Cerebral Inflammation and Disorders

Question 1

What is the definition of meningitis?

Answer 1

Inflammation of the meninges caused by viral or bacterial infection

Question 2

What is the definition of encephalitis?

Answer 2

Inflammation of the brain caused by infection or autoimmune mechanisms

Question 3

What is the definition of cerebral vasculitis?

Answer 3

Inflammation of blood vessel walls (angiitis)

Question 4

What is the definition of myelitis?

Answer 4

Inflammation of the spinal cord

Question 5

What causes the blood brain barrier?

Answer 5

• dense vascularisation of the CNS

Question 6

What forms the blood brain barrier (BBB)?

Answer 6

• extensive tight junctions at the endothelial cell-cell contacts, massively reducing the fluid leak across capillary walls

Question 7

What does the BBB do?

Answer 7

control the exchange of the substances using specific membrane transporters to transport into and out of the CNS (influx and efflux transporters).

Question 8

What happens in BBB disruption?

Answer 8

• endothelial layer disruption
• blood components leak into the brain (fibrinogen)
• astrocytes withdraw end feet from the vessel wall
• further compromising the BBB
• collagen buildup leading to harden of the vessel wall

Question 9

What are the implications of long term BBB disruption?

Answer 9

• fibrosis of the vessels

- small vessel disease

Question 10

What are the initial symptoms of encephalitis?

Answer 10

• flu-like
• pyrexia (fever)
• headache

Question 11

What are the subsequent symptoms of encephalitis?

Answer 11

• confusion/distribution
• seizures/fits
• personality/behaviour changes
• difficulty speaking
• weakness/loss of movement
• loss of consciousness

Question 12

What are the causes of encephalitis?

Answer 12

MOST COMMON:
- herpes simplex
- measles
- varicella
- rubella
OTHER:
- insect bites
- bacteria/fungal infections
- trauma 
- autoimmune

Question 13

How to treat encephalitis?

Answer 13

dependent on the cause, but may include:

• antivirals
• steroids
• antibiotics/antifungals
• analgesics
• anti-convulsants
• ventilation

Question 14

What is MS?

Answer 14

• autoimmune demyelinating disease of the CNS
• relapses linked to inflammatory activity
• progression is linked to neurodegeneration
• neurological deficit, relapses and remits but steadily progresses

Question 15

Why do MS symptoms vary?

Answer 15

due to the amount and location of damage to the nervous system varies person to person

Question 16

What inflammation is involved in MS?

Answer 16

perivascular immune cell infiltration

• CD3 T-cells
• CD20 B-cells

Question 17

What is meningitis?

Answer 17

irritation, inflammation and swelling of the meninges?

Question 18

What are the causes of meningitis?

Answer 18

bacterial:
- meningococcal
- pneumococcal
- haemophilus Influenza type B
- streptococcal (new-born)
other:
- viral (rarely life threatening)
- fungal

Question 19

How do you confirm a diagnosis of meningitis?

Answer 19

CSF sample, lumbar puncture

Question 20

How does antibiotics pass the BBB?

Answer 20

high dose, IV antibiotics does pass through the BBB

Question 21

What is the cellular pathology of MS?

Answer 21

• inflammation
• demyelination
• axonal loss
• neurodegeneration

Question 22

What is an infection of the spinal cord known as?

Answer 22

Myelitis

Question 23

What types of infections tend to cause encephalitis?

Answer 23

Virus

Question 24

What are some of the long term effects of meningitis?

Answer 24

• seizures
• visual disturbances
• behavioural changes
• confusion
• amnesia
• excessive fatigue
• hearing loss (biggest cause in children)

Question 25

What diagnostic tests can be performed to diagnose meningitis and encephalitis?

Answer 25

- physical examination - lumbar puncture, with subsequent cultures + glucose test - Brain scan (CT+MRI) - bloods - urine analysis

Question 26

What are some of the long term effects of meningitis?

Answer 26

- seizures - visual disturbances - behavioural changes - confusion - amnesia - excessive fatigue - hearing loss (biggest cause in children) - aphasia - learning disabilities - memory loss - poor concentration - clumisness/co-ordination problems - headaches - weakness - speech problems

Question 27

Which is more severe, bacterial or viral meningitis?

Answer 27

bacterial, 1 in 10 die from it

Question 28

What is a hallmark of encephalitis?

Answer 28

- seizures - fever - behaviour changes - confusion and disorientation - aphasia - visual disturbances

Question 29

What is the glass test for meningitis?

Answer 29

- blanche with glass - no blood movement, therefore skin remains - doesn't lighten - rash normally in torso and the back

Question 30

Why is encephalitis more likely to be viral?

Answer 30

Because viruses are able to pass through the blood-brain barrier

Question 31

What is a hallmark of meningitis?

Answer 31

- sudden fever - severe headache - nausea/vomiting - double vision - drowsiness - light sensitivity - stiff neck - rash (not always

Question 32

What would you treat meningitis with?

Answer 32

- broad spectrum antibiotics - analgesia - steroids - anti-inflammatories - anti-pyretics

Question 33

Why do you measure glucose in CSF?

Answer 33

- glucose is low due to usage by bacteria

Question 34

What are the primary risk age group with meningitis?

Answer 34

- kids below the age of 3 | - university student age

Question 35

What is the structure of the capillaries that make up the BBB?

Answer 35

- extensive tight junctions at the endothelial cell-cell contacts - massively reduced solute and fluid leak across the capillary wall

Question 36

Describe the vascularisation of the CNS in the BBB?

Answer 36

no neuron is more than 100 micrometers from a capillary

Question 37

Why is the tight control of the BBB beneficial?

Answer 37

blood-borne infections have reduced entry to CNS tissue

Question 38

What is the structure of the BBB?

Answer 38

- endothelial layer - collagen layer - astrocytes with end feet on vessel wall

Question 39

What is an infection of the spinal cord known as?

Answer 39

myelitis

Question 40

What is an infection of both the spinal cord and brain known as?

Answer 40

encephalomyelitis

Question 41

What is normally found on tests for meningitis/encephalitis?

Answer 41

- CSF clear and colourless - Low glucose in bacterial meningitis - raised WCC

Question 42

How can you tell the difference between meningitis and encephalitis?

Answer 42

Encephalitis has: - photophobia - seizures - neurologic findings (weakness, aphasia, behviour change)