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This Concept Map, created with IHMC CmapTools, has information related to: CNS Infx, Central Nervous System INFECTIONS Prions TRANSMISSIBLE SPONGIFORM ENCEPHALOPATHIES -most -> progressive dementia -rapid -neuron intracellular vacuoles -esp deep gray matter -status spongiosis w/ expansion -KURU PLAQUES-PAS, Congo + PrP^c is NL-alpha helix -chrom 20-PRNP gene PrP^sc or ^res - beta pleated -protease resistant -high rate of mutation in: fam CJD, fam GSS, fatal familial insomnia ->corrupt other NL PrP, Central Nervous System INFECTIONS Fungal -immunosupp -brain often later ASPERGILLUS FUMIGATUS -vasculitis, Central Nervous System INFECTIONS HIV-1 -60% AIDS get neuro Sx HIV-1 MENINGOENCEPHALITIS (SUBACUTE ENCEPH) ->dementia (AIDS-related cog-motor complex)-mental slowing, amnesia, apathy, depression -motor ABNL, incontinence, Sz MORPH-vent. dilation, diffuse atrophy, focal ABNL in white matter -sim findings w/ dementia or not -microglial nodules, chronic inflam, gliosis, macs (pigment or foamy) -GIANT cells, MUCOR -vasculitis -direct extension to parenchyma -esp in DIABETIC KETOACIDOSIS -vasculitis->thrombosis ->infarction, hemorrhagic ->fungal ingrowth, sepsis ASPERGILLUS FUMIGATUS -vasculitis, Central Nervous System INFECTIONS Infx ACUTE ASEPTIC MENINGITIS (VIRAL)-fever, HA, nuchal rigidity CSF-inc'd LYMPHOS, mod protein inc, NL glucose, Central Nervous System INFECTIONS Prions FATAL FAMILIAL INSOMNIA -sleep disturbances initially -ataxia, autonomic distubances -stupor->coma w/in 3 yrs, Central Nervous System INFECTIONS Infx CHRONIC BAC MENINGOENCEPHALITIS TUBERCULOSIS, MYCOBACTERIOSES -HA, malaise, confusion CSF-mononucs raised, HIGH protein, glucose reduced or NL -thick exudate at base of brain -or dorsal spinal cord -ARACHNOID FIBROSIS -w/ caseous necrosis (acute) -granulomas there too (tuberculoma) ->obliterative arteritis in vessels ->infarction ->CSF obstruction->hydroceph HIV-also can get MAC, Central Nervous System INFECTIONS Viral Meningoencephalitis HSV-1-kids, young adults -10% w/ prior labial herpes Sx-altered mood, mem, behavior -subacute weakness, lethargy, ataxia, Sz (4-6 wks) MORPH-inf, med temporal lobes -orbital gyri -necrotizing, hemorrhagic -perivasc infiltrates -COWDRY bodies in nn, glia Tx-antivirals, Central Nervous System INFECTIONS Protozoa TOXOPLASMOSIS -T. gondii-cat feces -transplacental (TORCH) Newborns-hydroceph, MR, perivent calcifications -ceribritis -cortex, basal gang, retinae -heart, lungs, liver Adults-lymphadenitis Immunosupp-CNS involvement -very COMMON-4-30% autopsy -ring-enhancing lesions MORPH-encysted bradyzoites -free tachyzoites -vasculitis - intimal prolif, Central Nervous System INFECTIONS Fungal -immunosupp -brain often later CANDIDA ALBICANS Parenchymal invasion -occasional vasculitis -granulomas, microabscesses +/- giant cell grans, Central Nervous System INFECTIONS Infx BRAIN ABSCESS -paranasal sinus spread -or middle ear** -bronchopulm infx -Strep, Staph -cyanotic congenital HD ->Rt->L shunt, no filter -acute bac endocarditis ->multiple abscesses MORPH-frontal lobe>parietal> CBLM -destructive, progressive deficits -increased ICP->herniation CSF-raised WBC, raised pressure, raised protein, NL sugar Tx-surgery, ABX->mort 10%, Central Nervous System INFECTIONS Protozoa ACANTHAMOEBA -chronic granulomatous encephalitis -can look like histiocytes, Central Nervous System INFECTIONS Infx CHRONIC BAC MENINGOENCEPHALITIS NEUROSYPHILIS-tertiary syphilis-10% -follow ASx meningitis->usually mixed: 1-meningovascular syphilis-chronic inflam infiltrates-HUEBNER arteritis ->arterial fibrosis->infarction ->hydrocephalus, CN palsies -can have cerebral gummas too 2-paretic NS-frontal, temp lobes -nn loss, astrocytosis, spirochetes -mood change-delusions of grandeur ->severe dementia (gen par of insane) 3-tabes dorsalis-thoracolumbosacral menigeal inflam ->injure dorsal roots-position, pain -2ndary demyelinate dorsal cols ->ataxia, CHARCOT JOINTS (dmg), lightning pains -no spirochetes in cord lesions, Central Nervous System INFECTIONS Viral Meningoencephalitis POLIOMYELITIS -picorna virus -subacute or mild gastroenteritis ->invade CNS -mening irritation, aseptic mening -attack anterior horn cells ->flaccid paralysis -mm wasting, hyporeflexia -permanent -acute-death from resp attack -myocarditis can complicate -rare bulbar palsy or encephalitis MORPH-mononuc perivasc cuffs -neuronophagia of AHCs -inflam mostly in AH only ->cavitation, gliosis Stable-can->POSTPOLIO SYNDROME -25-35 yrs after resolution -progressive weakness, atrophy, pain, Central Nervous System INFECTIONS Protozoa NAEGLERIA -rapidly fatal necrotizing encephalitis, Central Nervous System INFECTIONS Viral Meningoencephalitis RABIES- in saliva of: -BATS, dogs, 'coons, foxes, squirrels -ascend to CNS on periph nn (1-3mos) -malaise, HA, fever, meningismus ->severe encephalitis ->increased CNS excitability->pain ->violent mm contractions, convulsions ->flaccid paralysis ->foaming (contracted phar mm) -hydrophobia ->mania, stuporous periods->coma MORPH-neuronal degeneration -basal gang, midbrain, 4th vent floor mononuc perivasc accum-stem, cord -NEGRI BODIES-eosinophilic -hippocampus, Purkinje cells -edema, vasc congestion, NO inflam Tx-abort dz w/ active immunization -fatal after SSx start, Central Nervous System INFECTIONS Fungal -immunosupp -brain often later MUCOR -vasculitis -direct extension to parenchyma -esp in DIABETIC KETOACIDOSIS, Central Nervous System INFECTIONS Fungal -immunosupp -brain often later CRYPTOCOCCUS NEOFORMANS Parenchymal invasion -granulomas, abscesses Meningitis-fulminant, fatal in 2 wks -or indolent, over mos-yrs CSF-few cells, high protein -block outflow from foramina ->hydrocephalus -parenchymal cysts -lenticulostriate aa distribution -VIRCHOW-ROBIN spaces -expanded perivasc spaces, Central Nervous System INFECTIONS Prions VARIANT CJD (vCJD) -young adults -behavior d/os early -neuro syndrome slower -no PRNP alterations -?human ingestion of BSE beef, Central Nervous System INFECTIONS Prions GERSTMANN-STRAUSSLER-SCHEINKER SYNDROME (GSS) -inherited -mutated PRNP -chronic CBLR ataxia ->progressive dementia -death in a few years-slower than CJD