Podcast
Questions and Answers
What are the characteristic CSF findings in bacterial meningitis?
What are the characteristic CSF findings in bacterial meningitis?
- Normal pressure, normal sugar, high lymphocytes
- Decreased pressure, increased sugar, normal protein
- Increased pressure, increased protein, decreased sugar (correct)
- Normal pressure, decreased protein, increased neutrophils
Which organism is primarily associated with meningitis in adolescents and young adults?
Which organism is primarily associated with meningitis in adolescents and young adults?
- L.monocytogenes
- E.coli
- S.pneumoniae
- N.meningitidis (correct)
Which of the following is NOT a complication associated with N.meningitidis infection?
Which of the following is NOT a complication associated with N.meningitidis infection?
- Acute pancreatitis (correct)
- Waterhouse Friderichsen Syndrome
- Photophobia
- Septicemic shock
Which condition is primarily associated with caseating granulomas in the brain?
Which condition is primarily associated with caseating granulomas in the brain?
What is a key characteristic of aseptic (viral) meningitis in terms of CSF analysis?
What is a key characteristic of aseptic (viral) meningitis in terms of CSF analysis?
What are the characteristics of red neurons observed after acute injury?
What are the characteristics of red neurons observed after acute injury?
Which of the following is a common reactive change in astrocytes during gliosis?
Which of the following is a common reactive change in astrocytes during gliosis?
What is the main function of oligodendrocytes in the CNS?
What is the main function of oligodendrocytes in the CNS?
Which of the following best describes central chromatolysis?
Which of the following best describes central chromatolysis?
Which condition is associated with intracellular inclusions seen in neurodegenerative diseases?
Which condition is associated with intracellular inclusions seen in neurodegenerative diseases?
Which of the following infections is most commonly associated with hematogenous spread?
Which of the following infections is most commonly associated with hematogenous spread?
What type of cells are Gitter cells associated with in the CNS?
What type of cells are Gitter cells associated with in the CNS?
What is the role of ependymal cells in the CNS?
What is the role of ependymal cells in the CNS?
Which condition is characterized by the accumulation of gangliosides in the CNS?
Which condition is characterized by the accumulation of gangliosides in the CNS?
What type of infections typically lead to the formation of cytoplasmic inclusions in the CNS?
What type of infections typically lead to the formation of cytoplasmic inclusions in the CNS?
What characterizes paretic neurosyphilis?
What characterizes paretic neurosyphilis?
Which of the following complications can arise from bacterial meningitis?
Which of the following complications can arise from bacterial meningitis?
What symptom is indicative of tabes dorsalis?
What symptom is indicative of tabes dorsalis?
What is the typical cause of a brain abscess?
What is the typical cause of a brain abscess?
What is a common manifestation of meningovascular neurosyphilis?
What is a common manifestation of meningovascular neurosyphilis?
Which of the following statements about fungal encephalitis is correct?
Which of the following statements about fungal encephalitis is correct?
What leads to increased intracranial pressure in brain abscess patients?
What leads to increased intracranial pressure in brain abscess patients?
In patients with acute syphilitic meningitis, what is the associated risk?
In patients with acute syphilitic meningitis, what is the associated risk?
What is the primary characteristic of cryptococcal meningoencephalitis in AIDS patients?
What is the primary characteristic of cryptococcal meningoencephalitis in AIDS patients?
Which virus is known to cause temporal lobe encephalitis primarily?
Which virus is known to cause temporal lobe encephalitis primarily?
What type of necrosis is commonly seen in cytomegalovirus infections?
What type of necrosis is commonly seen in cytomegalovirus infections?
Which condition is characterized by the presence of Negri bodies?
Which condition is characterized by the presence of Negri bodies?
Which of the following is NOT a feature common to most viral infections of the CNS?
Which of the following is NOT a feature common to most viral infections of the CNS?
What characterizes the neural degeneration seen in rabies?
What characterizes the neural degeneration seen in rabies?
Which virus primarily affects anterior horn cells of the spinal cord?
Which virus primarily affects anterior horn cells of the spinal cord?
What is a characteristic histological finding in Creutzfeldt-Jakob Disease?
What is a characteristic histological finding in Creutzfeldt-Jakob Disease?
