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Path Quiz

Path Quiz. CNS Infections. M eningitis. See the purulent material filling the subarachnoid space . Patient is 3 months. What are the likely organisms? H.Influenzae , s.pneumoniae ( Pneumococcal meningitis ). Acute Pyogenic Meningitis ( pneumococcal).

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Path Quiz

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  1. Path Quiz CNS Infections

  2. Meningitis See the purulent material filling the subarachnoid space. Patient is 3 months. What are the likely organisms? H.Influenzae, s.pneumoniae (Pneumococcal meningitis)

  3. Acute Pyogenic Meningitis (pneumococcal) There is a copious purulent exudate in the subarachnoid space. Note also the very congested blood vessels. What would her CSF profile have been? Turbid colour, low Glucose, high protein, polymorphonuclear cells, Gram +

  4. Tuberculous meningitis Note changes at base of brain, with adhesions present (arrows). The haemorrhage is probably the result of neurosurgical exploration.

  5. Brain stem tuberculomas Tuberculomasare granulomatous masses that mimic the clinical and gross pathological features of a neoplasm.

  6. Cryptococcal Meningitis What are the risk factors for infection with cryptococcus? AIDS, hodgkins lymphoma, sarcoidosis and long term corticosteroid therapy. This patient wasnawoman aged 66 with a thymomaand myasthenia gravis, who was treated with large doses of prednisone. Note characteristic opacificationof meninges.

  7. cryptococcal meningitis Shows expansion of the subarachnoid space (arrows) by inflammatory cells. On higher power there are macrophages and some multinucleated giant cells (black arrow) indicating granulomatous meningitis. The cryptococciare visible as refractile bodies (red arrows) in the centres of empty spaces that occur because the mucin of the capsules of the organisms has been dissolved by the processing fluids. The organisms can be highlighted with mucin stains.

  8. Cerebral Abscess What are the mechanisms of spread for brain abscess? Direct implantation, local extension, haematogenous spread This is a large acute streptococcal cerebral abscess The cavity is lined by necrotic brain tissue. The anterior horn (blue arrow) of the right lateral ventricle is also filled with pus. List 2 complications of brain abscess Herniation, rupture

  9. Chronic cerebellarabscess

  10. Herpes simplex encephalitis The main change is cerebral oedema with narrowing of sulci. Both parents had recently suffered from cold sores, and herpes simplex type I virus was grown from brain tissue taken at autopsy. Microscopy shows extensive neuronal necrosis, intranuclearacidophilic inclusions, and round cell infiltration with perivascular cuffing. Histology - Herpes encephalitis. In this case the perivascularcuffing by lymphocytes (arrows) is well seen, but intranuclear inclusions were not readily found in the neurones.

  11. Creutzfeldt-Jakob disease At low power the grey matter contains clear spaces or vacuoles. These are usually not found in the white matter. At higher power the vacuoles (arrows) are seen more easily. Spongiform encephalopathy Prevalence? 1 in 1,000,000 How does it present? Rapidly progressive dementia How long will they survive? 7 years

  12. Hydatid disease Note hydrocephalus and daughter cyst (red arrow) lying free in dilated ventricle.

  13. Cysticercosis This disease is due to the infestation of man as an accidental intermediate host; Name the parasite tapeworm Taeniasolium.

  14. Cerebral malaria This man is from PNG. What is the likely organism? Plasmodium falciparum. What do you see? the changes seen are due to plugging of the vessels by infected red cells with secondary hypoxia and small ring haemorrhages. (Note the similar appearance to that seen when fat embolism affects the brain.)

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