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jean robert
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05/07/08 - 02:58 AM

A 7 year old girl develops a fever, conjunctivitis, photophobia, and 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 trunks and extremities. One week later, the child suddenly begins to convulse, and loses consciousness. She is taken to the ER, 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 hemisphere 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 neurons and glia

e) Small granulomas with central caseation in the meninges

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Aashi
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05/07/08 - 05:53 AM

b) Perivenous microglial encephalitis with demyelination -----------------> post-infectious encephalomyelitis in this case most probably due to measles

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PGI2alpha
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05/07/08 - 07:03 AM

quick question...what are cowdry type A specific for....just to refresh my dusty memory

Tiff
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05/07/08 - 03:29 PM

A - these are cells seen in measles. Patient seems to have suffered measles with encephalitis short there after. So these cells should be present.

Tiff
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05/07/08 - 03:30 PM

PGI2alpha wrote:
quick question...what are cowdry type A specific for....just to refresh my dusty memory

I think HSV

jean robert
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05/08/08 - 12:28 PM

Correct answer: B

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jean robert
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05/08/08 - 12:37 PM

EXPLANATION

The sequela this child is experiecing is post infectious encephalomyelitis, which can follow either infection with

1.-Measles 2.- Varicella

3.-Rubella 4.- Mumps

5.-Influenza

Or vaccination with vaccinia 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

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jean robert
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05/08/08 - 12:42 PM

Demyelination of white matter of cerebral hemisphere with abnormal giant oligodendrocytes (Choice A ) describes the findings of Progressive Multifocal Leukoencephalopathy, a demyelinating disease caused by infection with JC virus, especially in IC individuals.

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