Term
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Definition
clear to inspection
opening pressure 80-180 mm/H2O
protein 20-40 mg/dL
glucose 45-65 mg/dL
cells 0-5 lymphocytes |
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Term
| pathological features of acute purulent meningitis |
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Definition
yellow-white exudate on brain surface actually within subarachnoid space
dilated blood vessels
polys in subarachnoid space
edema, ventriculitis and abscess formation
polys infiltrate and compromise vessel - infarcts |
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Term
| initial therapy for meningitis |
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Definition
Strep, H flu, Neisseria, listeria - ampicillin
gram negs - 3rd generation cephalosporin |
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Term
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Definition
1. infection begins in lung - reinfection TB with spread via blood
2. complications of chronic basilar fibrosing meningitis
3. thick exudate at base of brain leading to meningeal fibrosis
4. organism can leave meninges and invade brain tissue - tuberculoma
5. granulomatous exudate contains multinucleated giant cells |
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Term
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Definition
1. occurs in tertiary disease
2. meningovascular syphilis: chronic fibrosing meningitis at base of brain, ventral side, and obliterative arteritis with infarcts due to angiophilic infection of vessels
3. Tabes dorsalis: dorsal root disease, loss of axons in posterior column (Secondary demyelination)- loss of sensation in lower extremities, impaired proprioception 4. chronic fibrosing meningitis means very little CSF can circulate, can't be reabsorbed
5. a myelin stain will show white posterior columns because they are demyelinated - very specific for tabes dorsalis |
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Term
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Definition
1. primary focus in the lung
2. headache, low grade fever, cranial nerve palsies
3. chronic progressive course - months to years
4. treatment often not successful
5. chronic fibrosing meningitis at the base of the brain (appears white)- traps cranial nerves causing cranial neuropathies
6. may extend along virchow-robin spaces but organisms do not invade brain
7. noncommunicating hydrocephalus due to chronic meningitis - obstructs foramina and restricts CSF flow
8. organisms with thick unstained capsule - will stain with mucin stain (diagnostic of cryptococcus); india ink |
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Term
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Definition
1. usually viral in origin, culture negative
2. 80% caused by enterovirus; aslo HSV-2 and LCM (lymphocytic C meningitis)
3. infection usually self limited |
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Term
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Definition
1. local or distant usually bacterial infection
2. headache, seizures, elevated WBC, CSF not useful - 10% mortality
3. necrotic tissue with many polys, gliosis and fibrosis
4. fibrous capsule forms after a couple weeks
5. ring enhancing lesion on imaging studies |
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Term
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Definition
1. mycotic aneurysms: involve small arteries beyond circle of willis; due to bacteria, origin often endocarditis (arterial wall weakens and dilates)
2. septic infarcts: infected emboli from heart - small, hemorrhagic, multiple, cortical |
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Term
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Definition
1. opportunistic infection: HIV, cancer, immunosuppression
2. invasive disease that damages blood vessels then brain secondarily
3. may originate from pneumonia - angiocentric infection that travels to brain
4. typical lesion can be a deep hemorrhagic infarct - organisms invade vessel wall
5. silver stain shows branching hyphae |
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Term
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Definition
1. opportunistic infection, esp. AIDS
2. caused by paprasite T gondii
3. reactivated from dormant sites and presents as mass lesion or infection - ring enhancing lesion on imaging
4. abscess with necrotic cells and numerous polys
5. cyst containing many bradyzoites - large circle filled with tiny dots - only found in this and chagas disease |
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Term
| typical viral encephalitis |
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Definition
1. arbovirus infections represent the typical viral encephalitis and are the most common type of encephalitis
2. usually in summer, warm weather
3. sudden onset, fever, headache, drowsiness, stupor, coma
4. edematous brain with dilated vasculature, perivascular inflammation
