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Term 5: Neuro > 6/24- Infections of the Nervous System I > Flashcards

6/24- Infections of the Nervous System I Flashcards

(56 cards)

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1
Q

What kind of inflammatory reaction is seen in infections: bacterial?

A

Polymorphonuclear cells

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2
Q

What kind of inflammatory reaction is seen in infections: mycobacterial?

A

Granulomatous

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3
Q

What kind of inflammatory reaction is seen in infections: fungal?

A

Granulomatous

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4
Q

What kind of inflammatory reaction is seen in infections: viral?

A

Lymphocytic

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5
Q

What kind of inflammatory reaction is seen in infections: protozoal?

A

Lymphocytic

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6
Q

What kind of inflammatory reaction is seen in infections: metazoal?

A

Eosinophils

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7
Q

What kind of inflammatory reaction is seen in infections: Prion?

A

No inflammation

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8
Q

What is this?

A

Empyema- surface collection of pus

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9
Q

What is this?

A

Meningitis- subarachnoid pus

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10
Q

What is this?

A

Abcesses- parenchymal collection of pus

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11
Q

What is this?

A

Granuloma

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12
Q

What is this? Cause/characteristics?

A

Convexity meningitis

  • More likely to be bacterial (polymorphonuclear)
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13
Q

What is this?

A

Basilar meningitis

  • Morel likely to be fungal or TB (granulomatous)
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14
Q

What infections commonly cause convexity meningitis?

A

Bacterial

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15
Q

What infections commonly cause basilar meningitis?

A

Fungal and TB

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16
Q

What are the main causes of bacterial meningitis in neonates?

A
  • Group B strep
  • E. coli
  • Listeria
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17
Q

What are the main causes of bacterial meningitis in childhood?

A
  • Meningococcus
  • Pneumococcus
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18
Q

What are the main causes of bacterial meningitis in adolescence?

A

Meningococcus

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19
Q

What are the main causes of bacterial meningitis in adults?

A

Pneumococcus

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20
Q

What etiology of bacterial meningits has been dramatically lessened due to vaccines?

A

H. influenza

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21
Q

Which agent may be used in bioterrorism in regards to meningitis? Characteristics? Diagonsis?

A

Inhalational anthrax with systemic dissemination may produce severe hemorrhagic meningitis

  • Dx: Gram(+) bacilli in CSF
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22
Q

How is bacterial meningitis diagnosed?

A

Lumbar puncture

  • Polys
  • Low glucose (consumed by PMNs)
  • High protein
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23
Q

What is this?

Study These Flashcards
A

Bacterial Meningitis

  • Left layers are dura
  • Box is around subarachnoid space
  • See mostly polys
  • PMN inflammation -> bacterial meningitis
24
Q

Where do brain abscesses occur?

