cavity
44
When is it called a cyst?
If it it a free fluid
45
What is Granuloma?
A reaction of the bugs antigen and the body's response
46
What is a scar of the brain formed by?
Glial tissues e.g. neurons and astrocytes
47
What are astrocytes?
Supporting cells
48
What is the process of scar tissue in the brain called?
Gliosis caused by astrocytes
49
What is the role of Imaging?
1. Location and extent of the involvement e.g. load of disease process 2. Type of infection 3. Detection of complications 4. Guidance to biopsy and therapy
50
What is it very rare for a virus to cause?
Abscess
51
Where are Abscesses very common in?
1. Bacterium infections | e. g. funguses and bacteria
52
What are the CNS infections approach?
1. Supporting clinical features, background information and laboratory findings 2. Pathogens vary 3. Imaging of neuraxis to include spinal cord and caudal equina 4. Choice of tools and tricks
53
When is CD4 count essential?
when dealing with HIV patients | CD4 counts go down and viral load goes up
54
How do pathogens vary?
``` Based on locations of infection within CNS Geographic exposures Vaccination status Age Surgical intervention Immune suppression ```
55
What are examples of extent of involvement?
1. Multi-focal 2. Diffuse 3. Atypical clinical or CSF findings
56
What are the imaging modalities for CNS infections: Approach?
1. CT 2. FLAIR 3. T2 4. DWI 5. Gd-T1w 6. Othera
57
CT
Readily availible | It has a limited role
58
FLAIR
Neuroparenchymal features | Meningeal processes
59
T2
Extra-axial collections | cyst, abscess, granuloma
60
DWI
``` Cerebritis Abscess Empyema Ventriculitis Ischaemic complications Cryptococcomas vs pseudocysts ```
61
Gd-T1w
BBB breach
62
Others
MR spectroscopy, perfusion, MRA, vessel wall imaging, PET
63
When is surgical intervention required?
If the puss is on the surface of the brain (parenchyma) or inside the brain (abscess)
64
What is puss?
1. Dead tissue | 2. Thick molecule and is shown clearly on DWI image => Restricted diffusion
65
How is Gadolinium shown?
Enhancement Tells you that BBB is breached Doesn't tell you which infection it is
66
What does MR spectroscopy give?
Different chemical signatures | An abscess has different chemicals and metabolites
67
What is everything that is hyperintense (white) due to?
1. Calcium 2. Haemorrhage (acute haemorrhage/haemotoma)
68
When can infarction and haemorrhage only happen?
Coming from a systemic cell (endocarditis)
69
When does an infarct occur?
When the bug blocks the middle cerebral artery
70
What is anything that appears white on FLAIR image?
Abnormal
71
What is involved in herpes encephalitis?
Limbic system | Results in ganglion cells
72
What is FLAIR used to look for?
1. Parenchymal regions 2. Meningeal regions 3. Extra-axial features
73
How is acute infarct on DWI observed?
If the lesion was in the territory of middle cerebral artery
74
What is restricted diffusion?
1. Bright on DWI | 2. Dark on ADC map
75
What are the few pathologies that restricted diffusion have?
1. Acute ischaemia 2. Pure content - puss material 3. Lesions that have big molecules/marcomolecules
76
What shows restricted diffusion?
Anything that is vicious
77
What does antibiotic kill?
Bacteria | Dilutes the puss
78
What doesnt show free fluid motion?
Vascular degeneration
79
What does SWI show?
Disorders that are associated with intracranial calcification or iron deposition - Vasculitis - Deep vein thrombosis - Septicaemia
80
What is abnormal on SWI?
Anything which is black or dark grey
81
What is a classic example of malaria?
Deep vein thrombosis
82
What can clog the liver veins?
Malaria
83
What is very typical of bacterial infection?
Leptomeningeal
84
What are all the features of Inflammation?
1. Swelling 2. Oedema 3. Enhancement 4. Permeability 5. Gliosis
85
Why does hydrocephalus obstruct the ventricles?
Bunch of cysts
86
What are the 3 common metabolites found in the brain?
1. NAA 2. Choline 3. Creatine
87
What is Febrile Meningeal Syndrome?
Commonest infection observed in children
88
What are the symptoms of Febrile meningeal syndrome?
1. Acute confusion 2. Fever 3. Rash
89
Febrile Meningeal Syndrome
85% of acute bacterial meningitis: Pneumococcus or Streptococcus Lumbar puncture and urgent consecutive initiation of antibiotic therapy without prior imaging
90
Imaging in Mengitis
1. If the infection is severe 2. In case of immunosuppresison 3. H/O head trauma or neuro-surgery 4. Unfavourable course under antibiotic therapy 5. Bacteria other than pneuomoccocus or meningococcus 6. To detect osseous/ dural breach in relapsing meningitis
91
What can mimic any for of infection?
Tuberculosis
92
What is subdural empyema?
Abscess collection on the surface of the brain
93
What are examples of Intra-axial lesions?
1. Focal mass lesions 2. Diffuse lesions 3. Multifocal lesions
94
What is examples of Focal mass lesions?
1. Cerebritis 2. Abscess 3. Granuloma 4. Cyst
95
What is example of Diffuse lesions?
1. Leukoencephalopathy | 2. Encephalitis
96
What is examples of Multifocal lesions?
1. Encephalitis | 2. Myelitis
97
What is Cerebritis?
Localised inflammation of the brain
98
What is Encephalitis?
More diffused inflammation of the brain
99
How can cerebritis be identified on imaging?
Hypointense and restriction
100
What is a lesion that is bright on T2 and restricted on diffusion?
Abscess
101
What is a lesion that is bright on T2 but does not restrict on diffusion?
Cyst
102
What is Nocardiosis?
Renal transplant patients (70%) | Post-operative infections
103
What has peculiar affinity for CNS?
Listeria
104
What affects the medial temporal lobes?
Herpes encephalitis
105
What does each bacterium cause?
Metabolism
106
What are Bacteria with specific affinity for CNS?
1. Bacilli 2. Gram-postive bacteria 3. Spirochetes 4. Mycobacteria
107
What does pyogenic mean?
It causes pus formation

C2 Modules CLINICAL (26 decks)

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