1. DISEASES OF THE NERVOUS SYSTEM
CHAPTER 24
Copyright © 2012 John Wiley & Sons, Inc. All rights reserved.

2. Anatomy Review Central Nervous System Peripheral Nervous System
Meninges
3 layers covering the brain
Blood Brain Barrier
Exceptionally impermeable capillary network
© 2012 John Wiley & Sons, Inc. All rights reserved.

3. Bacterial Diseases of the Brain and Meninges - Meningitis
Symptoms
Headache, fever, chills, stiff neck
Diagnosis via CSF culture
Meningococcal meningitis
Neisseria meningitidis
15% mortality due to Rx delays
Infants, young adults
Fatigue, overcrowding
Death due to endotoxin shock
Penicillin
Vaccine does not cover all strains
© 2012 John Wiley & Sons, Inc. All rights reserved.

4. Bacterial Meningitis Haemophilus influenzae type B ( Hib)
Commonest cause of meningitis prior to vaccine development
30-50% carrier rate in children
Fatal without treatment
Seizures, mental retardation common in survivors
Largest cause of mental retardation in U.S.A. and world-wide
Streptococcus pneumoniae
Commonest adult cause of bacterial meningitis
Spreads from other sites
Blood
Lungs
40% mortality rate
Cocktail vaccine for pneumonia is effective
© 2012 John Wiley & Sons, Inc. All rights reserved.

5. Viral Meningitis Self limiting, non-fatal
More common, less serious than bacterial meningitis
Enterovirus and mumps virus most common
© 2012 John Wiley & Sons, Inc. All rights reserved.

6. Viral Diseases of the Brain and Meninges - Rabies
Rhabdoviridae inclusions seen in brain
Re-emerging in U.S.A. with cats as carriers
Fatal encephalitis
20-60 day incubation
Virus travels to CNS slowly and replicates slowly
Agitation, confusion, hallucinations
Death within days of CNS symptoms
Hydrophobia seen as throat muscles are infected and spasm
Vaccination can be used to “cure”
© 2012 John Wiley & Sons, Inc. All rights reserved.

7. Tetanus Clostridium tetani Anaerobic, endospore former
Found in soil, manure
Vaccine is available (10 yr)
Puncture wounds
Spastic paralysis, respiratory failure
Antitoxin and antibiotics for treatment
© 2012 John Wiley & Sons, Inc. All rights reserved.

8. Botulism Clostridium botulinum Flaccid paralysis, respiratory failure
Botulotoxin in contaminated canned goods (honey fed to infants)
Wounds may rarely be infected
Antitoxin (Ab) will neutralize preformed toxin
© 2012 John Wiley & Sons, Inc. All rights reserved.

9. Viral Nerve Diseases – Poliomyelitis
Poliovirus (Picornaviridae)
Affinity for CNS motor neurons
Fever, back pain, muscle spasms
Young/old may suffer permanent paralysis
Virus is excreted in human feces, problem in developing nations
Vaccines are available
Eradication target year – soon!
© 2012 John Wiley & Sons, Inc. All rights reserved.