Inflammation of the brain

introduction

At a inflammation in the brain different areas can be affected. If the inflammation is in the brain itself, it is referred to as Encephalitis. If the Meningesthat surround the brain are affected, the inflammatory change is called meningitis designated. It is also possible that both areas get sick together. That's called a Meningoencephalitis. Triggers such a disease bacteria, Viruses, Mushrooms and other Parasites.

causes

In most cases they are bacteria or Viruses who cause inflammation in the brain. Infestation by fungi or other parasites is less common, but still possible. The pathogens enter the body in different ways. You can mainly differentiate between the following options:

• after infection of the Nasopharynx the germs are over the Bloodstream carried to the brain (hematogenous spread) and settled there;
• after a Paranasal sinus, Ear- or Eye infection the pathogens penetrate deeper into the tissue up to the brain and establish themselves there;
• it comes from a head or spine injury Central nervous system in direct contact with the sick (pathogenic) Germination.

The pathogen causing the inflammation in the brain depends on various factors. The age and state of health of the patient are very important. An infestation with fungi or other parasites occur more frequently in the group immunocompromised people in front. Infection with Cryptococcus neoformans (yeast fungus - crytococcosis), Toxoplasma gondii (single cell - toxoplasmosis) or Cysticercus cellulosae (tapeworm - cysticercosis) is often the cause of the disease.

Also read our topic: Viral encephalitis

Causes of meningitis:

The causative agents of bacterial meningitis can most easily be classified according to the age of the patient. Newborns are most often infected with Escherichia coli, B streptococci (mostly Streptococcus agalactiae) or Listeria (Listeria monocytogenes) infested. In some cases, this already happens during delivery in the birth canal, later by the mother or nursing staff, or by contaminated food. Children and adolescents have an increased risk of developing Haemophilus influenzae type B, against which adults are usually already immune. From childhood to adulthood, meningococci (Neisseria meningitidis) and pneumococci (Streptococcus pneumoniae) the main cause of bacterial inflammation of the meninges.

Bacterial meningitis pathogens that cause special clinical pictures are Treponema pallidum (neurosyphilis), Leptospira icterohaemorrhagica (Weil disease) and the tick-borne Borrellia burgdorferi (neuroborreliosis). The most common viral pathogens of meningitis are various enteroviruses, various herpes viruses, the mumps virus and the flavivirus, which is usually transmitted by ticks and which is TBE (Early summer meningoencephalitis) triggers.

Causes of encephalitis:

Inflammation inside the brain is mainly caused by viruses. Encephalitis caused by bacteria usually develops as a result of previous meningitis - then there is one Meningoencephalitis. Due to the outbreak in the body Herpes simplex viruses I. Most encephalitides develop. Over 90% of the population carry this virus, sometimes unknowingly. After a single infection, usually in childhood, it settles in nerve nodes (Spinal ganglia) of its host and remains there until the end of his life. If the Immune system there can be an outbreak of the virus and one Herpes simplex encephalitis come. Other relevant virus strains are the Varicella zoster virus (chickenpox, Shingles), of the Cytomegalovirus, of the Measles virus, of the Rubella virus, of the Influenza virus (flu), HIV and the Rabies virus.

Inflammation of the brain from stress

Stress alone cannot generally lead to an inflammation of the brain, a so-called encephalitis.

However, herpes viruses that are activated by stress can lead to such encephalitis.

It is inherent in herpes viruses that after an initial infection, such as chickenpox, they hide in certain nerve cells of the person affected and cannot be eliminated by the immune system.

However, at this stage they are inactive. If various triggers, such as stress, reactivate these viruses, they can lead to different appearances. These range from the development of individual cold sores on the lip to the rare inflammation of the brain, which is then known as herpes encephalitis and can lead to death if left untreated. In most cases, however, encephalitis is not the first sign that the virus is reactivating.

Shingles and cold sores, for example, usually develop before the viruses spread to the brain. Herpes encephalitis should be considered if such initial manifestations are present and neurological deficits are developing.