In patients with HIV, what is the most common cause of dementia?
In patients with HIV, what is the most common cause of dementia?
Which fungal infection is specifically noted for causing hematogenous or direct spread?
Which fungal infection is specifically noted for causing hematogenous or direct spread?
Which condition is associated with large cytoplasmic and intranuclear inclusions in AIDS patients?
Which condition is associated with large cytoplasmic and intranuclear inclusions in AIDS patients?
What is the consequence of JC virus infection in immunosuppressed patients?
What is the consequence of JC virus infection in immunosuppressed patients?
What is the typical age of onset for sporadic Creutzfeldt-Jakob Disease cases?
What is the typical age of onset for sporadic Creutzfeldt-Jakob Disease cases?
Which virus is known for having the potential to cause encephalitis in immunosuppressed patients, particularly AIDS patients?
Which virus is known for having the potential to cause encephalitis in immunosuppressed patients, particularly AIDS patients?
Flashcards
Necrosis
Necrosis
A type of cell death that occurs rapidly and is characterized by swelling, rupture, and inflammation. It is often caused by irreversible ischemia or hypoxia.
Apoptosis
Apoptosis
A type of cell death that is programmed and occurs in a controlled manner. It is often involved in development and aging.
Astrocytes
Astrocytes
A type of glial cell that provides support and nourishment to neurons. They are also involved in the formation of the blood-brain barrier.
Oligodendrocytes
Oligodendrocytes
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Ependymal cells
Ependymal cells
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Microglia
Microglia
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Gemistocytes
Gemistocytes
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Rosenthal fibers
Rosenthal fibers
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Meningitis
Meningitis
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Epidural abscess
Epidural abscess
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Bacterial Meningitis
Bacterial Meningitis
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Aseptic (Viral) Meningitis
Aseptic (Viral) Meningitis
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Chronic Meningitis/Meningo-Encephalitis
Chronic Meningitis/Meningo-Encephalitis
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Tuberculous Meningitis
Tuberculous Meningitis
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Neurosyphilis
Neurosyphilis
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What is Neurosyphilis?
What is Neurosyphilis?
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What is Meningovascular Neurosyphilis?
What is Meningovascular Neurosyphilis?
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What is Paretic Neurosyphilis?
What is Paretic Neurosyphilis?
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What is Tabes Dorsalis?
What is Tabes Dorsalis?
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What is a Brain Abscess?
What is a Brain Abscess?
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What is Fungal Encephalitis?
What is Fungal Encephalitis?
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What is Obstructive Hydrocephalus?
What is Obstructive Hydrocephalus?
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What is Cranial Nerve Palsy?
What is Cranial Nerve Palsy?
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Cryptococcal meningoencephalitis
Cryptococcal meningoencephalitis
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Mucormycotic infection
Mucormycotic infection
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Candidiasis
Candidiasis
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Aspergillus infection
Aspergillus infection
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HSV encephalitis
HSV encephalitis
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Varicella Zoster Virus (VZV) encephalitis
Varicella Zoster Virus (VZV) encephalitis
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Neurotropic viral encephalitis
Neurotropic viral encephalitis
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Antenatal viral encephalitis
Antenatal viral encephalitis
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Immune deficiency encephalitis
Immune deficiency encephalitis
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CMV encephalitis
CMV encephalitis
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Rabies encephalitis
Rabies encephalitis
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Poliomyelitis
Poliomyelitis
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HIV encephalopathy (HIVE)