Study These Flashcards
A

In the brain parenchyma

Often occurs as direct extension from a sinusitis or mastoiditis

  • Frontal, temporal, or cerebellar as direct extension
25
Brain abscesses may mimic what?
Brain tumor
26
What are the most common causes of brain abscesses?
**Suppurative bronchopulmonary infections with hematogenous spread (#1 cause)** - Deep, particularly in MCA distribution - Multiple at gray-white junction when hematogenous Often occurs from **sinusitis** **or mastoiditis with direct extension** - Frontal, temporal, or cerebellar **Penetrating or surgical wounds**
27
What is a common characteristic of bacteria that typically cause abscesses?
Micro/anaerobes - Hard to grow/culture
28
T/F: May have multiple brain abscesses
**True**; multiple in **15-20%**
29
What is seen on imaging for brain abscess?
- Smooth ring enhancing mass - Purulent material within (smoother ring points to abscess rather than neoplasm, but there may be exceptions)
30
What is this?
Brain abscess with smooth ring enhancing mass
31
What are the zones of a classic brain abscess (4)?
**1. Central necrosis with acute inflammatory cells** **2. Granulation tissue** (contrast-enhancing on imaging; neovascularization?) **3. Fibrous "capsule"** (proliferating fibroblasts with abundant collagen deposition) **4. Reactive astrogliosis and edema**
32
Label the picture
33
What are common characteristics of mycobacterial infection meningitis?
**Tuberculous meningitis** - Basilar - Thick exudate - Involvement of CNs (and CSF foramina) - Chronic - Tends to be slower-paced than bacteria
34
What does the CSF look like in mycobacterial-caused meningitis (tuberculous meningitis)?
- Lymphocytes - Increased protein - Decreased glucose - Increased pressure - Send for culture
35
What is this?
Cortical TB granuloma
36
What is this? When would it typically be seen?
**Granulomatous inflammation** - **Multinucleate giant cells** (can be seen in any granulomatous inflmn, not just TB) - Lymphocytes - Plasma cells This suggests **mycobacteria** (TB) or **fungal** infections
37
What kind of necrosis is associated with TB?
Caseous necrosis
38
What is this?
TB seen on acid fast stain (bacilli)
39
What are the two types of fungi (and common fungi within them) causing meningitis?
**Yeast** - Cryptococcus - Coccidioiomycosis - Histoplasmosis - Blastomycosis (uncommon) **Hyphae** (tend to involve BV walls -\> infarction -\> tissue substrate for growth of fungi) - Aspergillosis - Mucormycosis
40
What is the most common cause of fungal meningitis? In AIDS population?
**Cryptococcus** - Even moreso in AIDS pts - Seeing cryptococcal meningitis is an indicator for AIDS
41
Source and characteristics of Cryptococcus?
- Found in **pigeon droppings** (C. neoformans) - **"Soap bubble" cysts** in **parenchyma** (intra-axial microabscesses; glistening) - "Tear drop" (**narrow-based) budding** yeast seen with india ink and mucicarmine - **Encapsulated** (polysaccharide)-thick, slimy; cloaks from immune response
42
What is this?
Multiple cryptococcal microabscesses - Clear like "soap bubbles" - Shiny b/c encapuslated
43
What is this?
Narrow-budding yeast of cryptococcus
44
What is this?
Thick capsule of cryptococcus
45
What are common characteristics of Histoplasmosis? Location, diseases caused, histology...
- Common pulmonary infection in **Ohio, Mississippi, and Missouri Valleys** - **OBLIGATE intracellular (intracytoplasmic)** yeasts; **very small** (2-5 um) in cytoplasm of macrophages - **Calcified granulomas-** usually benign and **self-limited** - **Disseminated** disease does occur in **infants and immunosuppressed**
46
What is this?
Multiple granulomata seen in **Histoplasmosis** - Thought before that these were brain mets
47
What is this?
Touch prep of masses from last scan - Can see macrophages with tiny little dots in cytoplasm; Histoplasmosis
48
What is this?
Tiny yeast forms inside of macrophages seen in Histoplasmosis
49
Characteristics of Aspergillosis? Commonly infects who? Histology?
- Common, lethal infection in **immunosuppressed** - **Hemorrhagic** due to angioinvasive nature - Septate, **true branching at 45'** uniform diameter - Sets up in lung and can spread hematogenously to the brain - Tends to occur in **SW (CA, AZ, W TX)**; aerosolized by **earthquakes**
50
Characteristics of Rhinocerebral mucormycosis?
- **Poorly controlled diabetics** or **immunocompromised** - Moor likely to have **fever** and elevation in peripheral white count - Tends to progress a little more **slowly** than straight up stroke - **Angioinasive large non-septate hyphae** - **Non-uniform and branching; 90'**
51
What is this?
**Aspergillosis cerebritis** - Can't be sealed off by brain - Hemorrhagic, dusty, and discolored
52
What is this?
**Aspergillosis cerebritis** (GMS stain) - Septate, true branching at 45' uniform diameter
53
What is this?
**(LEFT) Sphenoid bone in mucomycosis** - Can see hypothalamus at the top of the pic - Cavernous sinus (normal) and open carotid artery on right - Clogged carotid a. on left due to mucor **(RIGHT) Inside of sphenoid sinus** - Black discoloration is infarcted mucosa due to mucor growing in BVs supplying this area
54
What is this?
Mucor
55
What is this?
**Mucormycosis** - Can see hyphal forms in lumen of vessel and invading wall - Can impede flow and cause infarct
56
Characteristics of **Candidiasis**: form, affected populations, symptoms, histology?
- **Hyphae and yeast** forms - Commonly in **immunocompromised** hosts; the very ill - **Ubiquitous** in environment - #1 fungal infxn of CNS found at autopsy - **Microabscesses** - PAS/GMS positive

Term 5: Neuro (24 decks)

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