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NEUROPATHOLOGY III <ul><li>INFECTIONS OF THE CNS </li></ul><ul><li>  DEPT. OF PATHOLOGY </li></ul><ul><li>AMS07  </li></ul>
NEUROPATHOLOGY III <ul><li>INFECTIONS OF THE CNS.  </li></ul><ul><li>*Viral </li></ul><ul><li>-acute </li></ul><ul><li>-la...
NEUROPATHOLOGY III <ul><li>INFECTIONS OF THE CNS... </li></ul><ul><li>*Portal of entry. </li></ul>
NEUROPATHOLOGY III <ul><li>INFECTIONS OF THE CNS.. </li></ul><ul><li>Acute viral infections. </li></ul><ul><li>*Aseptic me...
NEUROPATHOLOGY III <ul><li>INFECTIONS... </li></ul><ul><li>ASEPTIC MENINGITIS. </li></ul><ul><li>*It is a benign, short-li...
NEUROPATHOLOGY III <ul><li>ASEPTIC MENINGITIS... </li></ul>
NEUROPATHOLOGY III <ul><li>ASEPTIC MENINGITIS... </li></ul>
NEUROPATHOLOGY III <ul><li>ASEPTIC MENINGITIS... </li></ul>
NEUROPATHOLOGY III <ul><li>VIRAL ENCEPHALITIS.... </li></ul>
NEUROPATHOLOGY III <ul><li>POLYOMYELITIS. </li></ul><ul><li>*Enteroviruses: </li></ul><ul><li>-Poliovirus-small RNA viruse...
NEUROPATHOLOGY III <ul><li>POLYOMYELITIS... </li></ul>
NEUROPATHOLOGY III <ul><li>POLYOMYELITIS.... </li></ul>
NEUROPATHOLOGY III <ul><li>POLYOMYELITIS... </li></ul>
NEUROPATHOLOGY III
NEUROPATHOLOGY III
NEUROPATHOLOGY III <ul><li>POLYOMYELITIS... </li></ul>
NEUROPATHOLOGY III <ul><li>HERPES VIRUSES – routes of infection </li></ul><ul><li>*HSV type 1. </li></ul><ul><li>-Direct c...
NEUROPATHOLOGY III <ul><li>HERPES VIRUS.... </li></ul>
NEUROPATHOLOGY III <ul><li>HERPES VIRUS... </li></ul>
NEUROPATHOLOGY III <ul><li>HERPES ENCEPHALITIS. </li></ul><ul><li>*Hemorrhagic ncrosis of temporal lobes, insula, cingulat...
NEUROPATHOLOGY III <ul><li>HERPES ENCEPHALITIS </li></ul>
NEUROPATHOLOGY III <ul><li>HERPES ENCEPHALITIS... </li></ul>
NEUROPATHOLOGY III <ul><li>HERPES ENCEPHALITIS... </li></ul>
NEUROPATHOLOGY III <ul><li>NEONATAL HSV ENCEPHALITIS. </li></ul><ul><li>*Etiologic agent is commonly HSV – 2 </li></ul><ul...
NEUROPATHOLOGY III <ul><li>VARICELLA-ZOSTER INFECTION. </li></ul><ul><li>*Due to reactivation of latent infection in dorsa...
NEUROPATHOLOGY III <ul><li>VARICELLA – ZOSTER INFECTION.... </li></ul><ul><li>  *Adult infections include: </li></ul><ul><...
NEUROPATHOLOGY III <ul><li>VARICELLA – ZOSTER INFECTION... </li></ul>
NEUROPATHOLOGY III <ul><li>VARICELLA-ZOSTER.... </li></ul>
NEUROPATHOLOGY III <ul><li>VARICELLA.ZOSTER.... </li></ul>
NEUROPATHOLOGY III <ul><li>VARICELLA – ZOSTER... </li></ul>
NEUROPATHOLOGY III <ul><li>CYTOMEGALOVIRUS INFECTION. </li></ul><ul><li>*Congenital CMV infection. </li></ul><ul><li>  -Is...
NEUROPATHOLOGY III <ul><li>CMV INFECTION... </li></ul>
NEUROPATHOLOGY III <ul><li>CMV INFECTION... </li></ul>
NEUROPATHOLOGY III <ul><li>CMV INFECTION... </li></ul><ul><li>*CMV encephalitis and myeloradiculitis is common in AIDS pat...
NEUROPATHOLOGY III <ul><li>CMV INFECTION... </li></ul>
