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*Viral encephalitis (Neurotrophic viruses):<ref>{{Cite journal | last1 = Ludlow | first1 = M. | last2 = Kortekaas | first2 = J. | last3 = Herden | first3 = C. | last4 = Hoffmann | first4 = B. | last5 = Tappe | first5 = D. | last6 = Trebst | first6 = C. | last7 = Griffin | first7 = DE. | last8 = Brindle | first8 = HE. | last9 = Solomon | first9 = T. | title = Neurotropic virus infections as the cause of immediate and delayed neuropathology. | journal = Acta Neuropathol | volume = 131 | issue = 2 | pages = 159-84 | month = Feb | year = 2016 | doi = 10.1007/s00401-015-1511-3 | PMID = 26659576 }}</ref> | *Viral encephalitis (Neurotrophic viruses):<ref>{{Cite journal | last1 = Ludlow | first1 = M. | last2 = Kortekaas | first2 = J. | last3 = Herden | first3 = C. | last4 = Hoffmann | first4 = B. | last5 = Tappe | first5 = D. | last6 = Trebst | first6 = C. | last7 = Griffin | first7 = DE. | last8 = Brindle | first8 = HE. | last9 = Solomon | first9 = T. | title = Neurotropic virus infections as the cause of immediate and delayed neuropathology. | journal = Acta Neuropathol | volume = 131 | issue = 2 | pages = 159-84 | month = Feb | year = 2016 | doi = 10.1007/s00401-015-1511-3 | PMID = 26659576 }}</ref> | ||
** Eteroviruses are the most common cause of aseptic meningitis. | |||
***Coxackie Virus. | |||
***Enteric cytopathic human orphan (ECHO) virus. | |||
** Human Herpesviruses (HSV1, HSV2, VZV, CMV, EBV, Roseola) | ** Human Herpesviruses (HSV1, HSV2, VZV, CMV, EBV, Roseola) | ||
*** HSV encephalitis has high mortality without acyclovir treatment. | *** HSV encephalitis has high mortality without acyclovir treatment. | ||
** Measles virus( worldwide more than 100.000 deaths | ** Measles virus(worldwide more than 100.000 deaths annually). | ||
***Is linked to [[acute demyelinating encephalomyelitis]] (ADEM) and Subacute sclerosing encephalitis (SSPE). | ***Is linked to [[acute demyelinating encephalomyelitis]] (ADEM) and Subacute sclerosing encephalitis (SSPE). | ||
** Seasonal influenza A virus (highest patogenic potential: avian influenza H5N1). | ** Seasonal influenza A virus (highest patogenic potential: avian influenza H5N1). | ||
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*Purulent bacterial encephalitis | *Purulent bacterial encephalitis | ||
**Streptococcus, [[Actinomyces]] .... | **Streptococcus, [[Actinomyces]] .... | ||
*Septic metastatic encephalitis | |||
**microabscesses, local astrogliosis, two or more granulocytic infiltrates without relation to vessel.<ref>{{Cite journal | last1 = Tauber | first1 = SC. | last2 = Bunkowski | first2 = S. | last3 = Brück | first3 = W. | last4 = Nau | first4 = R. | title = Septic metastatic encephalitis: coexistence of brain damage and repair. | journal = Neuropathol Appl Neurobiol | volume = 37 | issue = 7 | pages = 768-76 | month = Dec | year = 2011 | doi = 10.1111/j.1365-2990.2011.01196.x | PMID = 21696418 }}</ref> | |||
*Septic embolic encephalitis | |||
**Embolic endocarditis, Stroke-like lesions.<ref>{{Cite journal | last1 = Bitsch | first1 = A. | last2 = Nau | first2 = R. | last3 = Hilgers | first3 = RA. | last4 = Verheggen | first4 = R. | last5 = Werner | first5 = G. | last6 = Prange | first6 = HW. | title = Focal neurologic deficits in infective endocarditis and other septic diseases. | journal = Acta Neurol Scand | volume = 94 | issue = 4 | pages = 279-86 | month = Oct | year = 1996 | doi = | PMID = 8937541 }}</ref> | |||
*Non-purulent bacterial encephalitis | *Non-purulent bacterial encephalitis | ||
** [[Tuberculosis]]... | ** [[Tuberculosis]]... | ||
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File:Rabies encephalitis PHIL 3368 lores.jpg | Rabies encephalitis (CDC.gov) | File:Rabies encephalitis PHIL 3368 lores.jpg | Rabies encephalitis (CDC.gov) | ||
File:Rabies negri bodies brain.jpg | Negri bodies in Purkinje cells (CDC.gov) | File:Rabies negri bodies brain.jpg | Negri bodies in Purkinje cells (CDC.gov) | ||
</gallery> | |||
====Vasculitis==== | |||
DDx Cerebral vasculitis / angiitis: | |||
*[[Systemic lupus erythematosus]] (SLE) | |||
*[[Rheumatoid arthritis]]. | |||
*Medications and drugs (amphetamine, cocaine and heroin). | |||
*Paraneoplastic(lymphomas, leukemia and lung cancer). | |||
*[[Granulomatosis_with_polyangiitis]] | |||
*[[Giant cell arteritis]] | |||
*[[Takayasu's arteritis]] | |||
*[[Polyarteritis nodosa]] | |||
*Beta-amyloid-related angiitis (ABRA) | |||
<gallery> | |||
File:ABRA_HE_40x.jpg | Beta-amyloid related angitis, HE (WC) | |||
File:ABRA_beta-amyloid_40x.jpg | Beta-amyloid related angiitis, abeta IHC (WC) | |||
