Neuropathology, Set 4

For each of the following patient descriptions, select the most likely infectious agent involving the central nervous system to produce the Ūndings:

1. A 72-year-old man presents with bilateral decreased sensation in his lower extremities. He is noted to have a widened gait. He exhibits psychotic behavior. While in an extended care facility, he succumbs to complications of congestive heart failure from aortic valvular insufficiency. At autopsy there is meningeal thickening and cortical atrophy. Microscopically the meninges exhibit a mononuclear infiltrate, including many plasma cells. The underlying cerebral cortex demonstrates neuronal loss and microglial rod cells. An endaortitis is seen in the aortic wall:

2. A 50-year-old woman with chronic headaches has a head CT scan that reveals enlargement of the cerebral ventricles. By MR imaging there is cerebral cortical thinning, and there is meningeal thickening with several small 1 cm nodules at the base of the brain. A chest radiograph reveals bilateral upper lobe calcification and cavitation of the lungs:

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