NEUROPATHOLOGY III <ul><li>ARBOVIRUS INFECTIONS. </li></ul><ul><li>*Small enveloped RNA v iruses transmitted by arthropod ...
NEUROPATHOLOGY III <ul><li>ARBOVIRUS INFECTION... </li></ul>
NEUROPATHOLOGY III <ul><li>ARBOVIRUS.... </li></ul>
NEUROPATHOLOGY III <ul><li>ARBOVIRUS... </li></ul>
NEUROPATHOLOGY III <ul><li>ARBOVIRUS... </li></ul>
NEUROPATHOLGOY III <ul><li>PROGRESS.MULTIF.LEUKOENCEPHALOP. </li></ul><ul><li>*JC virus detectable in tonsilar tissue of 1...
NEUROPATHOLOGY III <ul><li>PROGRESSIVE MULTIFOCAL..... </li></ul>
NEUROPATHOLOGY III <ul><li>PROGRESSIVE MULTIFOCAL.. </li></ul>
NEUROPATHOLOGY III <ul><li>PROGRESSIVE MULTIFOCAL...  </li></ul><ul><li>*Result from reactivation of latent JC virus  infe...
NEUROPATHOLOGY III <ul><li>PROGRESSIVE MULTIFOCAL... </li></ul><ul><li>*Pathology: </li></ul><ul><li>-Multifocal white mat...
NEUROPATHOLOGY III <ul><li>PROGRESSIVE MULTIFOCAL... </li></ul>
NEUROPATHOLOGY III <ul><li>PROGRESSIVE MULTIFOCAL... </li></ul>
NEUROPATHOLOGY III <ul><li>PROGRESSIVE MULTIFOCAL... </li></ul>
NEUROPATHOLOGY III <ul><li>PROGRESSIVE MULTIFOCAL.... </li></ul>
NEUROPATHOLOGY III <ul><li>CHRONIC/SUBACUTE VIRAL INFECT. </li></ul><ul><li>*Subacute Measles encephalitis. </li></ul><ul>...
NEUROPATHOLOGY III <ul><li>SUBACUTE SCLEROSING PANENCEPH </li></ul><ul><li>*Refers to viral persistence related to hyper- ...
NEUROPATHOLOGY III <ul><li>SUBACUTE SCLEROSING PANENCEPH </li></ul><ul><li>(SSPE)... </li></ul><ul><li>*Is an uncommon cli...
NEUROPATHOLOGY III
NEUROPATHOLOGY III <ul><li>SSPE.... </li></ul>
NEUROPATHOLOGY III <ul><li>PROGRESSIVE RUBELLA PANENCEPHALITIS. </li></ul><ul><li>*Clinical presentation is between ages o...
NEUROPATHOLOGY III <ul><li>RETROVIRAL INFECTIONS OF CNS. </li></ul><ul><li>*Human T cell leukemia/lymphotropic virus – 1(H...
NEUROPATHOLOGY III <ul><li>RETROVIRAL INFECTIONS... </li></ul><ul><li>*Human Immunodeficiency Virus(HIV) </li></ul><ul><li...
NEUROPATHOLOGY III <ul><li>RETROVIRAL INFECTIONS.... </li></ul>
NEUROPATHOLOGY III <ul><li>RETROVIRAL INFECTIONS... </li></ul>
NEUROPATHOLOGY III <ul><li>HIV INFECTION... </li></ul>
NEUROPATHOLOGY III <ul><li>HIV INFECTION... </li></ul>
NEUROPATHOLOGY III <ul><ul><ul><ul><li>BACTERIAL INFECTIONS . </li></ul></ul></ul></ul>
NEUROPATHOLOGY III <ul><li>MENINGITIS, SUBDURAL EMPYEMA,  ABSCESS, VENTRICULITIS. </li></ul><ul><li>*Etiology: </li></ul><...
NEUROPATHOLOGY III <ul><li>BACTERIAL MENIGITIS. </li></ul><ul><li>*Sporadic – aprox.15,000 children/year,  6-9 months old ...
NEUROPATHOLOGY III <ul><li>BACTERIAL MENINGITIS.... </li></ul><ul><li>*Factors influencing outcome:  -Age, immune status(A...
NEUROPATHOLOGY III <ul><li>BACTERIAL MENINGITIS...  *Complications:  -Cerebral edema  raised intracranial press.   herni...
NEUROPATHOLOGY III <ul><li>BACTERIAL MENINGITIS....  *Complications...  -Subdural effusion(empyema)  -Hydrocephalus  -Moto...
 
