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CNS (Tumors (Familial Tumor Syndromes (von Hippel-Lindau Disease AD; VHL…

- - - - Acute Pyogenic Meningitis (Bacterial Meningitis)
        most likely causes of bacterial meningitis:
        neonates: E. coli and group B strep
        In adolescents & young adults: N. meningitidis
        in older adults: Strep pneumoniae & Listeria monocytogenes
        systemic signs of infection + meningeal irritation + neurologic impairment: headache, photophobia, irritability, clouding of consciousness, and neck stiffness
        Lumbar puncture: incr P
        examination of CSF: abundant neutrophils, elevated pr, and reduced glc
        Untreated pyogenic meningitis often fatal, but w/ prompt dx & administration of antibiotics, most patients can be saved
        MORPHO
      - Aseptic Meningitis (Viral Meningitis):
        acute illness w/ meningeal signs & symptoms believed to be of viral origin
        less fulminant than in pyogenic & typically self-limiting
        CSF: lymphocytosis, moderate pr elevation, and normal glc, but bacteria cannot be cultured
        no distinctive macroscopic findings except for brain swelling, which may be seen in only some
        microscopic examination, there is either no recognizable abnormality or a mild to moderate leptomeningeal lymphocytic infiltrate.
      - Chronic Meningitis
        
        Tuberculous Meningitis
        u manifests w/ generalized signs & symptoms of headache, malaise, mental confusion, and vomiting
        moderate incr in CSF cellularity, w/ mononuclear cells or a mixture of polymorphonuclear and mononuclear cells; pr elevated, often strikingly so, and glc content typically moderately reduced or normal
        Infection w/ M. tuberculosis also may--> well-circumscribed intraparenchymal mass (tuberculoma), which may be a. w/ meningitis
        Chronic tuberculous meningitis--> arachnoid fibrosis & hydrocephalus from interference w/ resorption of CSF
        
        Spirochetal Infections
        Neurosyphilis, a tertiary stage of syphilis, occurs in 10% of untreated Treponema pallidum infection
        Infection w/ HIV incr risk for developing neurosyphilis, and disease often more aggressive in this setting
        several patterns alone or in combination:
        
        Meningovascular neurosyphilis: a chronic meningitis, u involving base of brain, often w/ an obliterative endarteritis rich in plasma cells & lymphocytes
        
        Paretic neurosyphilis stems from parenchymal involvement by spirochetes & a. w/ neuronal loss and marked prolif of microglial cells--> insidious progressive loss of mental and physical functions, mood alterations (incl delusions of grandeur), and eventually severe dementia
        
        Tabes dorsalis results from damage to sensory nerves in dorsal roots--> impaired joint position sense and ataxia; loss of pain sensation--> skin & joint damage (Charcot joints); other sensory disturbances, partic charac “lightning pains”; and absence of deep tendon reflexes
- - - - Chiari type I: far milder; low-lying cerebellar tonsils that extend through foramen magnum--> partial obstruction of CSF flow & compression of medulla--> headache or cranial nerve deficits often manifesting only in adult life
        Surgical intervention can alleviate the symptoms
      - Dandy-Walker: enlarged post fossa, absence of cerebellar vermis, and a large midline cyst
      - Arnold-Chiari malformation (Chiari type II): small post fossa + misshapen midline cerebellum + downward extension of vermis through foramen magnum; hydrocephalus and a lumbar myelomeningocele typically also present