1. Anatomy
    2. 1. Embryology and Development
    2. Spinal cord and Spinal nerves
    3. Meninges
    4. Cerebrum
    5. Brain stem
    6. Cerebellum
    7. Diencephalon
    8. Cranial Nerves and Related Structures
    9. Ventricular system and CSF flow
    10. Special Sense Organs
  2. Physiology
    3. 11. General Neurophysiology
    12. Brain and Higher Functions
    13. Special Sensory Systems
  3. Pathology
    4. 14. Central Nervous System Disorders
    15. CNS Tumors
    16. Eye Disorders
    17. ENT Disorders
  4. Pharmacology
    5. 18. Introduction to autonomic pharmacology
    19. Cholinergic drugs
    20. Anti-cholinergic drugs
    21. Adrenergic drugs
    22. Anti-adrenergic drugs
    23. Drugs used in Glaucoma
    24. Drugs used in the treatment of pain
    25. Alcohols
    26. Sedative Hypnotics
    27. Antipsychotics
    28. Antianxiety drugs
    29. Antidepressants
    30. Analeptic agents
    31. Local anaesthetics
    32. General anaesthetics
    33. Anti-parkinsonial drugs
    34. Drugs used to reduce appetite or In the treatment of obesity
    35. Drugs for eye diseases
  5. Microbiology
    6. 36. Neisseria meningitidis
    37. Polio virus
    38. Rabies virus
    39. Japanese B Encephalitis Virus
    40. Laboratory Diagnosis of Meningitis
  6. Biochemistry
    7. 41. Introduction
    42. Acetylcholine neurotransmission steps
    43. Snake venom
    44. Neurotransmitters
Pathology
14. Central Nervous System Disorders
MENINGITIS

1.

Describe lab findings of tuberculous meningitis.

[2062]

➤

2.

Define suppurative meningitis. List two common causative organisms.

[2060]

➤

3.

Describe the etiopathogenesis of acute pyogenic meningitis. Describe the pathological findings of pyogenic meningitis.

[2058, 2054, 2052]

