Pathology of the CNS: Neuronal Reactions

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Questions and Answers

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?

  • L.monocytogenes
  • E.coli
  • S.pneumoniae
  • N.meningitidis (correct)

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?

<p>Tuberculous meningitis (D)</p> Signup and view all the answers

What is a key characteristic of aseptic (viral) meningitis in terms of CSF analysis?

<p>Clear CSF with slight increase in protein and normal sugar (A)</p> Signup and view all the answers

What are the characteristics of red neurons observed after acute injury?

<p>Shrinkage of the cell body, pyknosis of the nucleus, and intense eosinophilia (D)</p> Signup and view all the answers

Which of the following is a common reactive change in astrocytes during gliosis?

<p>Increased number and size of astrocytes (D)</p> Signup and view all the answers

What is the main function of oligodendrocytes in the CNS?

<p>Synthesis and maintenance of myelin (A)</p> Signup and view all the answers

Which of the following best describes central chromatolysis?

<p>Peripheral displacement of the nucleus and enlargement of the nucleolus (D)</p> Signup and view all the answers

Which condition is associated with intracellular inclusions seen in neurodegenerative diseases?

<p>Alzheimer disease (D)</p> Signup and view all the answers

Which of the following infections is most commonly associated with hematogenous spread?

<p>Bacterial meningitis (A)</p> Signup and view all the answers

What type of cells are Gitter cells associated with in the CNS?

<p>Microglia (C)</p> Signup and view all the answers

What is the role of ependymal cells in the CNS?

<p>Line the ventricles and detoxify cerebrospinal fluid (A)</p> Signup and view all the answers

Which condition is characterized by the accumulation of gangliosides in the CNS?

<p>Tay-Sachs disease (D)</p> Signup and view all the answers

What type of infections typically lead to the formation of cytoplasmic inclusions in the CNS?

<p>Viral infections (D)</p> Signup and view all the answers

What characterizes paretic neurosyphilis?

<p>Loss of neurons and proliferation of microglia in the frontal lobe (A)</p> Signup and view all the answers

Which of the following complications can arise from bacterial meningitis?

<p>Increased intracranial pressure (C)</p> Signup and view all the answers

What symptom is indicative of tabes dorsalis?

<p>Lightning pains and absence of deep tendon reflexes (C)</p> Signup and view all the answers

What is the typical cause of a brain abscess?

<p>Bacterial infections via direct implantation or local extension (D)</p> Signup and view all the answers

What is a common manifestation of meningovascular neurosyphilis?

<p>Chronic infection in the meninges with plasma cell infiltration (B)</p> Signup and view all the answers

Which of the following statements about fungal encephalitis is correct?

<p>It can occur in both normal and immunocompromised patients. (D)</p> Signup and view all the answers

What leads to increased intracranial pressure in brain abscess patients?

<p>Localized suppuration and severe edema (A)</p> Signup and view all the answers

In patients with acute syphilitic meningitis, what is the associated risk?

<p>Increased risk of complications like obstructive hydrocephalus (A)</p> Signup and view all the answers

What is the primary characteristic of cryptococcal meningoencephalitis in AIDS patients?

<p>Formation of multiple micro-abscesses (D)</p> Signup and view all the answers

Which virus is known to cause temporal lobe encephalitis primarily?

<p>Herpes Simplex Virus (HSV) (D)</p> Signup and view all the answers

What type of necrosis is commonly seen in cytomegalovirus infections?

<p>Hemorrhagic necrosis (D)</p> Signup and view all the answers

Which condition is characterized by the presence of Negri bodies?

<p>Rabies (A)</p> Signup and view all the answers

Which of the following is NOT a feature common to most viral infections of the CNS?

<p>Necrotizing inflammation (D)</p> Signup and view all the answers

What characterizes the neural degeneration seen in rabies?

<p>It is most severe in the midbrain and fourth ventricle. (C)</p> Signup and view all the answers

Which virus primarily affects anterior horn cells of the spinal cord?

<p>Poliovirus (D)</p> Signup and view all the answers

What is a characteristic histological finding in Creutzfeldt-Jakob Disease?

<p>Multifocal spongiform transformation (D)</p> Signup and view all the answers

In patients with HIV, what is the most common cause of dementia?

<p>HIV-associated neurocognitive disorder (HAND) (D)</p> Signup and view all the answers

Which fungal infection is specifically noted for causing hematogenous or direct spread?

<p>Cryptococcus (C)</p> Signup and view all the answers

Which condition is associated with large cytoplasmic and intranuclear inclusions in AIDS patients?

<p>Cytomegalovirus infection (A)</p> Signup and view all the answers

What is the consequence of JC virus infection in immunosuppressed patients?

<p>Progressive multifocal leukoencephalopathy (PML) (B)</p> Signup and view all the answers

What is the typical age of onset for sporadic Creutzfeldt-Jakob Disease cases?

<p>Usually seen in the elderly, around the 7th decade (B)</p> Signup and view all the answers

Which virus is known for having the potential to cause encephalitis in immunosuppressed patients, particularly AIDS patients?

<p>Cytomegalovirus (D)</p> Signup and view all the answers

Flashcards

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

A type of cell death that is programmed and occurs in a controlled manner. It is often involved in development and aging.

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

A type of glial cell that produces and maintains myelin, the fatty substance that insulates nerve fibers.

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Ependymal cells

A type of glial cell that lines the ventricles of the brain and helps to circulate cerebrospinal fluid.

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Microglia

A type of glial cell that acts as the brain's immune system, cleaning up debris and defending against pathogens.

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Gemistocytes

A type of gliosis where astrocytes become enlarged and have an eosinophilic cytoplasm.

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Rosenthal fibers

Aggregates of thick eosinophilic astrocytic fibers found in old gliosis or low-grade glial tumors.

