Meningoencephalitis Flashcards
what is meningitis?
infiltration of granulocytes, lymphocytes, monocytes, plasma cells
fibrosis
what are the most common types of non-infectious meningoencephalitis?
granulomatous meningoencephalitis
necrotizing meningoencephalitis
necrotizing encephalitis
how common is meningoencephalitis of unknown origin?
5-25% of all CNS disorders
who was necrotizing meningoencephalitis first described in?
pugs: pug dog encephalitis
what are the two forms of necrotizing meningoencephalitis?
acute
chronic
what areas of the brain does necrotizing meningoencephalitis often affect?
cortex
hippocampus
septal nuclei
thalamus
what is the signalment of necrotizing encephalitis?
yorkshire terriers mainly
mean age 4.5 years
no sex or intact status predilection
who usually gets granulomatous meningoencephalitis?
middle aged dogs
females>males
small breeds>large breeds
what are the 3 forms of granulomatous meningoencephalitis?
ocular form
focal form
disseminated form
what are the histopathological findings of granulomatous meningoencephalitis?
white matter most affected
perivascular accumulation of macrophages, lymphocytes, and plasma cells
when should you start an immune modulator?
after infectious testing negatives
often 2-3 weeks after starting prednisone
what are some indications for cyclosporine?
meningoencephalitis
skin disease
immune hemolytic anemia
what is encephalitis?
perivascular cuffing
infiltration granulocytes, lymphocytes, monocytes, plasma cells
necrosis, malacia
neuronophagia
inclusion bodies
gliosis
what are the protozoal causes of meningoencephalitis?
toxoplasmosis
neosporosis
sarcocystis-like organinism
what are the common causes of infectious meningoencephalitis in new england?
rabies
canine distemper
aspergillum
bastomycosis
Cryptococcus neoformans
Neospora canis, Toxoplasmata gati
Ehrlichia canis
rocky mountain spotted fever
how is meningoencephalitis of unknown origin diagnosed?
rule out other things
definitive: histopathology
what are the types of meningoencephalitis of unknown origin?
necrotizing meningoencephalitis
necrotizing encephalitis
granulomatous meningoencephalitis
what are lesions like in necrotizing meningoencephalitis?
multifocal, asymmetrical necrosis
collapse of hemispheric gray and white matter
where is necrosis and malacia seen in necrotizing meningoencephalitis?
adjacent white matter to inflammatory changes in gray matter
what is the cause of necrotizing encephalitis?
idiopathic
what is the distribution of lesions in necrotizing encephalitis?
large, focal, asymmetric necrosis, cyst formation
white matter, cortex
meninges mostly spared
mid brain, brainstem, cerebellum
what is thee cause of granulomatous meningoencephalitis?
idiopathic
most likely immune
infection cannot be excluded
where are granulomas mostly in the focal form of granulomatous meningoencephalitis?
brainstem
is the white matter or gray matter more affected in granulomatous meningoencephalitis?
white matter
what is the CSF like in meningoencephalitis?
mixed or mononuclear pleocytosis
elevated protein
is bacterial culture of CSF often negative even with a brain infection?
yes
how can you treat meningoencephalitis?
solumedrol: steroid
dexamethasone
immune modulatory therapy
doxycycline
gastric protectants: steroids
what is the total treatment time?
12-14 months
what are the indications for procarbazine?
CNS neoplasia, lymphoma
meningoencephalitis
what are the indications for cytarabine?
CNS lymphoma
non-infection meningoencephalitis
what are the indications for mycophenolate?
immune hemolytic anemia
immune mediated thrombocytopenia
SRMA
meningoencephalitis
what are the indications for azathioprine?
hemolytic anemia
inflammatory bowel disease
myasthenia gravis
SRMA
meningoencephalitis
what is leflunomide used for?
meningoencephalitis
but no information on penetration of blood brain barrier