➤

▢ definition: Meningitis is the inflammatory process of leptomeninges and CSF within subarachnoid space.
▢ image:
    ◉ data:
    ◈ attributes:
    ■ url: https://upload.wikimedia.org/wikipedia/commons/thumb/5/54/Neck_stiffness.jpg/1920px-Neck_stiffness.jpg
    ■ caption: Neck stiffness
▢ routes_of_spread_of_infection:
  1. Hematogenous route (Most common)
  2. Direct implantation
    3. ◉ example: Traumatic
  3. Local extension form infected adjacent structures like
    1. Sinuses
    2. Teeth
    3. Skull
    4. Vertebrae
  4. Via peripheral nervous system as with Rabies and Herpes Zoster Virus
▢ types:
❖ acute_pyogenic_meningitis:
◉ causative_agents:
◈ neonates:
  1. E. coli and
  2. Group B Streptococcus
◈ adolescents_and_young_adults: Neisseria meningitidis
◈ elderly: Streptococcus pneumonia
◉ morphology:
◈ gross:
■ CSF: Cloudy or Frankly purulent
■ exudate: Present within Leptomeninges and ,b>Over the brain
■ vessel: Meningeal vessels are engorged
■ leptomeningeal_fibrosis:
■ hydrocephalus:
■ chronic_adhesive_arachnoiditis: Produced in case of Pneumococcal meningitis
◈ microscopic:
■ neutrophils:
● sub_acute_case: Leptomeningeal vessels
● acute_case: Subarachnoid space
■ ventriculitis: In fulminant cases, infection may extend to ventricles producing ventriculitis.
■ phlebitis:
  1. Venous thrombosis
  2. Hemorrhagic infarction of underlying brain.
◈ CSF_findings:
■ CSF_glucose: Markedly reduced
■ CSF_protein: Markedly raised
■ CSF_pressure: About 180 mm of water (Elevated)
■ lymphocyte_count: 100-10000/μl
■ image:
    ⟣ data:
    ➢ attributes:
    ⬦ url: https://upload.wikimedia.org/wikipedia/commons/1/1d/MenigitisCSF2019.jpg
    ⬦ caption: Cloudy CSF from a person with meningitis due to Streptococcus
◉ signs_and_symptoms:
  1. Meningeal irritability
  2. Morning heachache
  3. Photophobia
  4. Neck stiffness
  5. Clouding of consciousness
◉ complications:
  1. Chronic adhesive arachnoiditis
  2. Leptomeningeal fibrosis and hydrocephalus
  3. Phlebitis and hemorrhagic infarction of brain
  4. Ventriculitis
  5. Focal cerebritis and Cerebral abscess
❖ viral_meningitis:
◉ other_name: Aseptic meningitis
◉ causative_agents:
  1. Enterovirus (Most common)
  2. Echovirus
  3. Mumps virus
  4. Coxsackie virus
  5. Epstein-Barr virus
  6. HSV-II
◉ morphology:
◈ gross:
■ some_cases: Swelling of brain
◈ microscopic: Lymphocytic infiltration of leptomeninges
◉ signs_and_symptoms:
  1. Same as bacterial meningitis.
  2. Onset is acute and usually has benign self-limiting course.
◉ CSF_findings:
◈ CSF_glucose: Normal
◈ CSF_protein: Normal or mildly raised
◈ CSF_pressure: Above 250 mm of water
◈ lymphocyte_count: 10-100/μl
◈ bacterioloogically: Sterile
❖ tuberculous_meningitis:
◉ causative_agents:
◉ morphology:
◈ gross:
■ sub_arachonid_space: Thick exudate particullarly abundant in sulci and base of brain.
■ tubercle: 1-2 mm diameter may be visible adjacent to blood vessel.
◈ microscopic:
■ inflammatory_cells: Acute or chronic inflammatory cells are found.
■ image:
    ⟣ data:
    ➢ attributes:
    ⬦ url: https://upload.wikimedia.org/wikipedia/commons/thumb/f/f9/Meningitis_Histopathology.jpg/1920px-Meningitis_Histopathology.jpg
    ⬦ caption: Histopathology of bacterial meningitis: autopsy case of a person with pneumococcal meningitis showing inflammatory infiltrates of the pia mater consisting of neutrophil granulocytes
■ granuloma: May or may not contain Giant cell and Caseous necrosis
■ acid_fast_bacilli: Present
◉ signs_and_symptoms:
  1. Headache
  2. Confusion
  3. Vomiting
  4. Malaise
◉ CSF_findings:
◈ CSF_glucose: Decreased
◈ CSF_protein: Increased
◈ CSF_pressure: Above 300 mm of water
◈ lymphocyte_count: 10-100/μl
◈ bacterioloogically: Acid fast bacilli
◉ tuberculoma:
◈ definition: Tuberculoma is a form of manifestation of tuberculous meningitis/brain TB.
◈ gross:
■ intraparenchymal_mass:
  1. Well-circumscribed
  2. Single of multiple
  3. Several cm in daimeter --> Mass effect
◈ microscopic:
■ caseous_necrosis:
● location: Central-core
● surrounded_by: Typical tuberculous granulomatous reaction
■ inactive_lession: Show calcification
TUBERCULOMA

1.

Define tuberculoma. Describe the microscopic features and its complications.

[2055]

➤

ENCEPHALITIS

1.

Define encephalitis. Explain the etiopathogenesis of viral encephalitis.

[2063]

