Neuropathology Part 3- Neuro Inf. (9)

Question 1

What is meningitis generally

Answer 1

Inflammation of the leptomeninges and sub arachnoid space

Question 2

what are the 4 types of meningitis

Answer 2

1. Acute purulent (bac)
2. Acute lymphocytic (viral)
3. chronic meningitis
   4 chemical meningitis

Question 3

what are the 2 types of acute meningitis

Answer 3

Acute aseptic (viral(
Acute purulent (bac)

Question 4

Acute aseptic meningitis- what is it, what is it due to, signs

Answer 4

• leptomeningeal inflammation due to virus
• mc is enterovirus
• fever, signs of meningeal irritation, depressed conscious (better overall tho)

Question 5

Acute purulent menigitis- what is it, s/s

Answer 5

Neutrophilic (bac) infiltration of leptomeniges and superficial cortex w extension into cortical layers

risk of death (worse)

-headache, nuchal rigidity etc

Question 6

mycobacterial menigoencephalitis- causative agent, where

Answer 6

myobacterial tuberculosis in immunocompramised host

-basal surface of brain (formation of tuberculomas withing the brain and dura mater)

Question 7

what are the nontuberculous mycobac and how are they transmitted

Answer 7

M. avium, m. Intracellulare

trans- water+soil, no evidence of human to human trans

-risk in immunocomp

Question 8

CNF findings for prulent (cells, glu, pro, pressure)

Answer 8

cells- up to 90000 neutrophils
glu- decreased <45
pro- Increased >50
pressure- very elevated

Question 9

Aseptic CNF- cells, glu, pro, pressure

Answer 9

cells- 100-1000 most lymphocytes
glu- normal
pro increased
pressure- slightly elevated

Question 10

Mycobacterial CNF- cells, glu, pro, pressure

Answer 10

cells- 100-1000 most lymphocytes
glu- decreaed
pro- increased
pressure- mod increase

Question 11

morphology of acute bacterial meningitis- step pneumonie, h. influenxa, neisseria

Answer 11

strep pneumonie- exudates on cerebral convexities

h. influenzae- basal exudates

neisseria- less exudates

Question 12

morphology of tb meningitis, cryptocaccal menigitis, acute lymphocytis

Answer 12

tb- thick basilar exudate

cryptococcal- gelatinous slick material in leptomeninges, no exudate

lymphocytic- parenchyma may be edamatous

Question 13

micropscopic morphology- bacterial, mycobacterial, cryptoccal, viral

Answer 13

bac- neutrophilic infiltrate

mycobacterial- granuomas and giant cells

cyrpto- numerous budding yeasts

viral- lymphocytic infiltate

Question 14

How does cerebral abscess spread and predisposing conditions

Answer 14

Hematogenous dissemination or direct spread from contigous foci

• Acute bac endocarditis
• cyanotic heart disease
• chronic pulmonary abbsces

Question 15

How does cerebral abcess appear on MRI and clinical manifestations

Answer 15

CT.MRI- ring enhancing lesion

clinical- signs of increased intracranial pressure, focal neuro deficits

Question 16

complications of bacterial menigitis

Answer 16

• leptomenigeal adhesions leading to hydrocephalus
• cranial nerve impairment
• coma/death

Question 17

Viral menigitis complications

Answer 17

usually resolves w no complications

Question 18

what is encephalitis and what is the usual origin

Answer 18

inflammation of the cerebral parenchyma, which is often viral in origin

Question 19

Viral encephalitides viral cause examples

Answer 19

arthropod borne
Herpes type 1
Rabies
HIV
Coxsachievirus
cytomegalovirus

Question 20

3 general microscopic mophology features of encephalitis

Answer 20

1. microglial nodules
2. perivascular lymphocytic cuffing of vessels
3. neuronophagia

all leading to neuronal loss

Question 21

Specific microscopic feature of viral encephalitedes (HSV, HIV, CMV)

Answer 21

HSV- intranuclear inclusions

HIV- Multinucleated giant cells

CMV- Intranuclear (owl eye) inclusions

Question 22

What is the mc CNS infection in AIDS

Answer 22

CMV encephalitis is mc nervous system inf seen in late stage disease

Question 23

Morphology of rabies viral encephalitides and where found

Answer 23

Negri bodies- round to oval eosinophilic cytoplasmic inclusions in pyramidal neurons of the hippocampus and purkinje cells of cerebellum

Question 24

histopathology of HIV and in spine

Answer 24

multinucleated giant cells

spine- vacuolar myelopathy

Question 25

What causes progressive multifocal leukoencephalopathy

Answer 25

JC virus

• astrocytes take bizzare shapes
• Olgodendrocytes in active lesions contain viral intranuclear inclusions

Question 26

What are the 4 causative agents of fungal meningoencephalitides

Answer 26

• Candida
• aspergillus
• cryptococcus
• mucor

Question 27

What is the typical lesion look in fungal meningoenncephalitides

Answer 27

Soap bubble lesion (cryptococcus)

Question 28

what does asperigillus and mucor target in fungal meningoencephalitides

Answer 28

Marked tropism for blood vessels

Question 29

What amoebaes cause amebic meningoencephalitis

Answer 29

Naegleria fowleri

Balamuthia mandrillaris

Question 30

Toxoplasmosis- what is it caused by, population, how does it look on MRI/CT

Answer 30

protozoa
-frequent in aids pts

MRI- Pathognomic ring enhancing lesion

Question 31

Cyrsticercosis- cuase and lifecycle

Answer 31

Tarnia soloim

-transmitted by pigs, pt is intermediate host (eggs), larvae travel + invade brain

Question 32

What is subacute sclerosisng panencephalitis

Answer 32

Rare complication of measles viral inf

Persistent immune resistant measles virus causing a slow virus encephalitis

Question 33

Pathogenesis of CJD

Answer 33

Normal PrPc changes to a beta pleated sheat called PrPsc

PrPsc then facilitates conformational change of other PrPc molecules into PrPsc

Question 34

What does CJD (prion disease) cause

Answer 34

• Spongiform changes
• fine vacuolization of the neurophil in gray matter

-neuronal loss, astrogliosis

Question 35

CDJ: incidence, s/s

Answer 35

85% sporatic, 15% familial

• middle to elderly
• rapid dementia
• startle myoclonus (body jerks)
• death 6-12m