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Path II > Infect Disease CNS > Flashcards

Infect Disease CNS Flashcards

1
Q

What are the mechanisms by which infectious diseases enter the CNS?

A

Hematogenous

Direct implantation

Local extension from adjacent site of infections

Axoplasmic transport along peripheral nerve axons

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2
Q

What causes pyogenic or granulamatous meningitis?

A

Most yeast forms and bacteria

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3
Q

What causes abscess formaotin in the brain?

A

Bacteria and hyphal forms

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4
Q

What causes cerebritis?

A

Hyphal forms

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5
Q

What causes aseptic meningitis?

A

Viruses

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6
Q

What causes aseptic meningitis?

A

Viruses

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7
Q

What is the most common form of infection in the CNS?

A

Bacterial

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8
Q

What types of mycoses and parasites hits immunocompromised patients?

A

Fungal: Asperigillus, Cryptococcus, Candida
Parasiteic: Toxoplasma

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9
Q

What are parenchymal infections?

A

Cerebritis
Abscess
Encephalitis
Myelitis(meninges)

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10
Q

What are peripheral nerve disease?

A

Radiculitis/neuritis

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11
Q

What are findings of pyogenic meningitis?

A

CSF:
High PMN
High Protein
Low glucose

Clinical symptoms:
HA
Alter Mental Status
Increased ICP
Seizures
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12
Q

What is the most common cause of meningitis in NEONATES, YOUNG CHILDREN, Older children

A

Neonates:
Group B Strep
E. coli
Listeria

Young children:
N. Meningitis
Strep Pneumo
Haemophilus influ

Adults:
Strep pneumo
Neisseeria mening

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13
Q

What is seen grossly with meningitis?

A

Cloudy meninges

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14
Q

Where is the exudate located in meningitis?

A

Leptomeninges

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15
Q

What are some complications of meningitsi?

A

Infarcts

Chronic hydrocephalus

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16
Q

What is lymphocytic meningitis?

A

Aseptic meningitis

  • Self limited usually
  • Viral

CSF:

  • Lymphocytes
  • Moderately high Protein
  • Normal glucose

Etiology:

  • Echovirus
  • Coxsackie virus
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17
Q

What is chronic meningitis?

A

Granulomatous

18
Q

What is the etiology of chronic meningitis?

A

Mycobac

Yeast forms of fungi

  • Crypto (little inflammation)
  • Coccidio, blastomycoses

Base of Brain

Can cause OBLITERATIVE ENDARTERITIS, infarct on underside of brain

19
Q

What is a problem with cerebritis and abscess?

A

Infection/abscess leads to liquefactive necrosis

-Ring enhancing lesion

Granulation tissue that has fibroblasts and collagen deposition

20
Q

What are common fungi and bacterial that cause cerebritis and abscess?

A

Bac: anaerobic strep, strep pneumo, Staph

Fungal: asperigillus, mucor, candida

Less common are protozola: Toxoplasma

21
Q

What is the etiology of direct spread cerebritis?

A

50%

Strep, Staph, bacterioides, actinomyces, gram neg bacilli

22
Q

What is the etiology of cerebritis from hematogenous spread?

A

25%

Congenital heart disease, immunodef, iatrogenic

23
Q

Where are the locations for abscess/cerebritis?

A

Frontal»»parietal>cerebelum

24
Q

What is often associated with aspergillus cerebritis?

A

Hemorrhagic infarcts

25
Q

What is seen in a chronic abscess?

A

A ring of collagen in granulation tissue at border of trichrome stain

26
Q

What can be seen with candida septicemia in the brain?

A

Many many little abscess throughout brain

27
Q

What is the most common cause of encephalitis?

A

Viruses

Inflammation of brain parenchyma

Arthropod born (mos or tick)

Epidemic viral

Nonspeecfici path findings (viral inclusions?)

Associated with viral meningitis

28
Q

What is seen in vrial encephalitis?

A

Perivascular inflammation

Microglial nodules

Neurophagia

29
Q

What are some specific types of encephalitis?

A

Poliomyelitis

Rabies: Negri inclusion bodies

Herpes Group: HSV, CMV, ZOSTER
-HSV 1 is most cocmmon

HIV Encephalitis

Progressive multifocal Leukoencephalopathy
JC virus

30
Q

What is seen in HSV 1 encephalitis?

A

Most often hits temporal lobe

Hemorrhagic, necrotizing

INCLUSIONS: COWDRY type A (also CMV)

31
Q

What is HIV encephalitis?

A

Microglial nodules and multinucleated giant cells around vessels

Chronic patchy inflammation

32
Q

What is seen in PML?

A

Loss of myelin

LFB shows areas of myelin that are lost

See bizaare atypical astrocytes

Intranuclear inclusion in oligos

33
Q

What is seen in PML?

A

Loss of myelin

LFB shows areas of myelin that are lost

See bizaare atypical astrocytes

Intranuclear inclusion in oligos

34
Q

What is seen in toxoplasma?

A

Enhancing lesion

Bradyzoite (encysted form of parasite)

35
Q

What is spongiform encephalopathy?

A

It is transmitted by prions (little proteins)

CJD, Mad cow, Gerstmann-Straussler-Scheinker
Fatal familial insomnia
Kuru
Scrapie

Characterized by vacuoles in the gray matter

36
Q

What is the triad of symptoms for spongiform encephalopathy?

A

Rapid dementia
Myoclonus
Periodic short wave activity on EEG

Subtle motor and cerebellar signs followed by death within 1 year

37
Q

What is the triad of symptoms for spongiform encephalopathy?

A

Rapid dementia
Myoclonus
Periodic short wave activity on EEG

Subtle motor and cerebellar signs followed by death within 1 year

38
Q

What is creuztfeldt-jacob disease?

A

Spongiform encephalopathy

Rapid dementia death within a year

1/1000000/year

Majority are sporadic

Rare is iatrogenic (cornea transplant, graft, eeg electrodes, HGH extracts)

Transmissable agent: Protease resistant prion

Normal gene on CHR 20

39
Q

What is the pathogenesis of CJD?

A

Conformational change of PrP 3D structure into B-pleated sheet

Gene mutations may play a role in conversion

SIngle pathogenic PrP can cause conversion of wild type proteins

Homozygosity for Met or Val on codon 129 increases risk of CJD

40
Q

What are microscopic features of CJD?

A

Looks normal grossly or may have atrophy

Microscopic:
-Neuronal loss, gliosis, sponigform change

Defined by small punched out vacuoles in gray matter

Path II (11 decks)

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