Central Nervous

System
INFECTIONS
 Introduction
 Meningitis is an inflammation of the
leptomeninges and underlying
subarachnoid cerebrospinal fluid
(CSF).
 Meningoencephalitis

 Meningeal carcinomatosis

 Three types

acute, aseptic and chronic.

 Acute pyogenic meningitis
 Streptococcus pneumoniae, Neisseria
meningitidis
 Group B streptococci, E coli in
newborns
 Listeria monocytogenes in newborns,
elderly, and immunocompromised
 Haemophilus influenzae
 Classic symptoms
 Headache
– Nuchal rigidity not present in children
<1 y
– Fever and chills
– Photophobia
– Vomiting
– URI symptoms (viral and bacterial)
– Seizures Focal neurologic symptoms
(including focal seizures)
 Signs of meningeal irritation
Nuchal rigidity or discomfort on neck flexion
– Kernig sign: Passive knee extension in supine
patient elicits neck pain and hamstring
resistance.
– Brudzinski sign: Passive neck or single hip
flexion is accompanied by involuntary flexion
of both hips.
 Papilledema

 Focal neurologic signs

– cranial nerve abnormalities III, IV, VI,

VII)
features Normal Bacterial Viral Tuber
culous

Appearance Clear Cloudy Mild Turbid forms

turbid coagulum

Pressure 60-150 >180mm >250mm >300mm

mm

Cells 0-4 1000-1 lac 10-100 100-1000

Proteins 15-45 Markedly Raised Raised

mg/dl raised

Glucose 50-80 Markedly Normal Reduced

mg/dl reduced

Bacterio Sterile Organism+ Sterile Tubercle

logy bacilli
 microscopy
 Neutrophils in entire subarachnoid
space
 Around the leptomeningeal blood
vessel
 Demonstrated by gram stain

 Infiltrate into vessel & cause focal

cerebritis.
 Later, fibrosis & hydrocephalous.

 Pneumococcal: ch adhesive
arachnoiditis
 Aseptic meningitis
 Misnomer

 Viral origin
 Less fulminant

 Self limiting

 70% enterovirus

 Echovirus, coxsackievirus
features Normal Bacterial Viral Tuberculous

Appearance Clear Cloudy Mild Turbid forms

turbid coagulum
Pressure 60- >180mm >250mm >300mm
150mm
Cells 0-4 1000-1 lac 10-100 100-1000

Proteins 15- Markedly Raised Raised

45mg/dl raised
Glucose 50-80 Markedly Normal Reduced
mg/dl reduced
Bacteriology Sterile Organism+ Sterile Tubercle
bacilli
 Tuberculous meningitis
 MC pattern - diffuse
meningoencephlitis
 Micro: macro+ lympho+ plasma cells

 Florid cases: granulomas

 Obliterative endartritis

 Organism: acid fast stain

 Intraparenchymal tuberculoma
features Normal Bacterial Viral Tuberculous

Appearance Clear Cloudy Mild Turbid forms

turbid coagulum
Pressure 60- >180mm >250mm >300mm
150mm
Cells 0-4 1000-1 lac 10-100 100-1000

Proteins 15- Markedly Raised Raised

45mg/dl raised
Glucose 50-80 Markedly Normal Reduced
mg/dl reduced
Bacteriology Sterile Organism+ Sterile Tubercle
bacilli
 Fungal meningitis
 less common.
 cryptococcus,

 found in pigeon droppings.

 rare in healthy people.

 impaired immune system- AIDS

 ACUTE FOCAL SUPPURATIVE
CNS INFECTIONS

CEREBRAL ABSCESSES
– Local (mastoiditis, sinusitis)
– Hematogenous (tooth extraction,
sepsis)
– Staph, Strep
– Often fibrous capsule, liquid center
SUBDURAL EMPYEMA (IN
SINUSITIS)
EXTRADURAL ABSCESS
(IN OSTEOMYELITIS)
SUBDURAL EMPYEMA
 CHRONIC BACTERIAL
Meningo-encephalits

 TB,brain and meninges

 SYPHILIS, gummas in brain

 LYME DISEASE (Neuro-

Borreliosis)
TUBERCULOMA
 VIRAL
Meningo-encephalitis
 ARBO VIRUSES (West Nile, Equines, Venez., many
more)
 HSV1
 HSV2
 V/Z
 CMV
 POLIO
 RABIES
 HIV
 Progressive Multifocal Leukoencephalopathy (JC)
 Subacute Sclerosing Panencephalitis (Measles)
 VIRAL
ENCEPHALITIS
PERIVASCULAR
LYMPHOCYTIC
“CUFFING”
Bitemporal encephalitis is HSV until proven otherwise!
HSV = TEMPORAL lobe(s)
 PERIVASCULAR
GIANT CELLS
in WHITE MATTER in
HIV
ENCEPHALITIS
 PROGRESSIVE MULTIFOCAL
LEUKOENCEPHALOPATHY (PML)
JC Polyoma virus is the cause
(JCV)

Primarilly
affects
oligodendocytes

Ergo,demyelination is the
main feature
PML
SUBACUTE SCLEROSING
PANENCEPHALITIS (SSPE)
 VERY rare since measles
eradicated
 Thought to be caused by measles
virus
 FUNGAL
MENINGO-ENCEPHALITIS
CRYPTOCOCCUS
CANDIDA
ASPERGILLIS
MUCOR

(Mostly in immunocompromised hosts)

CRYPTOCOCCUS
MICROABSCESSES
 OTHERS
MALARIA

TOXOPLASMOSIS (in HIV)

AMEBIASIS

TRYPANOSOMES

RICKETTSIAE

ECHINOCOCCUS