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CENTRAL NERVOUS SYSTEM INFECTIONS Flashcards

1
Q

Infection may damage the nervous system directly or indirectly

Directly through injury of neurons or glia by ___________

Indirectly through the ____________ and __________

A

the infectious agent

cytokines released by infectious agents and inflammatory response.

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2
Q

There are four principal routes by which microbes enter the nervous system

List them

A

Haematogenous spread
Direct implantation
Local extension
Along nerve

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3
Q

There are four principal routes by which microbes enter the nervous system

  1. Haematogenous spread
  2. Direct implantation of microorganisms is most often _______ or is sometimes associated with _______________ that provide ____________________
A

traumatic

congenital malformations

ready access for microorganisms.

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4
Q

There are four principal routes by which microbes enter the nervous system

3, Local extension can originate from __________, such as air sinuses, teeth, skull, or vertebrae.

4, Along nerve. Certain viruses such as ________,_________,_________ spread along cranial and peripheral nerves and ascend to CNS

A

infected adjacent structures

herpes simplex, herpes zoster and rabies

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5
Q

Meningitis is ________ involvement of the meninges.

A

inflammatory

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6
Q

Meningitis may involve the dura called ___________, or the leptomeninges (pia- arachnoid) termed ____________.

A

pachymeningitis

leptomeningitis

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7
Q

pachymeningitis , leptomeningitis

Which is more common

A

leptomeningitis is far more common, and unless otherwise specified, meningitis would mean leptomeningitis

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8
Q

Leptomeningitis, commonly called ________, is usually the result of _______ but infrequently _______ meningitis and _________ meningitis by infiltration of the ___________ by cancer cells may occur

A

meningitis; infection

chemical; carcinomatous

subarachnoid space

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9
Q

Infectious meningitis is broadly classified into 3 types:

○ ________________
○ _____________________ (________)
○—————(———-)

A

Acute pyogenic meningitis

Acute lymphocytic (viral, aseptic)

Chronic (bacterial or fungal).

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10
Q

Acute pyogenic (Bacterial) Meningitis

Distinctive microorganisms cause acute pyogenic meningitis in various age groups:

Neonates: ______________ and the ________

Infants and children: __________________

Adolescent and young adults: ___________

Extremes of life: _______________ and ____________

A

Escherichia coli and the group B streptococci

Haemophilus influenzae

Neisseria meningitidis

Streptococcus pneumoniae and Listeria monocytogenes

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11
Q

Acute pyogenic (Bacterial) Meningitis

____________ is most likely to cause epidemics and Is most prevalent in (dry or wet?) season

A

N.meningitidis

dry

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12
Q

Acute pyogenic meningitis: Routes of infection

•Most commonly by the __________

•From an adjacent ____________.

•By iatrogenic infection such as introduction of microorganisms at _________ or during _________

A

blood stream.

focus of infection

surgery ; lumbar puncture

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13
Q

Acute pyogenic meningitis : clinical features

The immediate clinical manifestations are fever, severe headache, vomiting, drowsiness,______,______ and occasionally, ________.

Neck _______, positive ______ and _______sign

A

stupor, coma

convulsions

stiffness

kernig and brudinsky

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14
Q

Acute bacterial meningitis is a medical emergency

T/F

A

T

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15
Q

Acute bacterial meningitis : Diagnosis

Naked eye appearance of ______ or _________ CSF.

_______ CSF pressure (above _____ of water).

__________ leucocytosis in CSF

________ CSF protein level (higher than ——- mg/dl).

____eased CSF sugar concentration (lower than ____ mg/dl).

Bacteriologic examination by Gram’s stain or by CSF culture reveals causative organism.

A

cloudy or frankly purulent

Elevated; 180 mm

Neutrophilic

Raised; 50

Decr; 40

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16
Q

Acute pyogenic meningitis: Morphology (macroscopy)

________ is evident within the leptomeninges over the surface of the brain.

The meningeal vessels are _______ and stand out prominently.

A

An exudate

engorged

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17
Q

Acute pyogenic meningitis: Morphology (macroscopy)

Anatomic distribution of the exudate varies;

it is usually ——— in H. influenzae meningitis

it is densest over the _________ near the _________ in pneumococcal meningitis

A

basal

cerebral convexities

sagittal sinus

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18
Q

Acute pyogenic meningitis: Morphology (macroscopy)

When the meningitis is fulminant, the inflammation may extend to the _______, producing _______

The Waterhouse-Friderichsen syndrome results from meningitis-associated _______ (commonly ____________) with ——————- of the ________ and _____________

A

ventricles; ventriculitis

septicemia; N.menigitidis

hemorrhagic infarction

adrenal glands ; cutaneous petechiae

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19
Q

Acute pyogenic meningitis: Morphology (microscopy)

There is presence of numerous —————— in the ————— as well as in the meninges, particularly around the ____________

Gram-staining reveals varying number of causative bacteria

A

polymorphonuclear neutrophils

subarachnoid space

blood vessels.

