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Most common cause of bacterial meningitis in adults?
Strep.Pneumo
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Common sequelae of bacterial meningitis?
- Hydrocephalus
- Epilepsy
- Hearing loss
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Major cause on meningitis in neonates?
Group B Strep
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MRI changes in congenital CMV infection?
Periventricular calcification
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What does congenital CMV cause?
- Sensorineural hearing loss
- Hepatosplenomegaly
- Petechiae
- Microcephaly
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What does congenital Toxo cause?
- Chorioretinitis,
- hydrocephalus,
- Scattered intracranial calcifications
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What does congenital rubella cause?
- Deafness
- Cataracts
- Cardiac malformations
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Most common cause of spinal cord dysfunction in AIDS?
HIV mediated vacuolar myelopathy
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Most common cause of mono neuritis multiplex in AIDS?
CMV
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What is coccidiomycosis?
- Common pulmonary fungal infection
- Will cause confusion and ataxia secondary to hydrocephalus
- TNF alpha MABs significantly increase your risk of it.
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Which fungal infection causes soap bubble cysts in the basal ganglia?
Cryptococcus
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Which fungal infection causes haemorrhage strokes in post transplant patients?
Aspergillosis
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Whats standard therapy for GBM?
- Surgery
- Radiotherapy
- Temozolamide
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Presence of which genetic mutation confers a favourable response to alkylating agents?
MGMT hypermethylation
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Histologic feature of GBM?
Pseudopallisading necrosis
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Anti-Hu antibody?
- From SCLC
- Sensory neuronopathy
- Cerebellar degen
- Limbic encephalitis
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Anti-TR antibody?
- Hodgkins lymphoma
- Cerebellar degeneration
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Anti-Yo antibody?
- Mostly ovarian and breast
- Cerebellitis
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Anti-Ta antibody?
- Testicular cancer
- Limbic encephalitis
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Anti-Ma2 antibody?
- Testicular and lung
- Limbic and brainstem encephalitis
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What is foster-kennedy syndrome?
- Olfactory groove tumors - lose sense of smell.
- Cause ipsilateral optic nerve atrophy
- Contralateral papilloedema
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What mutations are meningioma associated with?
Mutations of the Merlin gene
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Which cell line do meningiomas arise from?
Arachnoid
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Which is the most common primary brain tumour to haemorrhage?
Oligodendroglioma
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Histology of ol-egg-odendrogliomas?
- Chicken wire capillaries
- Fried egg appearing cells
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Cytarabine side-effect?
Acute cerebellar toxicity
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Pilocytic Astrocytomas?
- Cystic cerebellar lesion with an enhancing mural nodule
- Pilo means hair which represents the Rosenthal fibres on histology
- Respond well to treatment
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Ataxia-Telangectasia
- AR
- Due to mutation in ATM gene responsible for DNA repair
- Sensitive to radiotherapy
- Have an Immunoglobulin deficiency so they get sinopulmonary infections
- Increased risk of leukaemia and lymphoma
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Subependymal giant cell astrocytomas (SEGA) are typical for what?
Tuberous sclerosis
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Most common location for a DNET?
Temporal lobe
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Which variant of ependymomas arises from the filum terminale?
Myxopapillary ependympoma
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Common haemorrhage mets?
- Melanoma
- Renal
- Thyroid
- Choriocarcinoma
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What cancer is Anti-ampiphysin assoc with?
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Most common tumor associated with GABA-a?
Thymoma
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2 most common causes for leptomeningeal mets?
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Glial neoplasm with necrosis and pseudopallisading nuclei
GBM
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"Fried egg" appearance
Oligodendroglioma (fixation artefact)
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Perivascular pseudorosettes
Ependymoma
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Homer-Wright Rosettes
Medulloblastoma
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Ki-67
Marker of nuclear proliferation
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GFAP
Marker of glial intermediate filaments
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Cytokeratin
Marker of epithelial intermediate filaments
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Rosenthal Fibres
- Pilocytic astrocytomas
- Pleomorphic xanthoastrocytoma
- Alexander Disease
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Chromosome 1p and 19q deletion
Good prognostic factor in ODG
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Where do Brain mets arise from?
Lung>Breast>melanoma
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Tumors typically presenting with seizures?
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Anti-Ri?
- Opsoclonus myoclonus
- Breast, lung and ovarian
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Posterior fossa tutor with drop mets?
Medulloblastoma
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Radiological features of gangliomas?
Often in temporal lobes with cystic component.
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What differentiates a dermoid from an epidermoid?
- Dermoids and teratomas have all sort fo tissue in them so they have a heterogenous internal sinal.
- Epidermoid cysts are lined with squamous cells and are homogenous.
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What is a dandy walker malformation
- A posterior fossa cyst that communicates with the 4th ventricle.
- Severe atrophy of the vermis
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What differentiates GBM from lymphoma on MR?
- Lymphoma - Avid + homogenous enhancement NEAR CSF spaces
- GBM - Heterogenous enhancement, situated peripherally.
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Commonest intracranial tumor?
- Mets
- Then Meningioma, GBM, pituitary microadenomas
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Whats the relevance on HHV 6?
- Often comes out to play after bone marrow or solid organ transplant
- Usually causes a limbic encephalitis
- Can cause myelitis or leukoencephalopathy
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What percentage of patients with confirmed HSV have plum normal CSF?
5%
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What is Lemierre's syndrome?
- Primary oropharyngeal, tonsillar or peritonsillar inflammation
- With later development of sepsis, internal jugular vein thrombosis and septic emboli.
- This is typically caused by the bacterium Fusobacterium necrophorum.
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GabaA encephalitis
- Often presents in status/NORSE
- multifocal T2 lesions
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Which neoplasia is Morvan's most strongly associated with?
Thymoma
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How long do you give dexamethasone for pneumococcal meningitis?
4 days
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What is intracranial germinoma?
- Homogenous, avidly enhancing, extra axial mass on or near the pineal.
- Often presents in young male
- Don't do surgery, you'll spread it everywhere - radiology works very well for it.
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How would you manage cryptococcal meningitis?
- IV Amphoterocin
- Oral flucytosine (better than fluconazole)
- Daily LPs to drop ICP
- Start antiretroviral 10-14 days after start of anti-fungal
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