《Slide 161.》Tuberculous meningitis, Meninges

A. Brief Descriptions：

1. Chronic bacterial meningitis.

B. Gross Findings：

1. Discrete，white granules scattered over the leptomeninges.

2. Gelatinous or fibrinous exudates in subarachnoid spaces often at the base of the brain，obliterating the arteries and encasing cranial nerves.

C. Micro Findings：

1. Chronic inflammatory reaction: lymphoplasma cells and macrophages.

2. Well-formed granuloma with central caseous necrosis surrounded by epithelioid cells and giant cells.

3. Gliosis.

4. Calcification in inactive area.

D. Others:

1. 臨床症狀: 頭痛、倦怠、嘔吐、神智不清。

2. CSF的異常:

   • moderate pleocytosis ( mononuclear cells or mixture of mononuclear cells and PMN ).

   • elevated protein content.

   • normal or reduced glucose level.

3. 併發症: arachoid fibrosis result in hydrocephalus and obliterative endarteritis (阻塞性動脈內膜炎) with arterial occlusion and infarction of underlying brain.

E. Reference：

1. Robbins Pathologic Basis of Disease, 6^th ed.  P.1319-1317.

 

 

【 Fig. 161-1 (LP)】Nodules of caseous granulomatous inflammation in subarachnoid spaces.

　

 

　

【 Fig. 161-2 (LP)】Caseous necrotic centers surrounded with epithelioid cells and Langhans’ giant cells.

　

 

【 Fig. 161-3 (LP)】Caseous necrotic centers surrounded with epithelioid cells and Langhans’ giant cells.

　

 

【 Fig. 161-4 (HP)】 Langhans’ giant cells.