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Discussion Starter · #1 ·
A 7-year-old girl develops a fever, conjunctivitis, photophobia, and a cough. Her pediatrician notes white spots on a bright red background on the girl's buccal mucosa. Within days, a rash begins around the hairline, then spreads to the trunk and extremities. One week later, the child suddenly begins to convulse, and loses consciousness. She is taken to the emergency room, where involuntary movements and pupillary abnormalities are noted. Which of the following would most likely be seen on CNS biopsy?


A. Demyelination of white matter of cerebral hemispheres with abnormal giant oligodendrocytes
B. Perivenous microglial encephalitis with demyelination
C. Phagocytosis of motor neurons in the spinal cord
D. Severe hemorrhagic and necrotizing encephalitis of the temporal lobe with eosinophilic Cowdry type A
inclusion in neurons and glia
E. Small granulomas with central caseation in the meninges
 
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From Mayo site
Encephalitis. About 1 in 1,000 people with measles develops encephalitis, an inflammation of the brain that may cause vomiting, convulsions and, rarely, coma or even death. Encephalitis can closely follow measles, or it can occur years later.
From emedicine
Measles produces 2 devastating forms of encephalitis: postinfectious, which occurs in about 1 in 1000 infected persons, and SSPE, occurring in about 1 in 100,000 infected patients.
And one more
Acute disseminated encephalomyelitis
It usually occurs 1-2 weeks after a viral infection in children or young adults; these infections include measles, mumps, chicken pox, german measles, influenza and infectious mononucleosis. The brain may be swollen and histological examination demonstrates that many small veins are surrounded by lymphocytes, macrophages and plasma cells. This is associated with demyelination and there may be perivascular haemorrhages.
So we left with choice A.
 

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From Mayo site
Encephalitis. About 1 in 1,000 people with measles develops encephalitis, an inflammation of the brain that may cause vomiting, convulsions and, rarely, coma or even death. Encephalitis can closely follow measles, or it can occur years later.
From emedicine
Measles produces 2 devastating forms of encephalitis: postinfectious, which occurs in about 1 in 1000 infected persons, and SSPE, occurring in about 1 in 100,000 infected patients.
And one more
Acute disseminated encephalomyelitis
It usually occurs 1-2 weeks after a viral infection in children or young adults; these infections include measles, mumps, chicken pox, german measles, influenza and infectious mononucleosis. The brain may be swollen and histological examination demonstrates that many small veins are surrounded by lymphocytes, macrophages and plasma cells. This is associated with demyelination and there may be perivascular haemorrhages.
So we left with choice A.
You mean choice B rt?
 

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Discussion Starter · #8 ·
guys!! answer is B
The correct answer is B. The initial history given is classic for measles, with the appearance of Koplik's spots
(white spots on the buccal mucosa) followed by a rash beginning along the neck and hairline and spreading to
the trunk and extremities. The sequela this child is experiencing is post-infectious encephalomyelitis, which can
follow either infection with measles, varicella, rubella, mumps, or influenza, or vaccination with vaccinia vaccine
or rabies vaccine derived from nervous tissue. Treatment is supportive, with a mortality of 15 to 40%; survivors
frequently have significant permanent neurologic deficits. The pathologic finding is perivenous microglial
involvement with demyelination.

Choice A describes the findings of progressive multifocal leukoencephalopathy, a demyelinating disease caused
by infection with JC virus, especially in immunocompromised individuals.

Choice C describes the findings of poliomyelitis, a paralytic disease affecting the ventral horn of the spinal cord
and motor cortex, caused by an enterovirus (poliovirus).

Choice D describes the findings in herpes encephalitis, which typically affects the inferomedial temporal lobes
and orbitofrontal gyri.

Choice E describes the findings in tuberculous meningitis, caused by M. tuberculosis.
 
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