 
 
NEUROPATHOLOGY III <ul><li>BACTERIAL MENINGITIS....  *Dx.:  -Headache, malaise, mental confusion, fever, vomiting,convulsi...
NEUROPATHOLOGY III <ul><li>CSF .  -Normal.  Meningitis  pressure   pyogenic   TB   60-120mm  >200 mm  >200mmH2O  appearanc...
NEUROPATHOLOGY III <ul><li>SYPHILIS. </li></ul><ul><li>*Asymptomatic. </li></ul><ul><li>-CSF pleocytosis,increased Igs+ser...
 
NEUROPATHOLOGY III <ul><li>FUNGAL INFECTIONS. </li></ul>
NEUROPATHOLOGY III <ul><li>FUNGAL INFECTIONS. </li></ul><ul><li>*Most fungal infections occur as opportunistic infections ...
NEUROPATHOLOGY III <ul><li>FUNGAL.... </li></ul>
NEUROPATHOLOGY III <ul><li>FUNGAL... </li></ul>
 
 
 
 
 
NEUROPATHOLOGY III <ul><li>BRAIN ABSCESS. </li></ul><ul><li>Etiology.  *Streptococci milleri(most common) gram-  bacilli, ...
 
 
 
NEUROPATHOLOGY III <ul><li>PARASITIC INFECTIONS </li></ul>
NEUROPATHOLOGY III <ul><li>AMEBIASIS. </li></ul><ul><li>*Primary – Naegleria fowleri- acute hemorrhagic  necrotizing encep...
 
 
NEUROPATHOLOGY III <ul><li>TOXOPLASMOSIS. </li></ul><ul><li>*CNS infections seen in: </li></ul><ul><li>-Defective cell imm...
 
 
 
 
 
NEUROPATHOLOGY III <ul><li>CYSTICERCOSIS. </li></ul><ul><li>*Epidemiology.  -Endemic in all countries except in     Austra...
NEUROPATHOLOGY III <ul><li>CYSTICERCOSIS... </li></ul><ul><li>-Acquired after ingestion of larval stage in  unhygienic por...
NEUROPATHOLOGY III <ul><li>CYSTICERCOSIS...  *Clinical:  -Parenchymal cysts-seizures, focal signs without increased ICP </...
NEUROPATHOLOGY III <ul><li>CYSTICERCOSIS... </li></ul><ul><li>*Dx.: </li></ul><ul><li>-CT and MRI scans-cystic lesions+cal...
 
 
 
NEUROPATHOLOGY III <ul><li>PRION DISEASES. </li></ul><ul><li>*Creutzfeldt-Jakob disease(CJD) </li></ul><ul><li>*Gerstmann-...
NEUROPATHOLOGY III <ul><li>PRION DISEASES.... </li></ul>
NEUROPATHOLOGY III <ul><li>PRION DISEASES... </li></ul>
 
