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(Intracerebral hemorrhage, CNS infection, Ischemia) - Coggle Diagram
Intracerebral hemorrhage
Epidemiology of Cerebrovascular Diseases
Acute stroke
Hypertensive cerebrovascular disease
Lacunar infarct
Arteriosclerosis of deep penetrating small arteries
Lenticular nucleus > thalamus
Slit hemorrhage
Hypertensive encephalopathy
Hypertensive cerebral hemorrhage
Basal ganglia & thalamus:65%
Pons:15%
Cerebellum / Cortex & subcortex:10%
Aneurysm
between Anterior cerebral a. & anterior communicating a. 40%
Middle cerebral a. 34%
Vascular malformation
AV malformation 11%
Cavernous malformation (hemangioma)
CNS infection
Disease
Meningitis
Etiology
Acute pyogenic meningitis
bacterial inf.
Neonate:E.coli、Group B streptococci(如 S. agalactiae)
Elderly:Streptococcus pneumoniae、Listeria
Adolescent:Neisseria meningitidis
Immuno-compromised : Anaerobic、Klebsiella
sequelae
leptomeningeal fibrosis
obstructive hydrocephalus
Acute focal suppurative infection (Brain abscess)
Cause
Direct extension from sinusitis
basal temporal lobe
Acute bacterial endocarditis
multiple lesion
Congenital heart disease with right-to-left shunt
Chronic bacterial meningoencephalitis
Tuberculosis
Often involves basilar region
Viral meningoencephalitis
meninges + brain parenchyma
Latency
Neural tropism
Example
Arthropod-born viral encephalitis
Japanese B
West Nile disease
mosquito
Pathologic findings
Lymphocytic meningoencephalitis
Perivascular cuffing
Neuronophagia
Herpes simplex virus type I
Most common in children and young adults
clinical
Alterations in mood
memory / behavior change
low grade fever
Micro
Necrotizing hemorrhagic inflammation
Cowdry type A intranuclear viral inclusion bodies
CMV
immunocompromised / Infant
Microcephaly
periventricular calcification
Region
Periventricular subependymal region
Scattered foci in grey matter
Cerebellum
Congenital
Neurodevelopmental sequelae
Mother - > asymptomatic
Ultrasound / PCR = Low sensitivity
Poliomyelitis
Region
Anterior horn of spinal cord
Clinical
neuromuscular dysfunction
Paralyis
Rabies
peripheral nerve retrograde
Region
Brain stem
Mirco
Negri body
eosinophilic inclusion body
common seen in pyramidal neuron of hippocampus /
Purkinje cell of cerebellum
Progressive multifocal leukoencephalopathy (PML)
JC polyomavirus infection
Region
oligodendrocytes
demyelinating disease
Pathological finding
LFB (Luxol fast blue)
enlarged nucleus
Intranuclear or cytoplasmic glassy amorphous
viral inclusion
Fungal meningoencephalitis
immunocompromised
necrotizing inflammation
Region
Esophagus
candida
nasal sinus
Fungal ball
Clinical
Chronic meningitis
vasculitis
local thrombotic hemorrhagic infarction
Attack
parenchymal infection
Pathological finding
Aspergillosis
vasculitis
Cryptococcus
Mucin stain
Soap bubble-like multiple areas of tissue destruction
Candidiasis
Spore form + pseudohyphae form
Cerebral Toxoplasmosis
immunocompromised
toxoplasma gondii
Region
Cortex / junction
Tumor-Like Lesions
Entrance
Hematogenous spread
Direct implantation
Local extension
Transport along the PNS
Harm
Direct injury
Toxin
Immune-mediated
Inflammatory response
Ischemia
Global cerebral ischemia
Cause
hypotension or hypoperfusion
Selective vulnerability
Larger neuron (3 /5 /6 layer)
Hippocampus
Purkinje cell
Border zone infarcts
Focal cerebral ischemia
Infarction from obstruction of local blood supply
E.g.
emboli
Local vasculitis
thrombus
TYPE
Non-hemorrhagic
Hemorrhagic (red)infarct