Pathology

The presence of the blood brain barrier limits host defence mechanisms and enables multiplication of organisms.

Arachnoid membrane Polymorpho------- nuclear exudate

A purulent exudate most evident in the basal cisterns extends throughout the subarachnoid space.

The underlying brain, although not invaded by bacteria, becomes congested, oedematous and ischaemic.

The integrity of the pia mater normally protects against brain abscess formation.

The inflammatory exudate may affect vascular structures crossing the subarachnoid space producing an arteritis or venous thrombophlebitis with resultant infarction. Similarly, cranial nerves may suffer direct damage.

Hydrocephalus can result from obstruction to CSF flow in the ventricles and subarachnoid space.

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