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  1. 1. NEUROPATHOLOGY III <ul><li>INFECTIONS OF THE CNS </li></ul><ul><li> DEPT. OF PATHOLOGY </li></ul><ul><li>AMS07 </li></ul>
  2. 2. NEUROPATHOLOGY III <ul><li>INFECTIONS OF THE CNS. </li></ul><ul><li>*Viral </li></ul><ul><li>-acute </li></ul><ul><li>-latent </li></ul><ul><li>-slow virus infections </li></ul><ul><li>*Bacterial </li></ul><ul><li>-acute(pyogenic) </li></ul><ul><li>-chronic(granulomatous):AIDS(atypical myco bacteria), non-AIDS(mycobacterium TB, sy </li></ul><ul><li> philis) </li></ul><ul><li>*Fungal *Parasitic </li></ul>
  3. 3. NEUROPATHOLOGY III <ul><li>INFECTIONS OF THE CNS... </li></ul><ul><li>*Portal of entry. </li></ul>
  4. 4. NEUROPATHOLOGY III <ul><li>INFECTIONS OF THE CNS.. </li></ul><ul><li>Acute viral infections. </li></ul><ul><li>*Aseptic meningitis </li></ul><ul><li>*Poliomyelitis/Polioencephalomyelitis </li></ul><ul><li>*Encephalitis: </li></ul><ul><li>-Herpes simplex encephalitis </li></ul><ul><li>-Neonatal HSV encephalitis </li></ul><ul><li>-Varicella-zoster virus infections </li></ul><ul><li>-CMV infection </li></ul><ul><li>-Rubella encephalitis -Rabies infection </li></ul><ul><li>-Arbovirus infection </li></ul>
  5. 5. NEUROPATHOLOGY III <ul><li>INFECTIONS... </li></ul><ul><li>ASEPTIC MENINGITIS. </li></ul><ul><li>*It is a benign, short-lived meningeal infla- mmation *Viral causes include: </li></ul><ul><li>-Enteroviruses(MOST common)-Echovi ruses/Coxsackie A and B </li></ul><ul><li>-Herpes simplex type 2 </li></ul><ul><li>-Mumps, Measles and Adenovirus </li></ul><ul><li>*Scanty meningeal infiltrate </li></ul><ul><li>*Death may be due to secondary systemic disease vgr.: viral myocarditis </li></ul>
  6. 6. NEUROPATHOLOGY III <ul><li>ASEPTIC MENINGITIS... </li></ul>
  7. 7. NEUROPATHOLOGY III <ul><li>ASEPTIC MENINGITIS... </li></ul>
  8. 8. NEUROPATHOLOGY III <ul><li>ASEPTIC MENINGITIS... </li></ul>
  9. 9. NEUROPATHOLOGY III <ul><li>VIRAL ENCEPHALITIS.... </li></ul>
  10. 10. NEUROPATHOLOGY III <ul><li>POLYOMYELITIS. </li></ul><ul><li>*Enteroviruses: </li></ul><ul><li>-Poliovirus-small RNA viruses </li></ul><ul><li>-Infrequent since Salk vaccine(inactiva- ted) or Sabin(attenuated)development </li></ul><ul><li>-Rare reversion to virulence in attenua- ted virus </li></ul><ul><li>-Echovirus or Coxsackie A/B are rare causes in populations immunizated against poliovir. -Fecal-oral transmission </li></ul><ul><li>-Lytic inf. of motor neurons in spinal cord/brain  neuronophagia+microglia nodls. </li></ul>
  11. 11. NEUROPATHOLOGY III <ul><li>POLYOMYELITIS... </li></ul>
  12. 12. NEUROPATHOLOGY III <ul><li>POLYOMYELITIS.... </li></ul>
  13. 13. NEUROPATHOLOGY III <ul><li>POLYOMYELITIS... </li></ul>
  14. 14. NEUROPATHOLOGY III
  15. 15. NEUROPATHOLOGY III
  16. 16. NEUROPATHOLOGY III <ul><li>POLYOMYELITIS... </li></ul>
  17. 17. NEUROPATHOLOGY III <ul><li>HERPES VIRUSES – routes of infection </li></ul><ul><li>*HSV type 1. </li></ul><ul><li>-Direct contact w/infect.secretions from mouth vesicles(“cold sore”) -Involvement of olphactory tract after na sopharyngeal infection -Reactivation of latent infection(trigem. ganglia, temporal lobe or other areas of CNS. </li></ul><ul><li> *HSV type 2. </li></ul><ul><li>-General mucocutaneous infection -React. of latent infect. in sacral dorsal root ganglion </li></ul>
  18. 18. NEUROPATHOLOGY III <ul><li>HERPES VIRUS.... </li></ul>
  19. 19. NEUROPATHOLOGY III <ul><li>HERPES VIRUS... </li></ul>
  20. 20. NEUROPATHOLOGY III <ul><li>HERPES ENCEPHALITIS. </li></ul><ul><li>*Hemorrhagic ncrosis of temporal lobes, insula, cingulate gyri and posterior orbital frontal lobe </li></ul><ul><li>*Intense perivascular inflammation, micro- glial nodules, eosinophilic inclusions and necrosis </li></ul>
