Progressive loss of mental and physical functions caused by invasion of Treponema pallidum into the CNS:
neurosyphilis
Neurosyphilis - 4 chief manifestations:
- asx neurosyphilis
- meningovascular syphilis
- paretic syphilis
- tabes dorsalis
Meningovascular syphilis:
characterized by perivascular inflammation in the brain
Paretic syphilis:
result of widespread parenchymal invasion by spirochetes and resultant inflammatory changes that cause individual brain cell death and brain atrophy
Tabes dorsalis:
- slowly progressive degenerative form of syphilis involving the posterior columns and posterior roots,
- results in damage to sensory nerves in dorsal roots
- produces ataxia, loss of pain sensation/proprioception
MC presentation of meningovascular syphilis:
Stroke syndrome in a relatively young adult, involving the middle cerebral artery or branches of the basilar artery; freq involves base of brain and may result in cranial nerve palsies
Paretic syphilis usu occurs how long after exposure?
20-30 yrs as a result of progressive meningoencephalitis, resultant ongoing loss of cortical function
Paretic syphilis is characterized by:
- tissue invasion with spirochetes
- chronic perivascular and meningeal inflammatory changes
- meningeal fibrosis
MC sx of paretic syphilis:
- personality change (33%)
- ataxia (28%)
- stroke (23%)
- ophthalmic sx (17%)
Neurosyphilis often results in the formation of meningeal granulomas, called:
gummas - well-circumscribed, non-cancerous mass of granulation tissue resulting from a cell-mediated immune response to Treponema, tertiary stages.
Gummas are MC found in:
LIVER
also found in brain/dura, heart, skin, bone, testes
Several hours after tx of early stage syphilis, pts may undergo febrile reaction called:
Jarisch-Herxheimer reaction
Progressive multifocal leukoencephalopathy (PML) is caused by:
JC virus (polyomavirus family)
rare, progressive, demyelinating dz -> loss of oligodendrocytes
Subacute sclerosing panencephalitis (SSPE) is a rare complication of _______ that can develop from ____ years after the initial infx.
measles (rubeola)
1 to 20+
The only change in the CSF profile of SSPE is a marked elevation in a specially ordered CSF immunoglobulin:
Rubeola IgG Antibody
Poliovirus is an RNA virus that is transmitted:
- through the oral-fecal route
* ingestion of contaminated water
After a period of viremia, poliovirus becomes ________ and produces destruction of the motor neurons in the anterior horn and brainstem, leading to ____________.
neurotropic
flaccid paralysis
Zoonotic dz that is transmitted via saliva of animals:
Rabies virus
- severe HA
- irritability
- muscle spasm
- inc saliva production
- hydrophobia
Diagnostic finding for rabies:
Negri bodies - round/oval inclusion bodies
100% diagnostic, found in 20% of cases
Complicated syndrome of different nervous system and mental status symptoms, frequency inc with advancing effects of HIV disease, particularly as CD4+ cell counts decrease:
AIDS dementia complex (ADC)
Unusual, often fatal, two-phase encephalopathy characterized by fever, vomiting, fatty infiltration of the liver and swelling of the kidneys and brain:
Reye’s syndrome
- post-viral (VZV)
- NOT contagious
- assoc w/aspirin use
An infx of the brain d/t infx by a prion:
Spongiform encephalopathy
- Kuru
- CJD
Related spongiform encephalopathies that are invariably fatal brain diseases with unusually long incubation periods measured in years:
mad cow dz (BSE)
variant Creutzfeld-Jakob dz (vCJD)
Most prevalent neurologic disorder in terms of morbidity and mortality:
cerebrovascular dz - 3rd leading cause of death in US (particularly stroke)
3 major categories of cerebrovascular dz:
- thrombotic
- embolic
- hemorrhagic
From a pathophys standpoint, consider cerebrovascular disease as representing two processes:
- hypoxia, ischemia, infarction from impaired blood supply and oxygenation of CNS tissue
- hemorrhage from rupture of vessels in the CNS
Cerebral infarction (aka stroke) is characterized by:
sudden loss of circulation to an area of the brain which results in loss of neurologic function corresponding to the part of brain involved.
Leading cause of major disability in US
If you think I’m gonna get to the end of CNS…
you’ve got another thing coming! sorry kids.
