Week 9 Flashcards
Is the pia mater in the brain more associated with white or grey matter?
Grey matter
Note that the pia mater is a histological layer, not a separate layer like arachnoid or dura mater.
What cells in the CNS are most sensitive to injury?
Neurons
What cells in the brain are most metabolically active?
Astrocytes
How can you identify neurons histologically in the brain?
Defined cytoplasmic borders
Basophilic inclusions
What are the two most common types of infectious disease in the CNS? What are some other types?
Bacterial and fungal infections are the most common.
Viral and prion infections are also possible
Where do each of the types of CNS infections occur?
Abscess - located in parenchyma (functional tissue)
Empyema - occurs in potential space
Meningitis - involves the subarachnoid space and/or CSF
Encephalomyelitis - inflammation of the spinal cord or brain parenchyma (usually due to viral infection)
How are oral infections typically spread to the CNS?
Contiguously (direct extension), not hematogenously
What types of dental infections are most likely to cause direct extension to cause CNS infection?
Caries - pulpitis
Apical periodontitis
Abscess formation
NUG/NUP
True or fals , encephalomyelitis involves the parenchyma of the brain and will result in systemic symptoms
True
Oral infections are most likely to cause what kind of CNS infections? Describe these infections
CNS infections
Abscesses can have systemic effects (vomiting and fever) and changes in consciousness (associated with increased CSF pressure) but also have focal neurological effects for the parts of the CNS affected.
Abscesses in brochas area will result in speech impairment. Abscesses in the occipital lobe can cause visual defects.
Paresis is also a possible
What are the risk factors for developing CNS bacterial abscesses?
Oralpathology
Oral procedures
Immunocompromised patients
Chronic illness Chronic heart diesease (bacteria can seed off of infected valves and reach true brain) Skull fractures Meningitis Sinus infections
How can you diagnose a CNS abscess?
Evaluate symptoms
Physical exam
Imaging (this is the most important diagnostic aid)
Laboratory work: peripheral blood culture (typically poor diagnostic aid), CSF evaluation, cultures
Why is it that peripheral blood culture is typically a poor diagnostic tool for diagnosing CNS abscesses?
CNS abscesses are typically spread directly (contiguously), not hematogenously
What is the treatment for bacterial abscesses in the CNS?
Antibiotics,suregery may be indicated
Surgery is required if the abscess is greater that 2.5 cm
What may a bacterial CNS abscess look like histologically?
Reactive brain parenchyma overlaying an area of fibrosis. Fibrosis overlays an area of liquefactive necrotic tissue. Liquefactive necrosis is a pattern of necrosis that involves proteolytic enzymes that forms a liquid like pus instead of in-tact necrosis
___% of CNS infections have an underlying intra-oral pathology. In ___% of these cases, dental symptoms precede neurological symptoms. ___% of the time, the oral pathology and CNS infection are ipsilateral
87
40
70
___% of dental CNS infections are preceded by a dental procedure. What is the most likely procedure to cause a dental CNS infection?
47
Extraction of molar teeth
CNS infections are most likely to affect the ___ lobe
Frontal
What type of bacteria are the most likely to be the cause of a CNS infection ?
Gram positive cocci
In regards to the microbiology of a CNS infection, ___% of the oral cultures matches CNS cultures.
61
Why is it that even though you may have a CNS infection, 89% of the time the blood culture is negative?
Infection is usually due to direct extension, not hematogenously.
What is the most common intervention for a CNS infection? About what percentage of CNS infection patients die?
Craniotomy
~10%
True or false… actinomyces can be a culprit of CNS infection. It is a branching filamentous bacteria that is gram positive. It is part of the normal oral flora
True
What is the most likely cause for a CNS fungal infection?
Mycoses in immunocompromised patients.
Aspergillus fumigatus is the most common pathogen (goes from oral to sinus to CNS)
(Caused by aspergillus and zygomycete, sometimes candida spp., cryptococcus neoformans, or dimorphic fungi)
True or false… an aspergillus CNS infection results in systemic symptoms
False… just focal symptoms
What is the treatment for a CNS aspergillus infection?
Aggressive surgical excision
Ampotericin B + flucytosine (toxic antifungal)
What are the risk factors and presentation of zygomycetes (mucormycosis)?
Diabetes and immunosuppression are risk factors
Presentation = rapidly progressive facial swelling
May extend from sinuses directly into brain
Note that this is a surgical emergency