  21. 21. NEUROPATHOLOGY III <ul><li>HERPES ENCEPHALITIS </li></ul>
  22. 22. NEUROPATHOLOGY III <ul><li>HERPES ENCEPHALITIS... </li></ul>
  23. 23. NEUROPATHOLOGY III <ul><li>HERPES ENCEPHALITIS... </li></ul>
  24. 24. NEUROPATHOLOGY III <ul><li>NEONATAL HSV ENCEPHALITIS. </li></ul><ul><li>*Etiologic agent is commonly HSV – 2 </li></ul><ul><li>*Acquired during delivery or by feto-mater nal transmission in utero during early preg nancy </li></ul><ul><li>-15-20% of cases caused by HSV-1infec tion </li></ul><ul><li>*Diffuse necrotizing encephalitis </li></ul><ul><li>-May occur as part of a systemic HSV-2 infection </li></ul>
  25. 25. NEUROPATHOLOGY III <ul><li>VARICELLA-ZOSTER INFECTION. </li></ul><ul><li>*Due to reactivation of latent infection in dorsal root or trigeminal ganglia  shingles </li></ul><ul><li>*Risk factors for reactivation: </li></ul><ul><li>-Cancer </li></ul><ul><li>-Lymphoma </li></ul><ul><li>-Ionizing radiation </li></ul><ul><li>-Immunosuppresion </li></ul>
  26. 26. NEUROPATHOLOGY III <ul><li>VARICELLA – ZOSTER INFECTION.... </li></ul><ul><li> *Adult infections include: </li></ul><ul><li>-Zoster encephalitis/myeloradiculitis </li></ul><ul><li>-Zoster intracranial vasculopathy/vasculi tis(autoimmune process) </li></ul><ul><li> * Childhood infections include: </li></ul><ul><li>-Varicella cerebellitis </li></ul><ul><li>-Varicella meningoencephalitis </li></ul><ul><li>-Intrauterine VZ infection </li></ul><ul><li>-Neonantal VZ infection </li></ul>
  27. 27. NEUROPATHOLOGY III <ul><li>VARICELLA – ZOSTER INFECTION... </li></ul>
  28. 28. NEUROPATHOLOGY III <ul><li>VARICELLA-ZOSTER.... </li></ul>
  29. 29. NEUROPATHOLOGY III <ul><li>VARICELLA.ZOSTER.... </li></ul>
  30. 30. NEUROPATHOLOGY III <ul><li>VARICELLA – ZOSTER... </li></ul>
  31. 31. NEUROPATHOLOGY III <ul><li>CYTOMEGALOVIRUS INFECTION. </li></ul><ul><li>*Congenital CMV infection. </li></ul><ul><li> -Is the commonest intrauterine viral infect. (0.2 – 2% of live births) </li></ul><ul><li> -Fetomaternal transplacental transmission </li></ul><ul><li> -About 20% risk of transmission during pri mary maternal infection(2% during recrudes cence) </li></ul><ul><li> -Necrotizing encephalitis </li></ul><ul><li> -Ventriculoencephalitis </li></ul><ul><li> -Complications: microcephaly, microgyria,poren cephaly, hydrocephaly, periventricular calcific. </li></ul>
  32. 32. NEUROPATHOLOGY III <ul><li>CMV INFECTION... </li></ul>
  33. 33. NEUROPATHOLOGY III <ul><li>CMV INFECTION... </li></ul>
  34. 34. NEUROPATHOLOGY III <ul><li>CMV INFECTION... </li></ul><ul><li>*CMV encephalitis and myeloradiculitis is common in AIDS patients </li></ul><ul><li>*Patterns of CNS infection: </li></ul><ul><li>-Low grade encephalitis </li></ul><ul><li>-Necrotizing encephalitis w/large cysts </li></ul><ul><li>-Ventriculoencephalitis w/hemorrhagic necrosis </li></ul><ul><li>-Lumbosacral myeloradiculitis </li></ul>
  35. 35. NEUROPATHOLOGY III <ul><li>CMV INFECTION... </li></ul>
  36. 36. NEUROPATHOLOGY III <ul><li>ARBOVIRUS INFECTIONS. </li></ul><ul><li>*Small enveloped RNA v iruses transmitted by arthropod vectors from birds/rodents to man/horses, often in summer and fall </li></ul><ul><li>*Mosquito borne encephalitis: TOGAVIRIDAE. </li></ul><ul><li>-Eastern equine encephalitis </li></ul><ul><li>-Western equine encephalitis </li></ul><ul><li>-Venezuelan equine encephalitis </li></ul><ul><li>FLAVIVIRIDAE. -St.Louis encephalitis </li></ul><ul><li>BUNYAVIRIDAE. La crosse(California sero group) </li></ul><ul><li>| *Tick-borne encephalitis: Colorado tick fever </li></ul>
  37. 37. NEUROPATHOLOGY III <ul><li>ARBOVIRUS INFECTION... </li></ul>
  38. 38. NEUROPATHOLOGY III <ul><li>ARBOVIRUS.... </li></ul>
