inflammations infections of cns and cerebrospinal fluid
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Inflammations & infections of CNS and Cerebrospinal fluid. Dr Aarathi Rau. Infections of the CNS. Meninges,brain,both Meningitis- Pachymeningitis:Epidural and subdural infections Leptomeningitis-Subarachnoid Brain- Cerebral abscess-focal inflammation

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infections of the cns
Infections of the CNS

Meninges,brain,both

  • Meningitis-
  • Pachymeningitis:Epidural and subdural infections
  • Leptomeningitis-Subarachnoid
  • Brain-
  • Cerebral abscess-focal inflammation
  • Encephalitis-diffuse inflammation
formation circulation function of csf
Formation,circulation,function of CSF
  • Formation-500 ml/day
  • Ultrafilteration & secretion –choroid plexus, ependymal lining of ventricles
  • Circulation: ventricular system-foramina-subarachnoid space
function of csf
Function of CSF
  • Protects, lubricates the brain
  • Provides nutrients, removes waste

90-150 ml adult

10-60 ml in newborn

Blood brain barrier –homeostasis;electrolytes

Urea,glucose ,protein,creatinine passively along concentration gradient

normal csf
Normal CSF
  • Thin, colourless, clear fluid
  • Pressure 90-180mm WATER (10-100 neonates)
  • 0-5 WBC’s /mm3 (neonates 0-30/ mm3 )
  • Lymphocytes & monocytes
  • Occasional ependymal or choroid plexus cells
  • Protein 15-45mg/dl
  • Glucose 50-80mg/dl
  • Chloride 113-130 mEq/L
  • Sterile
meningitis
Meningitis

Def: inflammatory process of the leptomeninges & CSF within the subarachnoid space

  • Meningoencephalitis =+inflammation of brain parenchyma
  • Classification
  • Acute
  • Aseptic
  • Chronic
pyogenic meningitis pathogenesis
Pyogenic meningitis pathogenesis
  • Blood borne
  • Direct-sinuses,mastoid,middle ear,dural venous sinuses,direct trauma,fracture skull
  • Neonates:E Coli,Strep pneumoniae,

Adolescents: N Meningitides, H influenzae

  • Adults: N Meningitides, Strep pneumoniae type 3
  • Elderly :Listeria monocytogenes,strep pneumoniae type 3
clinical features
Clinical features
  • General
  • Headache,altered consciousness,vomiting
  • Neck stiffness
gross
Gross
  • Pus in the subarachnoid space
  • Meningeal vessels engorged
  • Location-Pneumococcal-convexities
  • Tracks along vessels, ventriculitis
  • Microscopy
  • PMN in SA space,> meningial vessels
  • Thrombosis of superficial vessels &
  • Cerebral ischemic damage
csf in pyogenic meningitis
CSF in Pyogenic Meningitis
  • Increased pressure
  • Purulent/cloudy
  • ↑protein
  • ↓ glucose
  • Leucocytosis
  • Neutrophils ++
  • Gram stain
  • Culture
sequele
Sequele
  • Resolution
  • Cerebritis,hemorrhagic infarction of brain
  • Fibrosing meningitis
  • Hydrocephalus
  • Chronic adhesive arachnoiditis
aseptic lymphocytic meningitis
(Aseptic)Lymphocytic meningitis
  • Viral usually (Coxsackie, EBV, ECHO)

Less fulminant than bacterial

  • Usually recover
  • Few specimens
  • Mild lymphocytic infiltrate of the meninges
csf in viral meningitis
CSF in Viral meningitis