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20
Q

Acute lymphocytic (viral, aseptic) meningitis

Acute lymphocytic meningitis is a viral or aseptic meningitis, especially common in ———- and __________

The aetiologic agents includes _______,______,_______,______,______,________,_______ and __________

However, evidence of viral infection may not be demonstrable in about ——— of cases.

A

children and young adults.

enteroviruses, mumps, ECHO viruses, coxsackie virus, Epstein Barr virus, herpes simplex virus-2, arthropod-borne viruses and HIV.

a third

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21
Q

Acute lymphocytic (viral, aseptic) meningitis

The clinical manifestations of viral meningitis are much the same as in bacterial meningitis with features of acute onset meningeal symptoms and fever

T/F

A

T

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22
Q

Viral meningitis has a (benign or malignant ?) and __________ clinical course of (short or long?) duration and is invariably followed by ________ without the life threatening complications of bacterial meningitis

A

benign and self-limiting

Short

complete recovery

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23
Q

Acute lymphocytic (viral, aseptic) meningitis: Diagnosis
The CSF findings in viral meningitis are:

○Naked eye appearance of _________ or ________ CSF.

○CSF pressure ____eased (above ———- water).

○Lymphocytosis in CSF (10-100 cells/μl).

○CSF protein usually ———————

○CSF sugar concentration usually ______.

○CSF is bacteriologically _______.

A

Clear or slightly turbid

incr; 250 mm

normal; sterile

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24
Q

Chronic meningitis

There are two principal types of chronic meningitis

_________ (__________ meningitis)

_________ (__________ meningitis).

Both types cause _________________ reaction and may produce parenchymal lesions.

A

bacterial; tuberculous

fungal ; cryptococcal

chronic granulomatous

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25
Q

Chronic meningitis: Tuberculous meningitis

Occurs in children and adults through _____________ spread of infection from tuberculosis

It may simply be a manifestation of —————-

Less commonly, the spread may occur directly from tuberculosis of a ____________

A

haematogenous spread

miliary tuberculosis.

vertebral body.

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26
Q

Chronic meningitis: Cryptococcal meningitis

Develops particularly in _________ or ————— persons, usually as a result of ————- dissemination from a ————

A

debilitated or immunocompromised

haematogenous; pulmonary lesion.

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27
Q

Cryptococcal meningitis is especially an important cause of meningitis in patients with _______.

A

AIDS

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28
Q

Chronic meningitis: Clinical features

Tuberculous meningitis manifests clinically as _____,_______,_____,_______.

The clinical course in cryptococcal meningitis may, however, be _———- and _______ in a few weeks, or be ______ for months to years.

A

headache, confusion, malaise and vomiting

fulminant and fatal; indolent

29
Q

Chronic meningitis: Diagnosis
The CSF findings in chronic meningitis are as under:

Naked eye appearance of a ______ or ________ CSF which may form ________ on standing.

________ CSF pressure (above ________ water).

________ leucocytosis consisting mostly of _________ and some _______

_______ protein content.

A

clear or slightly turbid ; fibrin web

Raised; 300 mm

Mononuclear; lymphocytes; macrophages

Raised

30
Q

Chronic meningitis: Diagnosis

_________ glucose concentration.

________ may be found on microscopy of centrifuged deposits by ____ staining in tuberculous meningitis.

Pathognomonic ______ cryptococci with a _____ are appreciated in _____ preparation of CSF in cases of cryptococcal meningitis, while the capsule is better demonstrated by ________

A

Lowered

Tubercle bacilli; ZN

encapsulated; hall ; India ink ; mucicarmine stain

31
Q

Chronic meningitis: Morphology (Tuberculous)

The most common pattern of tuberculous involvement is a __________________

__________ that characteristically involves the ____ of the brain, ______ the cisterns and ______ cranial nerves

On microscopic examination, involved areas contain mixed inflammatory infiltrates containing lymphocytes, plasma cells, and macrophages

A

diffuse meningoencephalitis.

Fibrinous exudate; base

effacing

32
Q

Chronic meningitis: Morphology (Tuberculous)

Florid cases show well-formed __________ with —————- and __________

Organisms can often be seen with __________ stains.