  39. 39. NEUROPATHOLOGY III <ul><li>ARBOVIRUS... </li></ul>
  40. 40. NEUROPATHOLOGY III <ul><li>ARBOVIRUS... </li></ul>
  41. 41. NEUROPATHOLGOY III <ul><li>PROGRESS.MULTIF.LEUKOENCEPHALOP. </li></ul><ul><li>*JC virus detectable in tonsilar tissue of 1/3 of children and adults </li></ul><ul><li>*50% of adolescents and 75% of adults have serological evidence of JC virus infect. </li></ul><ul><li>*Oligodendroglia support productive infect.  cell lysis  demyelination </li></ul><ul><li>*Astrocytes produce infect.  morphological transformation and bizarre appearance </li></ul>
  42. 42. NEUROPATHOLOGY III <ul><li>PROGRESSIVE MULTIFOCAL..... </li></ul>
  43. 43. NEUROPATHOLOGY III <ul><li>PROGRESSIVE MULTIFOCAL.. </li></ul>
  44. 44. NEUROPATHOLOGY III <ul><li>PROGRESSIVE MULTIFOCAL... </li></ul><ul><li>*Result from reactivation of latent JC virus infection due to impaired cell-mediated immunity: </li></ul><ul><li>-Post-renal transplants </li></ul><ul><li>-Lymphoma/leukemia patients </li></ul><ul><li>-Acquired immune deficiency syndrome (accounts for 89% of PML cases) </li></ul><ul><li>*Clinical: </li></ul><ul><li>-Focal neurologic deficits – dysartria,paresis, ataxia, visual deficits, personality changes and occasionally seizures. </li></ul>
  45. 45. NEUROPATHOLOGY III <ul><li>PROGRESSIVE MULTIFOCAL... </li></ul><ul><li>*Pathology: </li></ul><ul><li>-Multifocal white matter demyelination </li></ul><ul><li>-Scanty perivascular lymphocytic infiltr. </li></ul><ul><li>-Bizarre pleomorphic,hyperchromatic astrocytes </li></ul><ul><li>-Enlarged oligodendroglia w/intranucl. inclusions </li></ul><ul><li>-CSF + for JC viral nucleic acid </li></ul><ul><li>*Progression of relentless w/increasing neurologic </li></ul><ul><li> deficits, dementia and death. </li></ul>
  46. 46. NEUROPATHOLOGY III <ul><li>PROGRESSIVE MULTIFOCAL... </li></ul>
  47. 47. NEUROPATHOLOGY III <ul><li>PROGRESSIVE MULTIFOCAL... </li></ul>
  48. 48. NEUROPATHOLOGY III <ul><li>PROGRESSIVE MULTIFOCAL... </li></ul>
  49. 49. NEUROPATHOLOGY III <ul><li>PROGRESSIVE MULTIFOCAL.... </li></ul>
  50. 50. NEUROPATHOLOGY III <ul><li>CHRONIC/SUBACUTE VIRAL INFECT. </li></ul><ul><li>*Subacute Measles encephalitis. </li></ul><ul><li>-Measles inclusion encephalitis: </li></ul><ul><li> Develops several months after infect. </li></ul><ul><li> Most are immunosuppressed </li></ul><ul><li>*Subacute sclerosing panencephalitis: </li></ul><ul><li> Chronic progressive encephalitis that follows exposure to measles virus by several yrs. </li></ul><ul><li>*Progressive Rubella panencephalitis </li></ul><ul><li> Delayed complication of intrauterine or chilhood infection </li></ul>
  51. 51. NEUROPATHOLOGY III <ul><li>SUBACUTE SCLEROSING PANENCEPH </li></ul><ul><li>*Refers to viral persistence related to hyper- mutation of susceptible regions of virus encoding M,H and F proteins </li></ul><ul><li>*Non-production of altered proteins  effective evasion of immune response </li></ul><ul><li>*Persistent cell fusion ability results in persistent in- </li></ul><ul><li>fection </li></ul>
  52. 52. NEUROPATHOLOGY III <ul><li>SUBACUTE SCLEROSING PANENCEPH </li></ul><ul><li>(SSPE)... </li></ul><ul><li>*Is an uncommon clinical syndrome characte rized by: cognitive decline, spasticity of limbs and seizures </li></ul><ul><li>*It occurs in children or young adults, months or years after an initial, early age acute infec tion w/measles </li></ul>
  53. 53. NEUROPATHOLOGY III
  54. 54. NEUROPATHOLOGY III <ul><li>SSPE.... </li></ul>
  55. 55. NEUROPATHOLOGY III <ul><li>PROGRESSIVE RUBELLA PANENCEPHALITIS. </li></ul><ul><li>*Clinical presentation is between ages of 8 tand 20 yrs. with insidious onset of dementia and ataxia </li></ul><ul><li>*Other features: </li></ul><ul><li>-Seizures, spasticity, choreoathetosis and myo- </li></ul><ul><li>clonus </li></ul>