Clear appearance

Mild pleocytosis

Lymphocytes +

Protein↑

Glucose –WNL

Culture sterile

Virological exam-Coxsackie, EBV, ECHO

tubercular meningitis
Tubercular meningitis
  • Hematogenic spread
  • Gross:Thickening & opacity of leptomeniges
  • Basal meningitis, encasing cranial N’s
  • Discrete white granules on the meninges +/-
  • Microscopy-granulomas, lympho-plasmacytic infiltrate
  • Obliterative endarteritis
tubercular meningitis1
Tubercular meningitis
  • Sequele-adhesive, fibrous, arachnoiditis,
  • Hydrocephalus
  • Infarction following endarteritis
  • Tuberculoma-intraparenchymal
csf in tubercular meningitis
CSF in Tubercular meningitis
  • Moderate pleocytosis
  • Lymphocytosis (early –neutrophilia)
  • Glucose ↓ (< pyogenic )
  • Protein +++
  • Cobweb appearance /clot
  • AFB, culture, PCR.
  • Atypical mycobacteria
syphilis
Syphilis

Meningovascular neurosyphilis:Chronic meningitis

Base of brain

Cerebral convexities+/-,

Spinal leptomeninges

Cerebral Gumma

Microscopy-endarteritis obliterans (Heubner arteritis) with plasma cell cuffing

cerebral abscess
Cerebral abscess
  • Def: Focal inflammation of the parenchyma of the brain
  • Routes of infection
  • Secondary to meningitis
  • Local spread (middle ear,mastoid)
  • Hematogenous-BE,cyanotic heart disease,bronchiectasis
  • Trauma
gross morphology
GROSS MORPHOLOGY
  • Ill defined local swelling
  • preferred sites frontal lobe,parietal lobe cerebellum

depending on aetiology

  • C/S fibrous capsule soft central liquefactive necrosis

surrounding oedema

morphology
Morphology
  • Microscopy
  • Abscess containing necrosis surrounded by granulation tissue ,fibrosis & gliosis
  • Microbiology:mixed bacteria + anaerobes
encephalitis
Encephalitis
  • Diffuse brain inflammation
  • Causative org: viral,rickettsia,bacteria (listeria)
  • Death of neurons
hiv associated neurologic disorders
HIV associated Neurologic disorders
  • Primary:
  • CNS
  • Primary HIV encephalopathies
  • Giant cell encephalitis, leucoencepalopathy, gray matter disease
  • Myelopathy
  • Lymphocytic Meningitis-seroconversion
  • PNS
  • Skeletal muscle myositis
hiv associated neurologic disorders1
HIV associated Neurologic disorders
  • Associated with immune supressed condition
  • Opportunistic infections
  • Lymphoma
csf in aids
CSF in AIDS
  • Aseptic HIV meningitis-lymphocytic meningitis
  • Infections
  • M. tuberculosis less reactive
  • Mycobacterium avium intracellulare
  • Cryptococci
  • Neurosyphilis
  • Malignancies
other infections
OTHER INFECTIONS
  • Prion disease (CJD)
  • Fungal infections
  • Parasitic infections malaria, toxoplasmosis,Echinococcus,cysticercosis
intracranial hemorrhage
Intracranial hemorrhage
  • Intracerebral hematoma-associated with

hypertension,(AV malformations,tumour )

  • Subarachnoid hemorrhage
  • Any age group
  • Associated with rupture of Berry aneurysm
hemorrhagic tap
Traumatic

Clear supernatant

Clearing from tube 1 to 3

Fresh RBC’s

Subarachnoid hemorrhage

Xanthochromia>4 hrs upto 2-4 weeks

Same appearance in 1,2 & 3

Crenated RBC’s

Hemorrhagic tap
lumbar puncture
Lumbar puncture
  • Diagnostic
  • Meningitis;bacterial,TB,fungal, viral *,syphilis
  • encephalitis
  • Guillain Barre Syndrome
  • Matastasis lymphoma,leukaemia,breast,lung

Haemorrhage

  • Any disorder affecting the nervous system!
  • Therapeutic
  • Administer dye for imaging studies
  • Administer medications eg CT,anaesthesia
processing
Processing
  • Method of collection
  • 3 sterile bottles
  • Biochemistry & immunology-blood glucose
  • Microbiology
  • Cell count,cytology
  • Send QUICKLY
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