cns infections. infection of cns coverings dura – pachymeningitis leptomeninges - leptomeningitis...
TRANSCRIPT
![Page 1: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/1.jpg)
CNS Infections
![Page 2: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/2.jpg)
CNS Infections
Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis
Infections of neural tissue Brain – encephalitis Spinal cord – myelitis
Ventricles - ventriculitis
![Page 3: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/3.jpg)
CNS Infections
Pachymeningitis Sources
Direct spread from chronic suppurative infections of sinuses, ear, mastoid or compound fracture
Manifestations Usually localised +/- overlying
osteomyelitis Extradural abscess Subdural empyaema Spinal epidural abscess.
![Page 4: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/4.jpg)
CNS Infections
Leptomeningitis (commonly purulent) Sources
Haematogenous (most common) Direct from adjacent inflammatory lesion ? Through cribriform plate Iatrogenic eg. spinal tap
Microbiology
![Page 5: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/5.jpg)
CNS Infections
Pathology Gross
Swollen, congested brain (acute inflammation)
Purulent CSF (filling sulci & basal cisterns) Micro
Purulent exudate in subarachnoid space, extending into perivascular spaces
Some cortical oedema +/- degeneration in chronic cases
![Page 6: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/6.jpg)
Brain & Cord:
Purulent meningitis
![Page 7: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/7.jpg)
Brain: Purulent meningitis
![Page 8: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/8.jpg)
Brain: Purulent meningitis
![Page 9: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/9.jpg)
Brain: Purulent meningitis
![Page 10: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/10.jpg)
Brain: Purulent meningitis
![Page 11: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/11.jpg)
Brain: Purulent meningitis
![Page 12: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/12.jpg)
Brain: Purulent meningitis
![Page 13: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/13.jpg)
Spinal cord:
Purulent meningitis
![Page 14: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/14.jpg)
CNS Infections
Acute lymphocytic meningitis Causes
Viruses: ECHO, Coxsackie, Herpes simples II, E-B virus.
Manifestations Similar to bacterial meningitis – less severe Gross: acute inflammation, clear CSF Micro: lymphocytic cellular exudate in CSF
and subarachnoid space
![Page 15: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/15.jpg)
CNS Infections
Chronic meningitis Causes
Mycobacterium tuberculosis - TB Treponema pallidum – syphilis Brucella – brucellosis Fungi – Candida, Cryptococcus, Histopasma Protozoa – Toxoplasma, Amoebae
Micro: Largely mononuclear inflammation with
granulomas
![Page 16: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/16.jpg)
Brain:
Tuberculous meningitis.
![Page 17: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/17.jpg)
Brain: Tuberculous meningitis
![Page 18: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/18.jpg)
Tuberculous meningitis
![Page 19: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/19.jpg)
CNS Infection
Chronic meningitis Complications
Obstructive hydrocephalus Focal infarctions/microinfarcts due to
endarteritis oblitrerans Formation of intracranial mass Cranial nerve palsies
![Page 20: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/20.jpg)
CNS Infections
Infections associated with formation of intracranial mass Tuberculosis – tuberculoma Syphilis – gumma Amoebiasis – amoeboma Aspergillosis – aspergilloma, Crryptococcosis - toruloma. Parasites – cysticercosis, hydatid cyst.
![Page 21: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/21.jpg)
Tuberculoma
![Page 22: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/22.jpg)
Brain: Toruloma
![Page 23: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/23.jpg)
CNS Infections
CNS syphilis (tertiary) Meningoencephalitis
(meningovascular syphilis) Gumma General paresis of the insane (GPI) –
focal infarcts, atrophy and dementia Tabes dorsalis.
![Page 24: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/24.jpg)
CNS syphilis
![Page 25: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/25.jpg)
Brain: Syphilis
![Page 26: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/26.jpg)
CNS Infections
Cerebral abscess Sources
Direct spread (sinusitis, mastoiditis) Haematogenous.
Manifestations Mass effect Complications: spread into ventricles or
subarachnoid space – ventriculitis or meningitis
![Page 27: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/27.jpg)
CNS Infections
Cerebral abscess Pathology
Localised suppuration Surrounding pyogenic membrane Surrounding brain:
Oedema – vasogenic Inflammatory infiltrate rich in plasma cells and
lymphocytes. Gliosis – astrocytes mainly.
![Page 28: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/28.jpg)
CNS: Abscess
![Page 29: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/29.jpg)
Cerebral abscess
![Page 30: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/30.jpg)
Cerebral abscess
![Page 31: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/31.jpg)
Brain: cerebellar abscess.