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Meningitis

An infection that affects the membranes surrounding the brain and spinal cord.

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Epidural abscess

An infection that affects the space between the dura mater and the skull.

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Bacterial Meningitis

An inflammation of the meninges (membranes surrounding the brain and spinal cord) caused by bacteria, often affecting young adults and the elderly. Characterized by fever, headache, vomiting, neck stiffness, and sometimes a rash. CSF analysis reveals elevated protein and neutrophils, while sugar levels are reduced.

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Aseptic (Viral) Meningitis

A type of meningitis caused by viruses, typically mild and self-limiting. It is characterized by a mild mononuclear infiltrate in the meninges and superficial cortex, while the CSF shows a slight increase in protein but a normal sugar level and an elevation in lymphocytes.

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Chronic Meningitis/Meningo-Encephalitis

A persistent inflammation of the meninges and often the brain, caused by various agents like tuberculosis, syphilis, or Lyme disease. It can lead to serious complications like brain abscesses, neurological deficits, and even death.

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Tuberculous Meningitis

A form of chronic meningitis caused by Mycobacterium tuberculosis, often spreading from the lungs or vertebrae. It is characterized by thick cheesy exudate, granulomas, and inflammation of the meninges, leading to neurological damage. CSF analysis shows elevated protein and lymphocytes, sometimes with a normal or low sugar level.

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Neurosyphilis

A neurological complication of syphilis caused by the spirochete Treponema pallidum. It can affect the meninges, brain, and spinal cord, causing a variety of symptoms including meningitis, dementia, and paralysis.

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What is Neurosyphilis?

Neurosyphilis, a late stage of syphilis, affects the nervous system. It can manifest as meningitis, paresis (mental deterioration), or tabes dorsalis (damage to the spinal cord).

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What is Meningovascular Neurosyphilis?

Meningovascular neurosyphilis, a form of tertiary syphilis, involves inflammation of the meninges, blood vessels, and brain tissue. It causes damage to blood vessels and leads to the formation of gummas (inflammatory lesions).

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What is Paretic Neurosyphilis?

Paretic neurosyphilis is a severe form of neurosyphilis that affects the frontal lobe of the brain. It leads to neuronal loss, gliosis (scarring), and severe mental decline.

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What is Tabes Dorsalis?

Tabes dorsalis is a complication of tertiary syphilis that affects the spinal cord, particularly the dorsal columns. This leads to loss of sensation, impaired coordination, and characteristic 'lightning pains'.

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What is a Brain Abscess?

Brain abscess is a localized infection in the brain, typically caused by bacteria. It involves a collection of pus surrounded by a fibrous capsule, leading to inflammation and edema.

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What is Fungal Encephalitis?

Fungal encephalitis is an infection of the brain caused by fungi like Candida, Cryptococcus, Aspergillus, and Mucor. It can occur in both immunocompromised and healthy individuals, leading to inflammation and damage to brain tissue.

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What is Obstructive Hydrocephalus?

Obstructive hydrocephalus is a complication of bacterial meningitis. It occurs when the flow of cerebrospinal fluid (CSF) is blocked, causing a buildup of pressure within the brain.

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What is Cranial Nerve Palsy?

Cranial nerve palsy is a complication of bacterial meningitis that affects one or more of the cranial nerves, leading to loss of function in the affected nerves.

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Cryptococcal meningoencephalitis

A fungal infection that primarily affects individuals with weakened immune systems, particularly those with AIDS, and can lead to meningoencephalitis.

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Mucormycotic infection

A severe fungal infection that often originates from the sinuses or nose, particularly in diabetics with ketoacidosis.

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Candidiasis

A type of fungal infection that presents as multiple micro-abscesses and sometimes granulomas, commonly associated with Candida albicans.

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Aspergillus infection

A fungal infection that can invade blood vessels, causing hemorrhagic infarction. It is known for its characteristic morphology of blood vessel invasion and hemorrhagic infarction.

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HSV encephalitis

A type of encephalitis caused by the Herpes Simplex Virus (HSV), often impacting the temporal lobe and orbital frontal area of the brain.

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Varicella Zoster Virus (VZV) encephalitis

A type of encephalitis caused by the Varicella Zoster Virus (VZV), which can lead to shingles and post- herpetic neuralgia.

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Neurotropic viral encephalitis

A type of encephalitis associated with various neurotropic viruses like Poliovirus and Rabies, affecting specific brain regions.

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Antenatal viral encephalitis

A type of encephalitis that occurs during fetal development and can be caused by viruses like CMV and Rubella, resulting in various neurological deficits.

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Immune deficiency encephalitis

A type of encephalitis that can occur in individuals with weakened immune systems, often caused by viruses like HIV, CMV, PML, and VZV, leading to various neurological complications.

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CMV encephalitis

A viral infection that can infect the CNS and specifically target the ventricles of the brain.

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Rabies encephalitis

A viral infection that can cause severe and often fatal encephalitis, characterized by Negri bodies and ascending infection along peripheral nerves.

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Poliomyelitis

An enterovirus that can cause mild gastroenteritis but in those not immunized, can cause severe encephalitis affecting the anterior motor neurons of the spinal cord.

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HIV encephalopathy (HIVE)

A serious neurological complication of HIV infection that can lead to progressive neurological impairment, dementia, and even death.

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Progressive Multifocal Leukoencephalopathy (PML)

A progressive demyelinating disorder caused by the JC virus (polyomavirus), affecting individuals with weakened immune systems, especially those with AIDS.

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Prion diseases/spongiform encephalopathies

A group of fatal neurodegenerative diseases caused by infectious agents called prions. Examples include Kuru, Creutzfeldt-Jakob disease (CJD), and Bovine Spongiform Encephalopathy (Mad Cow disease).

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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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