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CNS infections

NA SHAO
Common types
• Bacteria infections
a) Acute bacterial meningitis

b) Brain abscess

c) Tuberculous infection

• Viral infections
a) Viral meningitis

b) Encephalitis

• Parasitic infections of the nervous system


Common types
• Bacteria infections
a) Acute bacterial meningitis

b) Brain abscess

c) Tuberculous infection

• Viral infections
a) Viral meningitis

b) Encephalitis

• Parasitic infections of the nervous system


Acute bacterial meningitis
• Etiology

• Pathogenesis

• Diagnosis

• Treatment

• Complication
etiology

• Depending on the age of presentation.

• Bacteria reach the subarachnoid space

through hematogenous spread.

• Neurosurgical

• Open head injury

• Infection of sinuses
Clinical findings

• acute bacterial meningitis is a medical emergency.

• clinical findings included headache, fever, neck stiffness, and can

also be confused or depressed level of consciousness.

• seizures or other focal neurologic symptoms when affects the brain

parenchyma (called meningoencephalitis).


Kernig's sign Brudzinski's sign

Pain upon attempted passive extension at the An involuntary flexion at the hips when the
knee when the hip is flexed. neck is flexed.
Diagnostic workup
• CSF analysis from lumbar puncture (LP).

• Head imaging (usually CT), should be performed before LP.

• Characteristic of CSF:

a) Elevated white blood cell count;

b) Predominance of polymorphonuclear leukocytes

c) Elevated protein

d) Low glucose (less than 40mg/dl or less than two-thirds of a simulataneously


measured serum glucose level ).
CSF

Bacterial viral TB
glucose low normal low

protein very high slightly increased raised

cells neutrophils lymohocytes lymohocytes


CSF pressure
• Elevated in :
• Normal opening pressure
in adults is • Congestive heart failure
90~180mmH2O, • Meningitis
10~100mmH2O in children. • Superior vena cava syndrome
• Cerebral edema
• Mass lesion

• Decreased In
• Spinal-subarachnoid block
• Dehydration
• Circulatory collapse
• CSF leakage
Treatment
• Appropriate antibiotic therapy needs to be administered promptly;

• Specific drugs initially chosen based on most likely organisms and


subsequently modified based on Gram stain or culture results;

• Corticosteroids are often used in children in an attempt to prevent


some of the long-term complications of acute bacterial meningitis,
such as deafness, Obstructive hydrocephalus.
Common types
• Bacteria infections
a) Acute bacterial meningitis

b) Brain abscess

c) Tuberculous infection

• Viral infections
a) Viral meningitis

b) Encephalitis

• Parasitic infections of the nervous system


Brain abscess

• Etiology

• Pathogenesis

• Diagnosis

• Treatment
etiology
• Usually from invasion of the intracranial space from neighboring
sites of infection, such as sinuses

• From direct open trauma

• Multiple brain abscesses are seen typically as a result of


hematogenous dissemination

• In general, most abscess contain multiple organisms, often a mixture


of aerobic and anaerobic pathogens
Clinical findings
• Present much like any other focal intracranial lesions;

• Headache;

• Focal neurologic signs (depend on location of abscess);

• Seizures, not invariable;

• Signs of increased intracranial pressure;

• Fever is present, but not invariable.


Diagnostic workup
• The diagnosis of brain abscess is made upon neuroimaging (CT or MRI).

• CT or MRI with intravenous contrast agents will usually demonstrate a


mass lesion, often surrounded by“ring enhancement”and signs of central
necrosis, within the brain parenchyma.

• Blood cultures can sometimes identify the responsible organism.

• Neurosurgical drainage is often necessary for definitive pathogen


identification.
Treatment

• Prolonged courses of intravenous antibiotics are the mainstay of treatment for

brain abscess, based on :

a) empirically for broad-spectrum coverage of organisms;

b) tailored specifically based on culture results.

• Neurosurgical can also be considered.


Common types
• Bacteria infections
a) Acute bacterial meningitis

b) Brain abscess

c) Tuberculous infection

• Viral infections
a) Viral meningitis

b) Encephalitis

• Parasitic infections of the nervous system


Tuberculous infection

• Etiology

• Pathogenesis

• Diagnosis

• Treatment

• Complication
etiology

• Mycobacterium tuberculosis affects the nervous system.

• Usually arises from hematogenous dissemination of mycobacteria form a

pulmonary source.
features

a) usual features of acute bacterial meningitis;

b) has a predilection for affecting the basal meninges (at the base of

the brain), so can present with cranial nerve palsies;

c) tends to have a more subacute or chronic, insidious presentation.


CSF features
• Demonstrate a leukocytosis with lymphocytic predominance, rather

than polymorphomuclear predominance

• CSF glucose is often very low;

• Elevated protein content.


CSF

Bacterial viral TB
glucose low normal Very low

protein very high slightly increased raised

cells neutrophils lymohocytes lymohocytes


treatment

• Require a regimen of multiple antituberculous drugs that penetrate the

blood brain barrier effectively.


Common types
• Bacteria infections
a) Acute bacterial meningitis

b) Brain abscess

c) Tuberculous infection

• Viral infections
a) Viral meningitis

b) Encephalitis

• Parasitic infections of the nervous system


Viral meningitis
• Presentation may be very similar to that of acute bacterial
meningitis.

• Fever, headache, neck stiffness.

• CSF profile differs from that of acute bacterial meningitis.

• Treatment generally involves supportive care and acyclovir.


CSF

Bacterial viral TB
glucose low normal low

protein very high slightly increased raised

cells neutrophils lymohocytes lymohocytes


viral encephalitis
viral encephalitis
• Affects the brain parenchyma itself;

• Presents with headache, fever, altered level of consciousness, seizure,


and focal neurologic abnormalities.

• often caused by herpes simplex virus (HSV1).


HSV1 encephalitis
• HSV1 encephalitis has a predilection for the base of the brain.

• Specifically including the medial temporal lobes and orbitofrontal


regions of cortex.

• CSF in HSV1 encephalitis often demonstrates an elevated red blood


cell count in addition to leukocytosis.

• Treatment: with a prolonged intravenous course of acyclovir, and can


be started empirically.
Common types
• Bacteria infections
a) Acute bacterial meningitis

b) Brain abscess

c) Tuberculous infection

• Viral infections
a) Viral meningitis

b) Encephalitis

• Parasitic infections of the nervous system


neurocysticercosis
neurocysticercosis

Infection caused by the pork tapeworm Taenia solium.


Nervous system infection presents with seizure, headache,
signs of increased intracranial pressure.
Treatment includes albendazole, and steroids are often used to
control the inflammation and edema accompany the initial
treatment.
Ring-enhancing

Calcified

Surrounding edema
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