  56. 56. NEUROPATHOLOGY III <ul><li>RETROVIRAL INFECTIONS OF CNS. </li></ul><ul><li>*Human T cell leukemia/lymphotropic virus – 1(HTLV –1). </li></ul><ul><li>Tropical spastic paraparesis </li></ul><ul><li> -progressive spastic paraparesis </li></ul><ul><li> -demyelination+gliosis of lateral columns and less often anterior and posterior cols. </li></ul><ul><li> -HTLV-1 is endemic in Caribbean, South </li></ul><ul><li> America, Japan, Seychelles, etc. </li></ul>
  57. 57. NEUROPATHOLOGY III <ul><li>RETROVIRAL INFECTIONS... </li></ul><ul><li>*Human Immunodeficiency Virus(HIV) </li></ul><ul><li>-Direct HIV infection of CNS+AIDS de- mentia complex </li></ul><ul><li>-Vacuolar myelopathy </li></ul><ul><li>-Opportunistic infections of CNS(CMV) </li></ul>
  58. 58. NEUROPATHOLOGY III <ul><li>RETROVIRAL INFECTIONS.... </li></ul>
  59. 59. NEUROPATHOLOGY III <ul><li>RETROVIRAL INFECTIONS... </li></ul>
  60. 60. NEUROPATHOLOGY III <ul><li>HIV INFECTION... </li></ul>
  61. 61. NEUROPATHOLOGY III <ul><li>HIV INFECTION... </li></ul>
  62. 62. NEUROPATHOLOGY III <ul><ul><ul><ul><li>BACTERIAL INFECTIONS . </li></ul></ul></ul></ul>
  63. 63. NEUROPATHOLOGY III <ul><li>MENINGITIS, SUBDURAL EMPYEMA, ABSCESS, VENTRICULITIS. </li></ul><ul><li>*Etiology: </li></ul><ul><li>-Neonate –Group B Streptococci, E.coli -1-10 yrs – H.influenza(most common), N.meningitides,Streptococcus pneumon. -11-20 yrs – N.meningitides(most common), S. pneumoniae ->30 yrs – S. pneumoniae, N. Meningitides, gram negative bacilli -Mycobacteria  meningitis, tuberculoma </li></ul>
  64. 64. NEUROPATHOLOGY III <ul><li>BACTERIAL MENIGITIS. </li></ul><ul><li>*Sporadic – aprox.15,000 children/year, 6-9 months old -Epidemic </li></ul><ul><li>*Mode of entry to CNS -Hematogenous -Compound Fx -Otitis media -Sinusitis -Bacterial endocarditis </li></ul>
  65. 65. NEUROPATHOLOGY III <ul><li>BACTERIAL MENINGITIS.... </li></ul><ul><li>*Factors influencing outcome: -Age, immune status(AIDS),sickle-cell ane- mia -Virulence of agent, vgr. meningococcus - skin rash,septicemia,adrenal hemorrhage  shock(W-F syndrome) -Duration of infection before Tx. </li></ul>
  66. 66. NEUROPATHOLOGY III <ul><li>BACTERIAL MENINGITIS... *Complications: -Cerebral edema  raised intracranial press.  herniation -Angiitis/obliterative endarteritis  brain in- farction(TB) -Inappropiate ADH secretion -Cranial nerve palsy(e.g.sensori-neural deafness) </li></ul>
  67. 67. NEUROPATHOLOGY III <ul><li>BACTERIAL MENINGITIS.... *Complications... -Subdural effusion(empyema) -Hydrocephalus -Motor deficits -Seizures -Mental retardation </li></ul>
  68. 71. NEUROPATHOLOGY III <ul><li>BACTERIAL MENINGITIS.... *Dx.: -Headache, malaise, mental confusion, fever, vomiting,convulsions or seizures(TB) -Physical examination showing neck stiff- ness, Kernig´s sign -Lab.: CSF examination w/Gram stain, culture. PCR for HSV </li></ul>
  69. 72. NEUROPATHOLOGY III <ul><li>CSF . -Normal. Meningitis pressure pyogenic TB 60-120mm >200 mm >200mmH2O appearance crystal clear turbid opalescent cell content 0-4mononucl. >1000PMN´s lymphos. proteins 0.2-0.4g/l 1-10 g/l 1-3g/l glucose 50-80 mg/100ml decreased low </li></ul>
  70. 73. NEUROPATHOLOGY III <ul><li>SYPHILIS. </li></ul><ul><li>*Asymptomatic. </li></ul><ul><li>-CSF pleocytosis,increased Igs+serology *Meningitis. -1-2 yrs after initial infection *Meningovascular syphilis -Arteritis *General paresis -Chronic meningoencephalitis -10-20 yrs after initial infection -Psychiatric disord.,seizures,intellectual decline, loss of motor control, incontinence *Tabes dorsalis-chronic inflamm. of dorsal roots+ ganglia  column degeneration </li></ul>