Diagnosis

In diagnostics, the focus is on the search for the pathogen, as the therapies against various pathogens differ fundamentally in some cases. For this purpose, a Lumbar puncture Brain water, also Liquor called, accepted and examined. A suitable treatment can often be found under the microscope or after cultivation on growth plates. In addition, a PCR (Polymerase chain reaction) the pathogen can be detected directly in the liquor. Since the results of the Laboratory diagnostics are not immediately available, will be additional physical exams and imaging tests, like CT (Computed Tomography) and MRI of the brain (Magnetic resonance imaging) carried out.

The physical exam focuses on neurological symptoms such as loss of motor function or sensory disorders, disorders of consciousness, and unusual sensation of pain. The latter is called in with meningitis Meningism Sign or a defensive tension of the patient if the head is passively tilted towards the chest in a lying position. The physical examination can reveal the location of the inflammation in the brain. The EEG (electroencephalogram) is also used as a diagnostic tool. The excitations in the brain are measured and the functionality or impairment assessed.

Examination of cerebral water

A very good diagnostic tool for suspicion of inflammation of the brain is to examine the cerebrospinal fluid, also known as liquor.

The liquor surrounds the central nervous system and has many functions, such as damping vibrations, disposing of degradation products and many others.

If there is an inflammation of the brain, certain substances and cells can be detected in increased numbers in the liquor. These include an increased number of white blood cells (neutrophil granulocytes) and an increased lactate and protein level.

As a rule, the CSF is removed for such an examination through a lumbar puncture. A needle is inserted into the lumbar spine in the liquor space that surrounds the spinal cord and the liquor can be obtained from it.

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Frequency distribution

The incidence of encephalitis and meningitis (inflammation of the brain and its skins) is 15 cases per 100,000 inhabitants per year. Meningococcal infections predominate in Europe from the age of six. The disease rate is in immunocompromised patients, for example at AIDS patient, significantly higher.

What can be the first signs of brain inflammation?

In the presence of encephalitis, the prognosis depends largely on the time of diagnosis and the subsequent therapy.

For this reason, when the first signs appear, it is extremely important to act quickly and have the presence of encephalitis clarified. The first signs of encephalitis are general exhaustion and severe headache, which are accompanied by the development of a fever.

This phase is known as the prodromal phase. In addition to this triad, there may be other symptoms such as nausea, sensitivity to light or a stiff neck when the meninges are also affected (Menigism) join in. In the further course, there may also be impaired consciousness, epileptic seizures or motor failures.

Symptoms

Every inflammation in the brain, both meningitis and encephalitis, has its own set of symptoms. However, if both brain areas are involved, the clinical pictures can mix and result in a complicated overall picture, which is sometimes difficult to diagnose.

Symptoms of meningitis:

The first symptoms of meningitis develop relatively quickly after infection and spread of the pathogen Vomit and very strong a headache counting. The inflammation of the meninges causes an increased CSF production and a subsequent one Increase in intracranial pressure. This increase causes the initial symptoms to worsen. In addition, impaired consciousness can develop in the patient - he loses attention and appears increasingly dull and uninvolved. If the pressure in the skull rises too high, you can coma or death as an acute consequence.

Other symptoms are Neck stiffness, more or less high feverlarge skin rashes and unconsciousness, Seizures or psychotic symptoms, due to the involvement of the brain. Occasionally it can be seen as accompanying symptoms Herpes labialis and a Conjunctivitis observe with photosensitivity. In children, rising fever can be the only symptom of meningitis. In infants must pay particular attention to the Fontanelles attention should be paid to the bulging outward with high intracranial pressure.

Symptoms of encephalitis:

The symptoms of inflammation inside the brain (encephalitis) are initially similar cold and is usually milder than meningitis in the course of the disease. At first the patient notices a rise in temperature and chills. There are increasing a headache, Disturbances of consciousness, neurological and psychotic symptoms. How the neurological-psychotic symptoms manifest themselves depends on which areas in the brain are affected by the inflammation. This can be the case when the frontal lobe, the front of the brain, is affected Personality changes come.