5. brain is diffusely swollen and congested
6. lymphocytic perivascular cuffing - lymphocytes clustered around vessels as begin to migrate out
7. glial nodules very suggestive of viral encephalitis
8. grey matter disease - attacks neurons, cytolytic - neuronophagia of dead cells |
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Term
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Definition
1. reservoir in birds, culex mosquito transmission
2. diagnosis based on IgM Ab (early) in CSF
3. sudden onset, fever, headache, rash, profound muscle pain and weakness
4. most cases are mild but 15-20% mortality with encephalitis; risk greater after age 50
5. brainstem encephalitis; punched out necrotic regions - profound motor signs
6. severe axonal neuropathy |
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Term
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Definition
1. animal bite or confine space with bats (aerosol)
2. long incubation period, but shorter when bit is closer to head
3. diagnosis can be made with corneal smear showing rabies antigen with IF, but by this time the disease has already begun
4. headache, fever, paresthesias or pain at wound site - eventually develops into relentless, fatal disease (100% mortality)
5. hydrophobia: laryngeal muscle spasm
6. vaccine can be given after bite with human rabies Ig
7. lymphocytic perivascular cuffing, especially in brainstem
8. negri bodies - cytoplasmic viral inclusions, especially in hippocampus and purkinje cells |
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Term
| Herpes Simplex Encephalitis |
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Definition
1. most common sporadic encephalitis, usually due to HSV-1 recurrent infection
2. sudden onset of headache, fever, may present as mass lesion
3. CSF contains polys and RBCs early, xanthochromia later, do PCR
4. rapidly progressive with 20% mortality
5. hemorrhagic lesions tend to be located in temporal lobe or inferior frontal lobe, increased density on CT
6. encephalitis tends to produce marked brain edema; patients in danger of dying from herniation
7. neutrophils predominate early; Cowdry inclusion bodies |
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Term
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Definition
1. inflammation in nerve root and ganglia
2. inclusions in neurons (like simplex)
3. may be necrosis or hemorrhage in ganglia |
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Term
| Progressive multifocal leukoencephalopathy (PML) |
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Definition
1. papovavirus (DNA virus); 80% of population has antibodies; virus latent in lymphoid organs and bone marrow
2. opportunistic infection - AIDS, lymphoma, natalizumab MS treatment
3. onset 45-65 yrs, gradual development of symptoms
4. dementia, focal findings, loss of visual acuity
5. CSF exam often normal
6. 3-6 mo survival
7. multiple small foci of demyelination (oligodendrocyte attacked) located in occipital white matter with many gitter cells and bizarre atypical astrocytes (very large nucleus)
8. intranuclear inclusions in oligodendroglia composed of numerous viral particles, wine colored - oligos die |
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Term
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Definition
1. developing countries, travel - caused by cestode, taenia solium - eating uncooked pork
2. fecal-oral route: eat eggs, larvae hatch penetrate gut and spread via blood to brain
3. meningitis, seizures, focal signs, hydrocephalus caused by intraventricular lesions
4. multiple cysts in brain - thin walled and contain parasites contained in fibrous capsule
5. intact cyst does not produce inflammation but Rx and death of parasite may induce an inflammatory response |
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Term
| Creutzfeldt-Jakob Disease |
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Definition
1. subacute spongiform encephalopathy
2. disease both genetic and infectious
3. agent is an abnormal protein or prion
4. PrP(sc) derived from normal protein PrP(c) - results from conformational change
5. 10% of cases are inherited PRNP gene on chromosome 20 |
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Term
| symptoms in Creutzfeld-Jakob |
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Definition
1. middle aged patients
2. severe dementia with memory loss
3. myoclonus, ataxia
4. CSF contains excessive protein
5. fatal in 6-24 months |
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Term
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Definition
1. early spongiform stage: spongiform change with marked cellular edema in neurons and neuropil
2. Late stage: cerebral atrophy, striking gliosis and marked neuronal loss, elaborate glial scar
3. amyloid formation: prion protein undergoes a conformation change into B-pleated sheet - becomes insoluble amyloid plaque |
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