PREPARED BY: MUHAMMAD ARIFF B. MAHDZUB BACHELOR MEDICINE AND SURGERY (MBBS) UNIVERSITY COLLEGE SHAHPUTRA, KUANTAN

1. 1
MeningitisPROBLEM BASED LEARNING (PBL)
PREPARED BY: MUHAMMAD ARIFF B. MAHDZUB
BACHELOR MEDICINE AND SURGERY (MBBS)
UNIVERSITY COLLEGE SHAHPUTRA, KUANTAN

2. Infection
&
Tumors

3. Infectious agents reach the Nervous
System through
• Hematogenous spread: through arterial blood
supply.
• Direct implantation of microorganisms.
• Local extension with infections of the skull.
• Peripheral nerves: entry of pathogens such as
rabies.

4. INFECTIONS
• Meningitis.
• Parenchymal infections.
• Prion diseases.

5. Meningitis
• Acute Pyogenic Meningitis (Bacterial
Meningitis)
• Aseptic Meningitis (Viral Meningitis).
• Chronic Meningitis.

6. Acute Pyogenic Meningitis (Bacterial
Meningitis)
• The organisms vary with patient age.
• Neonates: Escherichia coli and group B streptococci.
• Adolescents and young adults: Neisseria meningitidis.
• Older individual: Streptococcus pneumoniae and Listeria
monocytogenes.
• Signs: meningeal irritation and neurologic impairment
(headache, photophobia, neck stiffness).
• Lumbar puncture: increase
pressure, CSF show
abundant neutrophils,
elevated protein and
reduced glucose.

7. Aseptic Meningitis (Viral Meningitis).
• Patient: meningeal irritation, fever and
alterations in consciousness (acute onset).
• Lumbar tap: CSF show lymphocytosis,
moderate protein level, normal glucose level.

8. Chronic Meningitis.
• Tuberculous Meningitis.
- Mycobacteria.
- S&S: headache, malaise, mental confusion &
vomiting.
• Spirochetal Infections.
- Neurosyphilis (tertiary stage of syphilis):
untreated Treponema pallidum infection.
- S&S: progressive loss of mental and physical
functions, mood alterations and severe dementia.

9. Parenchymal infections.
• Brain Abscesses.
- Nearly always caused by bacterial infections.
- Arise by direct implantation of organisms,
hematogenous spread.
- Patient: progressive focal deficits, general
signs related to increased intracranial
pressure.

10. • Viral Encephalitis
- Parenchymal infection of the brain that
associated with meningeal inflammation.
- eg: rabies virus, poliovirus.

11. Prion diseases.
• Agents: abnormal form of a cellular protein.
• Eg; Creutzfeldt-Jakob disease(CJD).
- A rapidly progressive dementing illness,
changes in memory and behavior (death in 7
month).

12. TUMORS
• Gliomas – astrocytomas, oligodendrogliomas,
ependymomas.
• neuronal tumors.
• Embyronal (Primitive) Neoplasms –
medulloblastoma.
• Meningiomas.
• Metastatic tumors.

13. Epidemiology
• Primary brain tumors in adults – 70% occur
above the tentorium cerebelli.
• Primary brain tumors in children – 70% occur
below the tentorium cerebelli (second most
common cancer in children).
• Risk factors – Turcot syndrome,
neurofibromastosis, cigarette smoking.
• General clinical findings – headache, seizures.

15. Astrocytoma
• Accounts for about 70% of all neuroglial
tumors.
• In adults – tumor usually involves frontal lobe.
• In children – tumor usually involves
cerebellum.
• Low-grade cancer : Grades I and II.
• High-grade cancers: Grades III and IV.
• Rarely metastasize outside the CNS.

16. Oligodendroglioma
• Benign tumour derived from
oligodendrocytes.
• Primarily occur in adults.
• Site of calcifies – usually frontal lobes.

17. Ependymoma
• Benign tumor derived from ependymal cells.
• In adults – arise in cauda equina.
• In children – arise in the fourth ventricle, can
produce noncommunicating hydrocephalus.

18. Medulloblastoma
• Malignant small cell tumour – primarily occurs
in children.
• Arises from the external granular cell layer of
cerebellum.
• Often invades the fourth ventricles.

19. Meningiomas
• Most common benign brain tumour in adults.
• Derived from meningothelial cell within the
arachnoid membrane.
• Firm tumours
- Not invade the surface of brain.
- Often infiltrate the overlying bone – caused
increased bone density.

20. Metastatic tumors
• Most common brain malignancy.
• Common cancer : lung, breast, skin
(melanoma), kidney,
gastrointestinal tract (in order
of decreasing frequency).
• Prostate cancer can metastasize
to brain and dura (but rarely
to the brain).