Areej Al Daur
Dr.Ayham Abu Laila
Bara’a Sheek Al Eed
Let’s begin with Bara’a
Bacterial infection in CNS may cause:
• brain abscess,
• subdural and epidural abscesses
The diagnosis for the bacterial infection
• severe headaches
• stiff neck
Examination of the CSF typically reveals:
• elevated protein concentration,
• a depressed glucose concentration,
• a moderate leukocytosis composed mainly of
• The exception is the cerebellar syndrome, in
which the protein concentration is elevated
but there is no leukocytosis.
• Cultures of CNS tissue and fluid are frequently
sterile; however, bacteria are occasionally
recovered from the CSF and from the brain
1. Through contaminated food
• (e.g., L. monocytogenes, Salmonella, and
• a gram-positive, nonsporulating bacillus that is
facultatively anaerobic and produces weak betahemolysis on blood agar.
• Most human infection by L. monocytogenes is
acquired by consumption of contaminated food.
• L. monocytogenes, is able to enter the brain via a non
hematogenous route by retrograde transport within
• Brucellae are small, nonmotile, and
non spore-forming gram-negative
• human disease is caused
predominantly by B. abortus, B.
melitensis, and B. suis
• Human infection typically is acquired by ingestion of
unpasteurized milk or cheese.
• occupational exposure to infected animals, in
particular sheep, goats, swine, camels, and cattle.
• Brucella attacks the CNS and neurobrucellosis is
found much less commonly in children than in
• permanent neurological deficits, particularly
deafness, are common.
• Salmonella spp. are gram-negative, facultative
anaerobic, motile, non-lactose-fermenting, nonspore-forming bacilli.
• In addition to headache,
• CNS manifestations of enteric fever in the form of
neuropsychiatric manifestations from encephalitis,
including confusion and psychosis, occur in 5 to 10%
2. Through inhalation
(M. tuberculosis and C. burnetii).
• CNS infection by M. tuberculosis occurs in individuals of any
• Most cases in children occurred between the ages of 6
months and 4 years, whereas adult cases clustered in patients
aged 20 to 50 years.
3. Through the bite of infected arthropods
(R. rickettsii, R. prowazekii, and E. chaffeensis),
What is meningitis? What is
• Infection of the meninges, the membranes that surround the
brain and spinal cord, is called meningitis.
• inflammation of the brain itself is called encephalitis.
• Myelitis is an infection of the spinal cord.
• When both the brain and the spinal cord become inflamed,
the condition is called encephalomyelitis
Diffuse purpuric lesions
principally involving the
Who is at risk for encephalitis and
People with weakened immune systems,
• HIV patients:
• substance abuse disorder
• prolonged use of steroid
• upper respiratory tract infection.
• bacteria invade the meninges directly.
• penetrating wound (surgical procedure)
• Pneumococcal meningitis is the
most common form of meningitis.
• At particular risk are children under
age 2 and adults with a weakened
or depressed immune system.
meningitis, is common
in children ages 2-18.
• Between 10 and 15
percent of cases are
• with another 10-15
percent causing brain
damage and other
serious side effects.
• Haemophilus meningitis was at one time
the most common form of bacterial
• Fortunately, the Haemophilus influenzae
b vaccine has greatly reduced the
number of cases.
• Listeria monocytogenes meningitis, which can cross
the placental barrier and cause a baby to be stillborn
or die shortly after birth.
• Mycobacterium tuberculosis meningitis
• Escherichia coli
meningitis, which is
most common in elderly
adults and newborns
and may be transmitted
to a baby through the
How are these disorders
• nasal discharge,
• respiratory and throat secretions
(often spread through kissing,
coughing, or sharing drinking
glasses or cigarettes).
• inflammation and collection of infected
material, within the Brain.
• Brain abscess is relatively rare, accounting for 1
in 10,000 hospital admissions.
• Single abscess occurs in 75% of cases, and the
remainder of cases involve multiple abscesses.
spread of bacteria from a nearby infection.
• Otitis media.
• an abscessed tooth.
Other sources of bacteria include:
• abdominal infection .
• penetrating head wounds.
Collection of purulent material confined within
epidural or subdural space
Subdural empyema usually occurs in association
• a severe ear infection,
• a head injury, or a blood infection.
Jaya suffers from
cerebral empyema, a
brain infection. She
has already undergone
a number of
continues to be
The most common symptoms are:
• altered mental status
• Fever and stiff neck.
• vomiting, eye tremor, and uncoordinated movements.
bacteria that cause brain abscesses can cause subdural
• H. influenzae, and E. coli.
Go with Areej…
• Infection of brain parenchyma
• Presents of neurological abnormalities
distinguish it from meningitis
• California encephalitis is an arbovirus-induced, arthropodborne encephalitis or encephalomeningitis.
• The virus is transmitted to humans through a mosquito bite.