CNS involvement may also take the form of one or more well-circumscribed ____________ ( ___________ ), which may be associated with meningitis

A

granulomas

caseous necrosis and giant cells.

intraparenchymal masses

tuberculomas

33
Q

Chronic meningitis: Morphology (Tuberculous)

A tuberculoma may be as large as several centimeters in diameter, causing ____________.

These lesions usually have a _____ area of _______ necrosis surrounded by ________
________ may occur in inactive lesions.

A

significant mass effect

central

caseous; granulomas

calcification

34
Q

Chronic meningitis: Morphology (Cryptococcus)

With cryptococcal infection, there is a chronic meningitis affecting the _________________ , which are ______ and ________ by reactive connective tissue that may obstruct the outflow of CSF from the __________________________, giving rise to __________

The meningeal infiltrates consist of chronic inflammatory cells and fibroblasts admixed with cryptococci

A

basal leptomeninges

opaque; thickened

foramina of Luschka and Magendie

hydrocephalus

35
Q

Chronic meningitis: Morphology

(Tuberculosis) On microscopic examination, involved areas contain mixed inflammatory infiltrates containing ______,__________, and ———-

(Cryptococcus) The meningeal infiltrates consist of chronic inflammatory cells and _________ admixed with ________

A

lymphocytes, plasma cells, and macrophages

fibroblasts

36
Q

Complications of meningitis

________ loss
recurrent _______
________
problems with ________
problems with ________ and _______
________ failure

A

Hearing

seizures

hydrocephaly

memory

movement and coordination

renal

37
Q

Acute focal suppurative infections

______ abscess
________ ———-
_______ abscess

A

Brain

Subdural empyema

Extradural

38
Q

Acute focal suppurative infections

________ and _____ are the most common
offending organisms identified in brain abscess in non- immunosuppressed patients

A

Streptococci and staphylococci

39
Q

Brain Abscess

A brain abscess is a (localized or generalized?) focus of _____ of brain tissue with accompanying ______, usually caused by a ______ infection.

A

localized; necrosis

inflammation; bacterial

40
Q

Brain Abscess

Predisposing conditions include;

____________________ which may give rise to multiple brain abscesses

____________ disease (__________ )

___________(rare)

Immunosupression

A

Acute bacterial endocarditis

Congenital heart; R to L shunting

Bronchiectasis

41
Q

Brain Abscess: Morphology

Abscesses are discrete lesions with central ———- surrounded by brain ———.

At the outer margin of the necrotic lesion there is exuberant ________ with ___________ around the necrosis

A

liquefactive necrosis; swelling

granulation tissue; neovascularization

42
Q

Brain Abscess: Morphology

In well-established lesions, a __________ is produced by fibroblasts derived from the ________________.

Outside the fibrous capsule is a zone of _________ containing numerous ________ __________

A

collagenous capsule

walls of blood vessels

reactive gliosis

gemistocytic astrocytes

43
Q

Neurosyphillis

Neurosyphilis is a manifestation of the _______ stage of syphilis and occurs in only about ____% of individuals with untreated infection.

A

tertiary; 10

44
Q

Neurosyphillis

The major patterns of CNS involvement are

_________ neurosyphilis
_______ neurosyphilis
__________________

Causative organism is ___________

A

meningovascular

paretic

tabes dorsalis.

Tropenema pallidum

45
Q

Neurosyphillis

Symptoms include:

Abnormal ____/___________

numbness in ______ limbs, poor _______ control

Treatment is with ________,_______

A

gait/unable to walk

lower; bladder

penicillin, probenecid

46
Q

Neuroborreliosis (Lyme disease)

Lyme disease is caused by the ________ ,———- ————-, which is transmitted by various species of ______ .

A

spirochete

Borrelia burgdorferi

Ixodes tick

47
Q

______________ (Lyme disease)

A

Neuroborreliosis

48
Q

Neuroborreliosis (Lyme disease)

Neurologic symptoms are highly variable and include

______ meningitis

________ palsies and other polyneuropathies, as well as ___________.

A

aseptic

facial nerve

encephalopathy

49
Q

Viruses can infect the CNS and produce either _________,_________, or both ( ——————- ).

A

aseptic meningitis, viral encephalitis

meningoencephalitis

50
Q

Viral Encephalitis

○ Herpes simplex virus/Herpes zoster infects the ______ and ———- to get into the blood
○ Enteroviruses like poliovirus via the —————-
○ Arbovirus by _______
○ CMV by __________ infection

A

skin and mucous membrane

alimentary canal

arthropod bite

transplacental

51
Q

Viral Encephalitis

Although histologic changes vary from one viral infection of the CNS to the other but, in general, the characteristic features of viral diseases of the CNS
are:

Parenchymal infiltrate, chiefly in _______ location, of ______ cells consisting of _____,______, and _______

Microscopic clusters of ______ cells and presence of _________.