![Page 32: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/32.jpg)
Encephalitis
Primary encephalitis Acute/subacute viral infections Persistent viral infections Slow viral infections
Secondary encephalitisPost-infectious encephalomyelitis
![Page 33: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/33.jpg)
CNS Infections
Primary viral encephalitisHerpesviruses – HSV 1 and 2Enteroviruses – PoliovirusArbovirusesRabiesvirusPersistent virus infections (SSPE,
PMLE)HIV-1 infection
![Page 34: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/34.jpg)
Encephalitis
Primary encephalitis – morphology Gross
Focal/generalised inflammation +/- necrosis Micro
Mononuclear inflammatory infiltrate with perivascular extension (lyphocytes, plasma cells)
Neuronal destruction + neuronophagia Proliferation of microglia – rod cells Reactive gliosis – astrocytosis Inclusion bodies Demyelination.
![Page 35: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/35.jpg)
Viral encephalitis: Preferred sites for various viruses
![Page 36: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/36.jpg)
Brain: Encephalitis
![Page 37: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/37.jpg)
Viral encephalitis: Histological lesions
![Page 38: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/38.jpg)
Viral encephalitis: Neuronophagia
![Page 39: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/39.jpg)
Encephalitis: Perivascular infiltrate
![Page 40: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/40.jpg)
Encephalitis: Types of inclusion bodies
![Page 41: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/41.jpg)
CNS infection:
Rabies
![Page 42: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/42.jpg)
Brain: Herpes simplex encephalitis
![Page 43: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/43.jpg)
Brain: Herpes encephalitis: vessel necrosis + inflam. cells
![Page 44: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/44.jpg)
Encephalitis: Intranuclear inclusions
![Page 45: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/45.jpg)
CNS: Poliomyelitis
![Page 46: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/46.jpg)
Encephalitis
Primary encephalitis Persistent viral encephalitis
Subacute sclerosing panencephalitis (SSPE) Chronic infection Result of measles virus infection Affects older children Brain shows loss of myelin + gliosis + perivascular
lymphocytic infiltration CSF contains high titres of measles antibody and
viral antigen Expression of aberrant T-cell response to presence
of virus in brain.
![Page 47: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/47.jpg)
Encephalitis
Primary encephalitis Slow virus infections
Progressive multifocal leucoencephalopathy (PMLE)
Infection by papovavirus group (JC virus) In immunosuppressed patients (HD,
chemotherapy for malignancies) Focal demyelination in white matter, basal
ganglia Gitter cells in affected areas + atypical
astrocytes + abnormal oligodendrocytes (contain virions as inclusions)
![Page 48: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/48.jpg)
Brain: Progressive multifocal leukoencephalopathy
![Page 49: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/49.jpg)
Encephalitis
Secondary encephalitis Bacterial eg Brucella Spirochaetal eg Treponema Rickettsial eg. Borrelia Parasitic
Protozoa – Toxoplasma, Plasmodium, Trypanosoma
Metazoa – Schistosoma, Cysticercus, Hydatid.
Viral eg Mumps, Yellow fever
![Page 50: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/50.jpg)
Encephalitis
Postinfectious encephalomyelitisMeaslesRubellaVaricella-ZosterVacciniaInfluenzaVariola.
![Page 51: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/51.jpg)
CNS Changes in HIV Infection
Aseptic meningitis 1-2 weeks after seroconversion in 10%. HIV
1 antibodies in CSF.
Meningoencephalitis Gross
Diffuse cortical atrophy Micro
Chronic inflammation, focal necrosis + gliosis, endarteritis, microglial nodules +/- giant cells, multifocal/diffuse demyelination + gliosis
![Page 52: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/52.jpg)
CNS Changes in HIV Infection
Vacuolar myelopathy (20-30%) Similar to subacute combined
degeneration Immunosuppression (not due to HIV)
Inflammatory myopathy Muscle fibre necrosis + phagocytosis Interstitial infiltration with HIV-
positive macrophages
![Page 53: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/53.jpg)
CNS Changes in HIV Infection
Cranial and peripheral neuropathies Acute & chronic demyelinating
polyneuropathy Distal symmetrical polyneuropathy Polyradiculopathy Mononeuritis multiplex Sensory neuropathy due to
ganglioneuritis (rare)
![Page 54: CNS Infections. Infection of CNS coverings Dura – pachymeningitis Leptomeninges - leptomeningitis Infections of neural tissue Brain – encephalitis Spinal](https://reader037.vdocuments.net/reader037/viewer/2022110101/56649e7f5503460f94b83519/html5/thumbnails/54.jpg)
CNS in Childhood AIDS
Neurological manifestations in 1 year: Microcephaly + mental retardation + delay of
motor development
Micro: Calcification in basal ganglia or deep cortical
white matter (blood vessels) Foci of tissue destruction in grey/white matter Loss or delay in myelination Opportunistic CNS infections (rare in children)