LivingBrain inflammation that can kill you

Brain inflammation that can kill you

That something is inflamed in our body is a concept with which we are more or less familiar. Infections cause inflammation, when we get hit the hit area becomes inflamed or when we have tendinitis we are talking about an inflammation of the tendons.

What is perhaps less well known is that inflammation is a process by which white blood cells (one of our lines of defense) and the things they produce protect you from infection by foreign invaders, such as bacteria, viruses, parasites, and fungi . It’s true, it’s not all infections, inflammation is also a reaction that helps us heal damaged tissue (that’s why blows also inflame).

So far so good, nothing new, right? But what would you tell me if I told you that the brain can also become inflamed?

 

Can the brain really get inflamed?

Yes, and this condition is called encephalitis . The name, like so many others in medicine, we get from the Greek. Encéfalo literally means “inside the head”, and the suffix “-itis” speaks of inflammation. Therefore, “inflammation inside the head”.

The problem is that, even if our immune system “intends” to be good, having your brain inflamed is usually not a good thing, and it wouldn’t do it without a good reason . You see, encephalitis usually occurs when a virus, vaccine or other agent crosses the barrier between the blood and the nervous system, and arrives where it shouldn’t, in our brain. That region is prohibited, access is restricted, and when our body detects that there is something there that shouldn’t be, it immediately sends our little soldiers to protect us. Unfortunately, there are also times when our “little soldiers” turn against us (or so it seems) and lead to autoimmune diseases, another possible cause of encephalitis.

As you know, when something swells, it also swells, and this is no exception. The brain swells and our head hurts (by way of curiosity, the brain does not have pain receptors, our heads hurt because, when it swells, the brain presses on the structures that surround it, the meninges – this is called meningoencephalitis -). I wish the matter would stay here! The brain is not an isolated, disconnected organ, but is connected to the rest of the body by the spinal cord, something like a tangle of cables that connect it to the rest of our body. Well, you know that infections can spread and spread. When the spinal cord is affected we speak of encephalomyelitis . Taking into account that in most cases we are talking about infections (although the inflammation process itself can also cause it), other symptoms are fever, neck stiffness, altered mental status, hallucinations, confusion , paralysis of any part of the body, hearing loss, sensitivity to light and even seizures. Sometimes, even after recovering, we can be left with consequences of the disease (from memory loss or speech difficulties, to paralysis of some region, for example). In the worst cases, death is one of the possible destinations in this disease (due to several possibilities, but one of the most frequent is the affectation of the respiratory centers in our brain, thus preventing us from breathing correctly -or from knowing how to do it). -).

 

What causes encephalitis?

It is common to talk about viruses when talking about encephalitis because it is one of the most likely causes, but let’s remember that the definition of the condition is established by inflammation, not infection. And even speaking of infection, there are other microorganisms that can cause it, such as bacteria, fungi or parasites. Therefore, risk factors include a weak immune system (the more “bugs” that can attack us, the greater the risk). Other factors are young children or the elderly (an immature or “worn out” immune system).

But if we have learned anything in the last 2 years, it is that “a virus” is too ambiguous and now we want to know exactly what virus. You see, as I was saying, the problem is often that an infectious agent crosses the blood-brain barrier (the barrier that separates our blood from our nervous system) and reaches the brain. This means that there is not a single virus that causes this disease, but that several viruses, as long as they are able to cross this barrier (usually due to their small and elusive size), can cause encephalitis. Therefore, it is not surprising that several of the possible viruses sound familiar to you: from the herpes simplex virus, rabies or measles, to HIV. And even recently some cases of what is thought to be SARS-CoV-2 encephalitis have been reported.

 

 

How is it diagnosed?

Regarding diagnosis, encephalitis is usually suspected in patients with unexplained altered mental status . The clinical presentation and differential diagnoses may suggest some diagnostic tests, but brain MRI and cerebrospinal fluid analysis (including PCR for herpes simplex virus, among others) are usually done, usually with other tests (eg. g., serological tests) to identify the causative virus. Despite extensive testing, the cause in many cases remains unknown.

If magnetic resonance imaging is not available, a computed tomography (CT) scan is performed . MRI and CT can help doctors rule out disorders that can cause similar symptoms (such as stroke and brain tumor). These tests can also find problems that can make a lumbar puncture dangerous. In some cases (luckily infrequently) we even do a brain biopsy (take a piece of the brain and look at it under a microscope).

In spite of everything, as I mentioned above, sometimes the viruses, bacteria or other causes of the infection are not identified. If so, other reasons begin to arise, such as whether the cause is autoimmune or paraneoplastic (related to cancers, which have a bad habit of releasing compounds that generate inflammation into our blood).

 

Do you have treatment?

Treatments may vary depending on whether or not the cause is identified, and depending on the particular case of each person. Some causes, if determined, have a specific treatment, and others do not. In all cases, there is no shortage of efforts to relieve symptoms (such as seizures and fever) and, when necessary, provide life support (for example, with a breathing tube) until the infection resolves (usually within 1 -2 weeks).

References:

Cleveland Clinic (2021, July 28). Inflammation: What Is It, Causes, Symptoms & Treatment. Cleveland Clinic. https://my.clevelandclinic.org/health/symptoms/21660-inflammation

Greenlee, J.E. (2020, July 13). encephalitis . MSD Manual General Public Version; MSD Manuals. https://www.msdmanuals.com/en/home/brain,-spinal-and-nerve-diseases/brain-infections/encephalitis

‌Hopkins Medicine (2022). Encephalitis. (2022).  Hopkinsmedicine.org. https://www.hopkinsmedicine.org/health/conditions-and-diseases/encephalitis#:~:text=Encephalitis%20is%20inflammation%20of%20the,light%2C%20mental%20confusion%20and%20seizures

Howes, D. S. (2021, July 15). Encephalitis: Practice Essentials, Background, Pathophysiology. Medscape.com; Medscape. https://emedicine.medscape.com/article/791896-overview#a1

Mayo Clinic (2020, April 17). Encephalitis – Symptoms and causes. Mayo Clinic; https://www.mayoclinic.org/diseases-conditions/encephalitis/symptoms-causes/syc-20356136

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