File:Giant cell arteritis -- low mag.jpg | Giant cell arteritis, HE (WC) | |||
</gallery> | </gallery> | ||
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====IHC==== | ====IHC==== | ||
*Abeta-amyloid (AKA beta-amyloid). | *Abeta-amyloid (AKA beta-amyloid). | ||
===Cerebral amyloid angiopathy associated with inflammation (I-CAA)=== | |||
* Cognitive decline. | |||
* Microbleedings in MRI. | |||
* Responsive to steroids. | |||
* Abeta deposits in vessels. | |||
* Perivascular lymphocytic infiltrate (but no vasculitis!). | |||
* Giant cells may be present. | |||
===Vascular malformations=== | ===Vascular malformations=== | ||
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*[[Takayasu's arteritis]]. | *[[Takayasu's arteritis]]. | ||
*[[Antiphospholipid antibody syndrome|Antiphospholipid antibody]] mediated thrombosis. | *[[Antiphospholipid antibody syndrome|Antiphospholipid antibody]] mediated thrombosis. | ||
===Microangiopathy=== | |||
*Defined as Small vessel disease (<300µm in transverse section). | |||
*Includes atherosclerosis and cerebral amyloid angiopathy. | |||
Other causes: | |||
*Primary angitis of the CNS (PACNS). | |||
*[[Polyarteritis nodosa]]. | |||
*[[Granulomatosis with polyangiitis]] (Wegener's granulomatosis). | |||
*[[Lymphomatoid granulomatosis]]. | |||
*Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (commonly abbreviated ''CADASIL''). | |||
{{Main|Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy}} | |||
===Hypoxic-ischemic encephalopathy=== | ===Hypoxic-ischemic encephalopathy=== | ||
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{{Main|Neurodegenerative diseases}} | {{Main|Neurodegenerative diseases}} | ||
This is a hueueuge topic. It is covered in its own article and includes a general discussion of dementia. | This is a hueueuge topic. It is covered in its own article and includes a general discussion of dementia. | ||
==Epilepsy== | |||
{{Main|Epilepsy}} | |||
==Epilepsy== | ==Epilepsy== | ||
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</gallery> | </gallery> | ||
===Hamartia=== | |||
* Small collection of ectopic glioneuronal cells. | |||
**Morpholology resembling oligodendroglial-like cells. <ref>{{Cite journal | last1 = Kasper | first1 = BS. | last2 = Stefan | first2 = H. | last3 = Buchfelder | first3 = M. | last4 = Paulus | first4 = W. | title = Temporal lobe microdysgenesis in epilepsy versus control brains. | journal = J Neuropathol Exp Neurol | volume = 58 | issue = 1 | pages = 22-8 | month = Jan | year = 1999 | doi = | PMID = 10068310 }}</ref> | |||
* Mostly amygdala, less common in hippocampus or temporal lobe. | |||
* Can coexist with focal cortical dysplasia. | |||
==Demyelination== | |||
==Multiple sclerosis== | ===Multiple sclerosis=== | ||
*Abbreviated ''MS''. | *Abbreviated ''MS''. | ||
{{Main|Multiple sclerosis}} | {{Main|Multiple sclerosis}} | ||
===Osmotic demyelination syndrome=== | |||
{{Main|Osmotic demyelination syndrome}} | |||
*Previously known as ''central pontine myelinolysis'' (abbreviated ''CPM''). | |||
===Acute disseminated encephalomyelitis=== | |||
*Abbreviated ''ADEM''. | |||
{{Main|Acute disseminated encephalomyelitis}} | |||
== | ===Neuromyelitis optica=== | ||
*Abbreviated ''NMO''. | |||
* | |||
General: | |||
* | *Rare autoimmune disease - once considered a variant of [[multiple sclerosis]]. | ||
**Autoantibodies directed at aquaporin-4.<ref name=pmid22087205>{{Cite journal | last1 = Kim | first1 = W. | last2 = Kim | first2 = SH. | last3 = Kim | first3 = HJ. | title = New insights into neuromyelitis optica. | journal = J Clin Neurol | volume = 7 | issue = 3 | pages = 115-27 | month = Sep | year = 2011 | doi = 10.3988/jcn.2011.7.3.115 | PMID = 22087205 }}</ref> | |||
Diagnosis: | |||
* | *NMO-IgG. | ||
Clinical - preferentially: | |||
*Eye (optic neuritis). | |||
*Spinal cord (myelitis). | |||
* | |||
* | |||
Microscopic: | |||
*Inflammation - lymphocytes, macrophages. | |||
*Reactive astrocytes. | |||
Images: | Images: | ||
*[http:// | *[http://path.upmc.edu/cases/case637.html Neuromyelitis optica - several images (upmc.edu)]. | ||
* | |||
IHC: | |||
*Mixed lymphocyte population with CD3 > CD20. | |||
*Aquaporin-4 loss. | |||
===Progressive multifocal leukoencephalopathy=== | |||
*Abbreviated ''PML''. | |||
{{Main|Progressive multifocal leukoencephalopathy}} | |||
=Cysts= | =Cysts= | ||
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===Epidemiology=== | ===Epidemiology=== | ||
*Autosomal recessive - mutation in a number of genes including NPHP1, AHI1, and CEP290.<ref name=ninds_joubert/> | *Autosomal recessive - mutation in a number of genes including NPHP1, AHI1, and CEP290.<ref name=ninds_joubert/> | ||
=See also= | =See also= |