HIV encephalopathy (HIVE)
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Progressive Multifocal Leukoencephalopathy (PML)
Progressive Multifocal Leukoencephalopathy (PML)
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Prion diseases/spongiform encephalopathies
Prion diseases/spongiform encephalopathies
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Study Notes
Pathology of the CNS: Neuronal Reactions to Injury
-
Acute Injury: Necrosis
- Occurs within 12 hours of ischemia/hypoxia
- Red neurons show cell shrinkage, nuclear pyknosis, and cytoplasmic eosinophilia
- Spheroids result from axonal injury, cell body enlargement, and peripheral displacement of the nucleus and Nissl bodies (central chromatolysis)
-
Apoptosis
- Neuronal death during development and aging processes
-
Chronic/Subacute Injury (Degenerative Diseases)
- Neuronal loss and replacement by gliosis occurs in progressive diseases
- Some diseases show intracellular inclusions (e.g., thickened and tortuous neurites in Alzheimer's and Parkinson's diseases)
-
Axonal Injury
- Leads to cell body swelling
- Central chromatolysis (nuclear displacement)
- Peripheral dispersion of Nissl substance
-
Inclusions
- Can be nuclear or cytoplasmic
- Seen in viral infections (e.g., Negri bodies in rabies)
-
Accumulations
- Lipofuscin (aging pigments)
- Ganglioside accumulation (e.g., Tay-Sachs disease)
Glial Cells
-
Astrocytes
- Increase in number and size in gliosis
- Gemistocytes are swollen, reactive astrocytes with acidophilic cytoplasm
- GFAP (glial fibrillary acidic protein) increases
- Rosenthal fibers are aggregates of thick eosinophilic astrocytic fibers in chronic conditions or tumors
-
Oligodendrocytes
- Synthesize and maintain myelin
- Inclusions in demyelinating diseases (e.g., PML, JC virus infections)
-
Ependymal Cells
- Line the ventricles and detoxify cerebrospinal fluid (CSF)
- Ependymal granulations are areas of ependymal lining sloughing (may be normal or pathologic, ventriculitis)
- Inclusions characteristic of CMV
-
Microglia
- Macrophages in infarction (gitter cells)
- Elongated cells in syphilis (rod cells)
- Aggregates of microglia around injured cells (microglial nodules)
- Aggregate around dead neurons (neuronophagia)
CNS Infections
-
Routes of Infection
- Hematogenous (most common)
- Direct (trauma, iatrogenic)
- Local extension from adjacent foci (air sinuses, congenital abnormalities, peripheral nerves)
-
Epidural/Subdural Infections
- Caused by bacteria, fungi, or mixed infections
- Direct spread from adjacent infections (sinusitis, osteomyelitis)
-
Acute Pyogenic Meningitis
- Neonates: Group B Streptococcus, E. coli
- Adolescents/Adults: Neisseria meningitidis
- Elderly: Streptococcus pneumoniae, Listeria monocytogenes
-
Clinical Picture
- Fever, headache, vomiting, photophobia, neck rigidity
- Septicemic shock/Waterhouse-Friderichsen syndrome as complications
-
Aseptic Viral Meningitis
- Often hematogenous spread
- Mild self-limiting disease, frequent in seasonal patterns
- CSF shows slight protein elevation, normal sugar, lymphocytes elevated
-
Chronic Meningitis/Meningoencephalitis (e.g., TB, Syphilis, Lyme Disease)
- Characterized by chronic inflammatory process
- Often involves a variety of CNS sites
- Syphilis, specifically, causes meningitis and vasculitis
- TB meningitis usually involves a primary site in lung spreading hematogenously to brain, causes inflammation of the meninges
-
Tuberculous Meningitis
- Hematogenous spread from lung, direct from vertebral infection
- Thick cheesy exudate and thick meninges
- Basal cisterns and sulci most affected
- Caseating granulomas
-
Neurosyphilis
- Meningovascular: meninges infection and obliterative endarteritis in brain vessels
- Paretic: invasion of frontal lobe; plasma cells characteristic of lesions
-
Parenchymal Infections
- Localized (abscesses, tuberculomas, toxoplasmosis, parasites)
- Diffuse (encephalitis, viruses)
-
Brain Abscess
- Direct implantation, local extension (mastoiditis, sinusitis, middle ear infection), hematogenous (e.g. predisposing conditions)
- Focal suppuration and liquefactive necrosis surrounded by granulation tissue, reactive astrocytes
- CSF shows increased protein, cells, and normal sugar
-
Fungal Encephalitis
- Candida, Cryptococcus, Aspergillus, Mucor (especially in diabetics)
- Hematogenous or direct spread
-
Viral Encephalitis
- HSV, VZV, Rabies
-
Antenatal Infections (e.g. CMV, Rubella)
- Systemic infection that may produce some CNS effects
-
Immune Deficiency Infections (e.g., HIV, PML)
- Progressive multifocal leukoencephalopathy (PML) caused by JC virus
- Infect oligodendrocytes and astrocytes
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