_____________ bodies in most viral diseases and specific cytoplasmic inclusions of _______ in rabies

A

perivascular; mononuclear

lymphocytes, plasma cells and macrophages.

microglial; neuronophagia

Intranuclear inclusion; Negri bodies

52
Q

HIV Encephalopathy (AIDS-Dementia Complex)

HIV has profound ______ but unlike tropism for _______ cells of the immune system.

HIV has not been identified to infect the _________ but instead infects the cells of _______________ cell line including _______ cells.
HIV infection then sets in a cascade of toxic mediators and cytokines—TNF- a, IL-1, IL-6, TGF-b, IFN-g, platelet activating factor (PAF) and endothelin, all of which cause damage to the ________

A

neurovirulence; CD4+ T

neuronal cells; monocyte-macrophage ; microglial

neuroglial tissues

53
Q

HIV Encephalopathy (AIDS-Dementia Complex)

(Early or Late?) in the course of AIDS, a group of signs and symptoms of CNS disease appear termed HIV encephalopathy or AIDS-dementia complex.

One major clinical feature of this entity is the occurrence of ————- i.e. ___________________________ of the individual compared to previous level.

A

Late

dementia

fall in the cognitive ability

54
Q

Progressive multifocal leucoencephalopathy

is a (slow or rapid?) viral infection of the CNS caused by a ______virus called JC virus (not to be confused with _______ or __________)

A

Slow ; polyoma

CJ disease or mad-cow disease

55
Q

PML develops in __________ individual like CMV and Toxoplasmosis

A

immunocompromised

56
Q

Progressive multifocal leucoencephalopathy

It is an important form of encephalitis due to _______________________.

PML infects _______ and causes progressive ________ at multifocal areas scattered throughout the CNS.

A

increasing number of cases of AIDS

oligodendrocytes; demyelination

57
Q

____________ Encephalopathy

=

Creutzfeldt-Jakob Disease

=

___________

A

Spongiform

Mad cow disease

58
Q

Spongiform Encephalopathy (Creutzfeldt-Jakob Disease)

though included under the group of viral encephalitis but is caused by _______________

A

accumulation of prion proteins

59
Q

Prions are abnormal forms of a _________ that cause (gradual or rapidly?) _____________ disorders that may be sporadic, familial or transmitted

A

cellular protein

Rapidly

progressive neurodegenerative

60
Q

Spongiform Encephalopathy (Creutzfeldt-Jakob Disease)

Majority of cases occur sporadically though ______ predisposition with ___________ inheritance has also been reported in 5-15% cases

A

familial ; autosomal dominant

61
Q

Clinically, CJD is characterised by rapidly progressive________ with prominent association of _________. CJD is invariably _____ with mean survival of about _______ after diagnosis.

A

dementia

myoclonus

fatal

7 months

62
Q

The progression of the dementia in CJD is usually so rapid that there is little if any grossly evident brain atrophy

T/F

A

T

63
Q

Spongiform Encephalopathy (Creutzfeldt-Jakob Disease): Morphology

The pathognomonic finding is a ______ transformation of the ________ and, often, (shallow or deep?) (white or gray?) matter structures (______,_______ )

this multifocal process results in the (even or uneven?) formation of (small or large?) , apparently _____, microscopic vacuoles of varying sizes within the ______ and sometimes in the ______ of neurons

A

spongiform; cerebral cortex

deep ; gray

caudate, putamen

uneven ; small; empty

neuropil ; perikaryon of neurons

64
Q

Spongiform Encephalopathy (Creutzfeldt-Jakob Disease): Morphology

___________ : are extracellular deposits of aggregated abnormal protein

they are ______ and _______ -positive and usually occur in the _______ but are abundant in the _______ in cases of CJD

A

Kuru plaques

Congo red- and PAS

cerebellum; cerebral cortex

65
Q

Spongiform Encephalopathy (Creutzfeldt-Jakob Disease): Morphology

Immunohistochemical staining demonstrates the presence of ___________- resistant _____ in tissue.

A

proteinase K

PrPsc

66
Q

most common cause of brain abscess in immunocompromised patients is ???

A

Cerebral toxoplasmosis

67
Q

Other infectious diseases of the nervous system
Cerebral _________

Cerebral ________- _________

Cerebral __________- ________

________ infections

A

toxoplasmosis

malaria; Plasmodium falciparum

amoebiasis; Acanthamoeba

Rickettsial

68
Q

Cerebral amoebiasis- Acanthamoeba -

Common or Rare?

highly _____.

A

Rare

lethal

69
Q

Rickettsial infections are _______ borne

A

arthropod

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