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).
Signs and symptoms- Meningeal
infection
• nuchal rigidity, sudden high fever, and altered mental status
• Other signs commonly associated with meningitis include
photophobia (intolerance to bright light) and phonophobia
(intolerance to loud noises)
• Classic signs of meningeal infection Brudziński sign.

• Presence of positive Kernig's sign or Brudziński sign.

• Kernig's sign is assessed with the person lying supine, with the hip
and knee flexed to 90 degrees. In a person with a positive Kernig's
sign, pain limits passive extension of the knee.
• A positive Brudzinski's sign occurs when flexion of the neck
causes involuntary flexion of the knee and hip. Although Kernig's
sign and Brudzinski's sign are both commonly used to screen for
meningitis, the sensitivity of these tests is limited
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/Manifestation- Bacterial Meningitis

• Signs of infection (fever, malaise, rigor….)

• Signs of meningeal irritation:
1. headache
2. neck stiffness
3. photophobia
4. irritability
5. Convulsion in children
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
Polymorphonuclear leukocytes (PMN's) in the
(Cerebrospinal fluid) CSF is the most definitive
diagnostic index of meningitis
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 (cerebrospinal fluid) shows :
1.lymphocytes (Hallmark)
2. mild increase in protein
3. normal glucose level
Viral meningitis is usually self-limiting and treated
symptomatically.
Brain abscess
• Causes :
1. complication of bacterial meningitis
2. bacterial endocarditis
3. pulmonary sepsis : peumonia……etc
4. other sepsis

Brain abscess cause a space occupying lesion in the

brain
 Parkinson´s Disease
• The second most common progressive
neurodegenerative disorder
• The most common neurodegenerative
movement disorder
• Symptoms and neuropathology are well
characterized
• Pathogenesis of PD is not clear
• May be multifactorial and heterogeneous in
etiology
 PARKINSON’S DISEASE
Descriptive Epidemiology

• Prevalence Rate : 150-200 per 100,000

• Rare for individuals < 40 years of age
• 1% for individuals > 60 years of age
• 2% for individuals > 85 years of age
• Typically effects those in the 6th-8th decade of their life.
• Men > Women
• NPF estimates up to 1.5 million cases
• in the US
• Genetic factors and race (wihte, black) do not play a role
(except for a rare autosomal dominant disorder)
• The vast majority of cases are idiopathic
Explain the Clinical features of PD

 Resting tremor: Most common first symptom, usually

asymmetric and most evident in one hand with the arm at
rest.

 Bradykinesia: Difficulty with daily activities such as writing,

shaving, using a knife and fork, and opening buttons;
decreased blinking, masked facies, slowed chewing and
swallowing.

 Rigidity: Muscle tone increased in both flexor and extensor

muscles providing a constant resistance to passive movements
of the joints; stooped posture, anteroflexed head, and flexed
knees and elbows.
 Functional neuroanatomy of PD

 Substantia nigra: The major origin of the dopaminergic

innervation of the striatum.

 Part of extrapyramidal system which processes

information coming from the cortex to the striatum,
returning it back to the cortex through the thalamus.

 One major function of the striatum is the regulation of

posture and muscle tonus.
Clinical Manifestation of PD

• Depression
• Hypertonia
• Dementia
Therapy of PD: Other
treatments

 DA receptor agonists
(bromocriptine, pergolide,
pramipexole, ropinirole,
cabergoline)

 Amantadine

 Anticholinergics
 Diagnosis of PD

 Anamnesis and clinical examination

 No disease-specific biological marker available

 Positron Emission Tomography (PET) or Single-

photon Emission Computed Tomography (SPECT)
with dopaminergic radioligands

 Exclusion of several causes of secondary

Parkinsonism
 Alzheimer’s Disease
Overview
• Alzheimer’s is the most common cause of dementia
in adult life and is associated with the selective
damage of brain regions and neural circuits critical
for memory and cognition
• The pathogenesis of this disease is complex, and
involves many molecular, cellular, and physiological
pathologies
• The neurons in the neocortex, hippocampus,
amygdala, and the basal forebrain cholinergic
system are the most affected brain regions
 Alzheimer’s Disease
This disease is known as an insidious and progressive
neurologic disorder characterized by a loss of memory,
cognitive impairment, and eventual dementia?
 Alzheimer’s Disease
What are the Symptoms of Alzheimer’s disease?
• Gradual loss of memory,
• Loss in cognitive function,
• difficulty with language, and
• changes in behavior.
tangle

plaques
The Brain and Alzheimer’s Disease

Two major structural changes:

1. Neurofibrillary tangles
 Bundles of twisted threads that are the product of
collapsed neural structures (contain abnormal forms
of tau protein
2. Amyloid plaques
 Dense deposits of deteriorated amyloid protein,
surrounded by clumps of dead nerve and glial cells
 Beta protein amyloid may be the origin of
deposits found in the brain in Alzheimer’s disease
 Multiple Sclerosis
• A chronic demyelinating disease of the CNS
• Characterized by exacerbations and remissions over a
period of years.
• It is the most common demyelinating disorder (prevalence
1 in 1000)
 Multiple Sclerosis
• Risk Factors
• Most common in 40 year olds (uncommon before 14 and
after 60 years)
• Women affected twice as often as men
• Possibly other infectious, genetic, and infectious etiology