• Five types of arborviral encephalitis are found in the
United States, including:
I. eastern equine encephalitis (EEE)
II. western equine encephalitis
III. St Louis encephalitis
IV. La Crosse encephalitis
V. West Nile encephalitis.
Eastern Equine Encephalitis
• This infection is caused by an arthropod-borne
alphavirus of the Togaviridae family
Herpes Simplex Encephalitis
• HSV remains dormant in the nervous system; rarely,
it presents as encephalitis.
• This encephalitis is a neurologic emergency and the
most important neurologic sequela of HSV.
The infection of neonates may occur:
• Prognosis is poor as
• HSE in other age groups
• necrotizing encephalitis in
the temporal and
orbitofrontal lobes of the
• Japanese encephalitis is a neurologic infection closely related
to St. Louis encephalitis and West Nile encephalitis.
more than 85% of viral meningitis cases are caused by
• Mumps, polio, and lymphocytic choriomeningitis viruses
(LCMVs) are now rare offenders in developed countries.
• However, polio remains a major cause of debilitating myelitis
in some regions of the world.
• Enteroviruses account for more than 85% of all
cases of viral meningitis
• include echoviruses, coxsackieviruses A and B,
polioviruses, and the numbered enteroviruses.
• majority of meningitis cases are caused by
serotypes of coxsackievirus and echovirus
• 5% of cases
• Some of the important arboviruses include
the eastern and western equine encephalitis
viruses, from the Togavirus family; St. Louis
encephalitis’ West Nile, Japanese B, and
Murray Valley viruses, from the Flavivirus
family; and California group and Jamestown
Canyon viruses, from the Bunyaviridae
• The most common clinical manifestation is
meningoencephalitis rather than pure meningitis
• Seizures are more common with arboviral meningitis
than with any other group of viruses.
• A member of the Paramyxovirus family, mumps
virus was one of the first known causative
agents of meningitis and meningoencephalitis
• spongiform degeneration and
astrocytosis but no inflammatory
• The victims present with cerebellar ataxia
CREUTZFELDT - JACOB DISEASE
• The clinical manifestations include:
CREUTZFELDT - JACOB DISEASE
The congenital infection with this virus is
• optic atrophy
Acquired infections have been associated
• transverse myelitis
• brachial plexitis
• Guillain-Barré syndrome
• adult encephalitis
• several neurological manifestations
• At the stage of seroconversion
• the patient may experience, general signs and
symptoms of any viral illness
• mild meningitis
Go with Aya…
• Cryptococcosis - most common fungal
infection in CNS diagnosed in live
– Cryptococcoma (mucinous pseudocyst) occurs almost entirely in the HIV population
– 3-10mm, most commonly in the basal
• Candidiasis - most common fungal
infection in CNS diagnosed in dead
– rare in healthy individuals
• Coccidiomycosis - normally causes
• Aspergillosis – Abscess in the centrum ovale.
Note many satellite lesions common among
Mucor – aggressive and locally
• Insidious onset with progressive headache,
fever, lethargy, mild neck stiffness
• Complications: abcess, neuro deficits, ocular
nerve damage (especially cryptococcus)
• Usually pulmonary source, usually
• Presents similar to TB meningitis
• Most common parasitic infection in CNS
–Caused by larval stage of Taenia
solium- pork tapeworm
–Incubation period from months to
• 83% of cases show symptoms within 7
years of exposure
• Common routes of infection
–Food (usually vegetables) or water
containing eggs from human feces
–Fecal - Oral autoinfection (poor
–Autoinfection from reverse peristalsis
– meningeal 27-56%
– parenchymal 30-63%
– ventricular 12-18% (may cause hydrocephalus)
– mixed - 23%
– symptoms of increased intracranial pressure
–antibody titers significant if 1:64
in the serum and 1:8 in the CSF
• CT scan
–ring enhancing / calcified lesions,
Cystercercus cellulosae - (3-20 mm)
regular round thin walled cyst,
produces only mild inflammation
larva in cyst
• “Hydatid Cyst” - caused by ingestion of the
• Treatment - Surgical excision without cyst
– Cyst is full of worms
• Adjunctive treatment
Echinococcus Cyst –
• CNS manifestations
–Mass lesion (most common)
• CT findings
– Mass lesion - comprises 70-80% of cerebral masses
in AIDS patients
– large low density area with mild to moderate
– most commonly in the basal ganglia
– Often multiple
– Most patients with CT diagnosed toxoplasmosis
also have evidence of cerebral atrophy
• Naegleria fowleri "the brain-eating
• Invade the central nervous system via
• Cause primary amoebic
• PAM usually occurs in healthy children
or young adults with no prior history of
immune compromise who have
recently been exposed to bodies of
• Onset 1 to 14 days after exposure.
• The initial symptoms include:
– changes in taste and smell
– headache, fever, nausea, vomiting, and stiff neck.
• Secondary symptoms include:
– confusion, hallucinations, lack of attention, ataxia,
• The disease progresses rapidly 3 to 7 days, with death
occurring from 7 to 14 days