A brain swelling (cerebral edema) or Cerebral hemorrhage (cerebral hemorrhage) can be dangerous consequences of encephalitis and cause permanent brain damage. When infected with viruses, a similar clinical picture can be observed as with a bacterial infection. A special feature is the course of herpes simplex encephalitis, in which several foci of inflammation form in the brain. As a result, speech and consciousness disorders develop, Disturbances in the sense of smell and epileptic seizures.

What is the course of encephalitis?

The course of encephalitis is basically divided into two phases.

The prodromal phase, in which the first signs become noticeable, and the focus symptoms, which include the broader spectrum of encephalitis symptoms.

In addition to this rough phase subdivision, it is very difficult to depict an exact course of the disease, as this depends on the causative agent and the time at which therapy begins. The prodromal phase comprises the triad of symptoms described in almost all cases, consisting of general exhaustion that can last for several days, the development of fever and severe headache, which can occur very acutely.

The further course of the disease (focus symptoms) then depends on the exact localization of the inflammation. In addition to a general clouding of consciousness and fatigue, this can lead to epileptic seizures or loss of function, which can even lead to temporary paralysis.

The mortality rate is strongly dependent on the pathogen. With adequate therapy, TBE encephalitis is only 2%, whereas herpes virus-induced encephalitis, even with the best therapy, still has a high mortality rate of 10-20%, especially in small children.

Read more on the topic: Viral encephalitis

multiple sclerosis

Multiple sclerosis is a chronic inflammatory disease that affects the entire central nervous system, i.e. the brain and spinal cord.

The inflammation mainly leads to a demyelination of the nerves. The myelin surrounding the nerves usually acts as a kind of insulation for the nerves, which allows nerve stimuli to pass from one nerve cell to another much faster. If this isolation is broken down, the transmission of stimuli becomes slower and the typical symptoms of MS such as visual disturbances, motor disorders and mental or cognitive limitations develop.

Initially, these symptoms usually run in bursts, which are then treated with steroids. However, as the disease progresses, the symptoms usually become stronger and more permanent. MS is also generally associated with a reduced life expectancy.

There is no curative therapy at the current point of research.

Read more on the topic: multiple sclerosis

Herpetic encephalitis

Herpes encephalitis refers to the inflammation of the brain caused by a herpes virus.

Encephalitis is a possible but rare complication of all herpes diseases, which in addition to the common lip and genital herpes, also include chickenpox, shingles and Pfeiffer's glandular fever.

It is characteristic of the herpes viruses that, even after the initial infection has subsided, they remain in certain nerve cells in the body of the person affected and can be activated again and again. Since these viruses spread via the nerves, they can also spread to the brain and lead to life-threatening inflammation that requires immediate therapy.

Without treatment, the death rate from herpes encephalitis is around 70%. It is therefore very important to recognize the first signs, which include severe headache, fever and general weakness, at an early stage, so that adequate therapy can be started as early as possible.

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therapy

Inflammation in the brain caused by bacteria, commonly meningitis, needs treatment as soon as possible. After the removal of the CSF for diagnostic purposes, a Antibiotic therapy began. Antibiotic-resistant strains can be found more and more often, especially in hospitals. The right combination of drugs with different effects prevents the further development of resistance and increases the success of the therapy. A common side effect of antibiotic therapy is one allergic reaction on the drug. Therefore, known allergies must be observed and the medication adjusted accordingly. After the pathogen has been detected, a specific Antibiogram to be started. Factors that deserve special attention are those CSF penetration - Does the drug get to its target? - and the toxicity of the drug. The benefits must be weighed against the possible harm that the patient could suffer from the treatment.