  71. 75. NEUROPATHOLOGY III <ul><li>FUNGAL INFECTIONS. </li></ul>
  72. 76. NEUROPATHOLOGY III <ul><li>FUNGAL INFECTIONS. </li></ul><ul><li>*Most fungal infections occur as opportunistic infections </li></ul><ul><li>*Predisposing factors for opportunistic infections: </li></ul><ul><li> -Immunosuppresive therapy, HIV infect., diabetes mellitus,neutropenia,alcoholism, IV drug abuser,malnutrition,etc. *Most common: Candidosis, Cryptococcosis,As- pergillosis, Mucormycosis. </li></ul>
  73. 77. NEUROPATHOLOGY III <ul><li>FUNGAL.... </li></ul>
  74. 78. NEUROPATHOLOGY III <ul><li>FUNGAL... </li></ul>
  75. 84. NEUROPATHOLOGY III <ul><li>BRAIN ABSCESS. </li></ul><ul><li>Etiology. *Streptococci milleri(most common) gram- bacilli, Staph.aureus,bacteriodes -Direct spread from paranasal sinuses(50%) -Hematogenous(25%)from lung abscess,sub acute endocarditis, bronchiectasis,etc. -Mortality – 20% -Morbidity w/focal neurologic deficits or epilepsy (50%) </li></ul>
  76. 88. NEUROPATHOLOGY III <ul><li>PARASITIC INFECTIONS </li></ul>
  77. 89. NEUROPATHOLOGY III <ul><li>AMEBIASIS. </li></ul><ul><li>*Primary – Naegleria fowleri- acute hemorrhagic necrotizing encephalitis in healthy individuals w/recent past history of swimming on fresh waters </li></ul><ul><li>*Granulomatous-Acanthameba sp.-immune com promised patients </li></ul><ul><li>*Cerebral amebic abscess-disseminated E.hystoly- tica infection </li></ul>
  78. 92. NEUROPATHOLOGY III <ul><li>TOXOPLASMOSIS. </li></ul><ul><li>*CNS infections seen in: </li></ul><ul><li>-Defective cell immunity such as in AIDS and is secondary to reactivation of dormant infection. </li></ul><ul><li>-Congenital infection following transplacen tal spread </li></ul>
  79. 98. NEUROPATHOLOGY III <ul><li>CYSTICERCOSIS. </li></ul><ul><li>*Epidemiology. -Endemic in all countries except in Australia </li></ul><ul><li>-Very common in L.A.-1.4-3.6% in auto psies(México) </li></ul><ul><li>-Caused by Tenia solium(pig tapeworm) -Man is definitive host-adult parasite in small intestine </li></ul>
  80. 99. NEUROPATHOLOGY III <ul><li>CYSTICERCOSIS... </li></ul><ul><li>-Acquired after ingestion of larval stage in unhygienic pork meat </li></ul><ul><li>-Pig is intermediate host </li></ul><ul><li>-Infection after ingestion of eggs(fecal cont) -Human cysticercosis when man is interme- diate host w/ingestion of eggs. </li></ul>
  81. 100. NEUROPATHOLOGY III <ul><li>CYSTICERCOSIS... *Clinical: -Parenchymal cysts-seizures, focal signs without increased ICP </li></ul><ul><li>-Meningeal cysts(often basal)-hydrocephal., vascular occlusion </li></ul><ul><li>-Ventricular cysts-most commonly in 4th ventricle </li></ul><ul><li>-Spinal cord cysts-uncommon </li></ul>
  82. 101. NEUROPATHOLOGY III <ul><li>CYSTICERCOSIS... </li></ul><ul><li>*Dx.: </li></ul><ul><li>-CT and MRI scans-cystic lesions+calcifica tions in chronic cases </li></ul><ul><li>-CSF serology-ELISA  90% sensitivity </li></ul>
  83. 105. NEUROPATHOLOGY III <ul><li>PRION DISEASES. </li></ul><ul><li>*Creutzfeldt-Jakob disease(CJD) </li></ul><ul><li>*Gerstmann-Strausler-Scheinker dis.(GSS) </li></ul><ul><li>*Fatal familial insomnia(FFI) </li></ul><ul><li>*Kuru </li></ul><ul><li>COMMON FEATURES. </li></ul><ul><li>-Accumulation of abnormal cellular protein </li></ul><ul><li>-Transmission: sporadic(85%),familial(15%),iatrogenic CJD(ino- culation, tissue transplant),endocannibalism(kuru) -Epidemiology: CJD incidence 1-2/million </li></ul><ul><li>age of onset 55-75 M=F </li></ul>
  84. 106. NEUROPATHOLOGY III <ul><li>PRION DISEASES.... </li></ul>
  85. 107. NEUROPATHOLOGY III <ul><li>PRION DISEASES... </li></ul>
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