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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Inflammations infections of cns and cerebrospinal fluid

Inflammations & infections of CNS and Cerebrospinal fluid

Dr Aarathi Rau


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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