Special therapy is required in the event of an infection with Mycobacterium tuberculosis be applied. This one is the causative agent tuberculosis and one occurring in the secondary stage tubercular meningitis. A successful therapy promises the use of up to five combined Anti-tuberculotics. The massive killing of bacteria can lead to Jarisch-Herxheimer reaction come. The body is flooded with bacterial residues and it can nausea, high fever, headache and other symptoms that come at times in one State of shock end up. The encephalitides, which are mainly caused by viruses, are mildly treated with painkillers (Analgesics) and bed rest treated. If the symptoms are stronger, antivirals such as Acyclovir for use. At HIV disease be special antiretroviral drugs used that do not cure the patient, but inhibit or even stop the development.

What are the chances of a cure if the brain is inflamed?

The chances of recovery in the presence of inflammation of the brain (encephalitis) depends largely on the time of diagnosis and the subsequent therapy.

In general, the prognosis without therapy is extremely poor with a death rate of 70-80%.

However, if the early warning signs, such as neurological deficits, severe headache and fever, are recognized and immediate treatment is initiated, the mortality rate can be greatly reduced.

In the case of an infection with the herpes virus, this is now 10-20%. The therapeutic approach here is that as long as the pathogen is unknown, one tries to fight all possible pathogens, for example by giving antibiotics against bacteria and at the same time initiating antiviral therapy with acyclovir.

As soon as the exact pathogen is identified, the therapy can be specified further. This regimen has dramatically improved the chances of recovery in recent years. The extent of consequential damage can usually only be conclusively assessed after some time.

Is Brain Inflammation Contagious?

Most brain inflammations in Germany are caused by viruses.

In addition to the herpes viruses, these include the TBE viruses (early summer meningo encephalitis viruses), mumps viruses, measles viruses, rubella viruses and many more.

In themselves, all of these viruses are primarily contagious. It is important to know, however, that an infection does not always have to lead to encephalitis. For most adults, infection with normal herpes zoster viruses, for example, is largely harmless. Especially small children and people with a pronounced immune deficiency have an increased risk of developing encephalitis as a result of infection.

If these risk groups come into contact with sick people, certain protective measures should therefore be taken.

forecast

The course of inflammation in the brain depends on the age and health of the patient. The course of the disease is often fatal in immunocompromised patients.

The prognosis for bacterially caused meningitis is only favorable if a diagnosis is made as quickly as possible.

If the pathogens come into contact with the central nervous system via the bloodstream or through an injury, the patient has a better chance that the disease will heal without consequences than if the disease was transmitted after a previous infection of the nose or ears. Inflammation caused by pneumococci (30% death rate) is usually poor in adults, in contrast to meningococcal infections (5% death rate).

The faster the symptoms develop and the more complications arise in the course of the disease (e.g. heart failure), the worse the prognosis in general. Inflammations in the brain become dangerous at particularly low or old age. The death rate from E. coli meningitis is highest in infants, but infections from other pathogens are also more dangerous than in adult patients. Eye muscle paralysis can occur as a consequence of having overcome meningitis Hydrocephalus occlusus (Water head), numbness (in half of all pneumococcal meningitis) or epileptic seizures occur.

The prognosis for encephalitis is positive for the majority of all illnesses. Mild symptoms favor complete healing. Exceptions are herpes simplex encephalitis and encephalitis in HIV-infected people. The swelling of the brain caused by herpes simplex is the most common cause of death from infection and a quarter of the patients suffer severe permanent damage, such as mental disorders, paralysis or blindness. AIDS patients almost always develop neurological or psychological involvement in the late stages of their disease. Infections with other pathogens that can attack through the weakened immune system also play an important role.

prophylaxis

A comprehensive vaccination of children lowers the risk of developing various inflammatory pathogens. For example, against Pneumococci, Meningococci and Haemophilus influenzae "Serotype B" be vaccinated. The latter vaccination has become well established in recent years. When traveling to countries where the hygienic standard does not correspond to the local latitude, you should also find out about possible vaccinations from your family doctor. Nursing staff or family members who have come into contact with patients can use the antibiotic prophylactically Rifampicin be treated. In the event of sexual contact, preventive measures should always be taken condom can be used, as some of the pathogens can get into or on the body in this way. This probably plays the largest role in HIV transmission.