MENINGITIS

Meningitis is an inflammatory process of the leptomeninges and CSF

Space occupying lesions

CNS hemorrhage Brain tumours Brain abscess Metastatic tumours

Classification
1. acute pyogenic (bacterial) meningitis 2.acute aseptic (viral) meningitis 3.acute focal suppurative infection (brain

abscess,subdural and extradural empyema) 4.chronic bacterial infection (tuberculosis).

Acute pyogenic bacterial meningitis

Most important Can be fatal if untreated Organisms:

E.coli ---------- neonates Streptococci B ---------- neonantes H. influenzae-------------adolescents Neisseria meningitidis------------- young adults Streptococcus pneumonia--------- elderly

Clinical signs
Signs of infection (fever,malaise,rigor.) Signs of meningeal irritation:
1.headache 2.neck stiffness 3.photophobia 4.irritability C.S.F by lumbar puncture shows : a.cloudy purulent csf b.abundant neutrophils > 90,000/mm3 c.high protein level and d.reduced glucose level.

Morphology
Grossly , pyogenic meningitis shows a
thick layer of suppurative exudate covers the leptomeninges over the surface of the brain. Exudate in basal surface--- H.INFLUENZAE Exudate in covexity surface--- P.MENINGT Microscopically : neutrophils in the subarachnoid space

Complications
Antibiotic treatment------ full recovery Delayed or untreated cases--- can be fatal Healing by fibrosis cause obliteration of
subarachenoid space--- HYDROCEPHALUS Brain abscess Septic shock and skin rashes, why ?

Skin rashes

Is due to small skin bleed All parts of the body are affeced The rashes do not fade under pressure Pathogenesis: a. Septicemia b. wide spread endothelial damage c. activation of coagulation d. thrombosis and platelets aggregation e. reduction of platelets (cosumption ) f. BLEEDING 1.skin rashes 2.adrenal hemorrhage Arenal hemorrhage is called Waterhouse-Friderichsen Syndrome.It cause acute adrenal insufficiency and is uaually fatal

Acute Aseptic (Viral ) Meningitis

Can follow any viral infection Less danger CSF shows :
1.lymphocytes 2. mild increase in protein 3. normal glucose level Viral meningitis is usually self-limiting and treated symptomatically.

Brain abscess
Causes :
1. 2. 3. 4. complication of bacterial meningitis bacterial endocarditis pulmonary sepsis : peumoniaetc other sepsis

Brain abscess cause a space occupying lesion in the brain