➤

▢ types:
❖ chronic_bacterial_meningioencephalitis:
◉ causes:
  1. Tryponema pallidum
  2. Mycobacterium tuberculosis
❖ fungal_meningoencephalitis:
◉ causes:
  1. Candida albicans
  2. Mycor sp.
  3. Aspergillus fumigatus
  4. Cryptococcus neoformans
❖ viral_meningioencephalitis:
◉ causes:
  1. Herpes Simplex Virus (HSV-1 and HSV-2)
  2. Other Herpes Virus
    1. Varicella zoster virus
    2. Cytomegalo virus
    3. Epstein-Barr virus
    4. Human Herpes virus-6
  3. Rabies virus
  4. Arbo virus
  5. JC polyoma virus
  6. HIV
  7. Measles virus
  8. Polio virus
◉ image:
    ■ data:
    ● attributes:
    ⟣ url: https://upload.wikimedia.org/wikipedia/commons/5/59/Viral_encephalitis.png
    ⟣ caption: Virus infecting the brain in Viral encephalitis
◉ morphology:
◈ gross:
  1. Variable degree of meningitis
  2. Cerebral edema
  3. Congestion
  4. Hemorrhage
◈ microscopy:
■ parenchymal_infiltrate:
● of: Mononuclear cells like lymphocytes, plasma cells, macrophages
● in: Perivascular space (Virchow-Robin space)
■ microscopic_cluster_of: Microglial cells
■ neuronal_damage:
  1. Chromatolysis
  2. Neuronophagia
■ demyelination: Follow the destruction of oligodendrocytes.
■ hydranencephaly: Involvement of ependymal cells may lead to hydranencephaly
❖ HIV_virus_encephalitis:
❖ progressive_multifocal_leukoencephalopathy:
◉ causes:
  1. JC polyoma virus
❖ subacute_sclerosing_panencephalitis:
◉ causes: Occurs after acute infection with measles.
HYDROCEPHALUS

1.

Define hydrocephalus. Explain its etiopathogenesis.

[2059, 2056, 2054, 2052]

➤

▢ image:
    ◉ data:
    ◈ attributes:
    ■ url: https://upload.wikimedia.org/wikipedia/commons/9/95/Hydrocephalus_CDC.png
    ■ caption: Illustration showing different effects of hydrocephalus on the brain and cranium
▢ definition: Hydrocephalus is defined as the increase in volume of CSF within the ventricular system, accompanied by dilation of ventricles.
▢ types:
❖ on_the_basis_of_site_of_accumulation:
◉ internal_hydrocephalus:
◈ features:
  1. Increase in intracranial pressure
  2. Ventricular dilation
◉ external_hydrocephalus:
◈ features: Localized collection of CSF in the subarachnoid space.
❖ on_the_basis_of_cause:
◉ primary_hydrocephalus:
◈ features:
  1. Acutal increase in the volume of CSF within the skull.
  2. Elevated intracranial pressure
◈ types:
■ non-communicating_hydrocephalus:
● features:
  1. CSF flow is obstructed within ventricular system or in its outlet to sub-arachnoid space
  2. No communication of CSF between ventricles and sub-arachnoid space.
● causes:
⟣ congenital:
  1. Stenosis of Aqueduct of Sylvius
  2. Arnold-Chiari malformation
⟣ acquired:
➢ tumors:
  1. Ependymoma
  2. Choroid plexus papilloma
  3. Medulloblastoma
➢ inflammatory_lesions:
  1. Meningitis
  2. Cerebral abscess
➢ hemorrhage:
  1. Parenchymal
  2. Intraventricular
■ communicating_hydrocephalus:
● features:
  1. Full communication between ventricles and sub-arachnoid space.
● causes:
⟣ deficient_absorption_of_CSF:
  1. Meningitis
  2. Dural sinus thrombosis
  3. Subarachnoid hemorrhage
⟣ overproduction_of_CSF:
  1. Choroid plexus papilloma
⟣ venous_drainage_insufficiency:
◉ secondary_hydrocephalus:
◈ features:
  1. Less common
  2. Compensatory increase in CSF volume due to loss of neural tissue
  3. Not associated with rise in intracranial pressure
◈ causes:
  1. Cerebral atrophy in Alzheimer's disease
  2. Infarction
▢ morphology:
❖ gross:
  1. Dilation of ventricles
  2. Hinging of cerebral cortex
  3. Veins overlying the enlarged head are engorged
❖ microscopy:
  1. Damage of ependymal lining of ventricle
  2. Periventricular interstital edema
▢ complications:
  1. Raised intracranial pressure
  2. Herniation
  3. Cerebral atrophy
CEREBRO VASCULAR DISEASE OR STROKE

1.

What is aneurysm? Describe the morphology of berry aneurysm.

➤

2.

Describe the morphological features of global cerebral ischemia.

[2063]

➤

3.

Describe the etiology of cerebral ischemia. Explain gross and microscopic features of cerebral ischemia.

[2056]

➤

4.

Define intracranial hemorrhage. Enumerate different types and its complications.

[2055]

➤

5.

Define infarction. Define etiopathology, gross and microscopic features of cerebral infarction.

[2061, 2056]

➤