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Cerebritis is an infection of the brain that normally leads to the formation of an abscess within the brain itself. It is the inflammation of the cerebrum, a structure within the brain, which performs a number of important functions, including most of the things which people associate with being human, such as memory and speech. It is also defined as a purulent nonencapsulated parenchymal infection of brain which is characterized by nonspecific features on CT (ill-defined low density area with peripheral enhancement) and cannot reliably be distinguished from neoplasms.[1]

Cerebritis usually occurs as a result of an underlying condition, which causes the inflammation of the brain tissue. It is commonly found in patients with lupus. Lupus cerebritis may occur in adults and children. The duration of the central nervous system involvement may vary from a few minutes, as in classic migraine or a transient ischemic attack, to years, as in dementia. Resulting neurological deficits may be transient or permanent, occasionally resulting in death.[2]

Symptoms[edit]

The symptoms of cerebritis may range from mild to severe.[3]

The severity of the symptoms varies based on the degree of swelling and on how elevated is the intracranial pressure. Mild symptoms include headaches, depression, anxiety and in some cases, memory loss. In some cases inflammation of brain can be seen if the brain or the nervous system is attacked as a result of problems with the immune system. The serious problems caused because of inflammation include headaches, seizures, vision problems, dizziness, behavior changes and even stroke.[4]

Severe lupus cerebritis symptoms include psychosis, dementia, peripheral neuropathy, cerebellar ataxia (failure of muscular coordination, usually on one side of the body), and chorea (jerky, involuntary movements). Stroke incidence is 3-20% in systemic lupus patients, and is highest in the first five years of the disease. Peripheral neuropathy (carpal tunnel syndrome, for example) occurs in more than 20% of systemic lupus patients and cranial nerve palsies occur in 10-15%.[5]

Causes[edit]

Lupus systemic erythematosus is one of the most common causes of cerebritis as it is believed that more than half of the patients with lupus from the United States suffer from a degree or another of lupus cerebritis.[6]

The exact pathophysiological process of lupus cerebritis is unknown. The proposed mechanisms are likely due to the assault of several autoimmune system changes, including the following:

  • Circulating immune complexes. The immune complexes, which consist of DNA and anti-DNA, cause an inflammatory response as well as a disruption of the blood–brain barrier. These circulating complexes have been found trapped in the highly vascular choroid plexus of SLE patients upon autopsy. True vasculitis, however, is found only in about 10% of patients with cerebral lupus.[7]
  • Anti-neuronal antibodies. The three identified anti-neuronal antibodies postulated in CNS involvement are the lympho-cytotoxic antibodies (LCAs), which somehow react with brain tissue and interfere with the neuron's ability to respond. LCAs have a specific role and are found in both the serum and cerebrospinal fluid (CSF) of lupus patients with cerebritis. These antibodies also correlate with cognitive and visual spatial defects. Second, the anti-neuronal membrane antibodies are targeted directly to neuronal antigens. They, too, are found in the serum of SLE patients with cerebritis. And third, the intracytoplasmic antibodies target the constituents of the neuron cells and they are found in the CSF and serum. These antibodies are seen in 90% of SLE patients with psychosis.[8]
  • Antiphospholipid antibodies. The two antibodies implicated are anticardiolipin and lupus anticoagulant. Anticardiolipin antibodies attach to the endothelial lining of cells, causing endothelial damage, platelet aggregation, inflammation, and fibrosis.[9]
  • Cytokine release. The final mechanism of lupus cerebritis involves the cytokines. The cytokines trigger edema, endothelial thickening, and infiltration of neutrophils in brain tissue. Two cytokines, interferon alpha and interleukin-6, have been found in the CSF of SLE patients with psychosis.[10]

However, it is not clear which mechanism is the actual cause of cerebritis in lupus patients. Specialists believe that all mechanisms may be present at the same time or they may act independently.

In very rare cases, cerebritis may occur as a result of a Klebsiella pneumoniae infection.[11]

One other reason to develop cerebritis is an infection caused by bacteria, viruses, or other organisms. Infections can occur when infectious agents enter the brain through the sinuses or as a result of trauma. Some pathogens are also capable of passing over the blood–brain barrier and entering the brain through the bloodstream, despite the fact that the body has evolved defenses which are specifically designed to prevent this.

Treatment[edit]

Lupus is a condition with no known cure. Lupus cerebritis however is treated by suppressing the autoimmune activity.[12]

When it is caused by infections, treatment consists of medication that will primarily cure the infection. For inflammation, steroids can be used to bring down the swelling. If the swelling appears to have increased to a dangerous level, surgery may be needed to relieve pressure on the brain. The formation of an abscess also calls for surgery as it will be necessary to drain the abscess.

References[edit]

  1. ^ "Cerebritis (Brain)". Retrieved 2010-04-20. 
  2. ^ "Lupus cerebritis: a case study". Retrieved 2010-04-20. 
  3. ^ "Lupus Cerebritis". Retrieved 2010-04-20. 
  4. ^ "Lupus Cerebritis". Retrieved 2010-04-20. 
  5. ^ "Lupus". Retrieved 2010-04-20. 
  6. ^ "Cerebritis Symptoms and Treatment Alternatives". Retrieved 2010-04-20. 
  7. ^ "Mechanisms of CNS Involvement in SLE". Retrieved 2010-04-20. 
  8. ^ "Anti-neuronal Antibodies". Retrieved 2010-04-20. 
  9. ^ "Antiphospholipid Antibodies". Retrieved 2010-04-20. 
  10. ^ "Cytokine Release". Retrieved 2010-04-20. 
  11. ^ "Cerebritis: An unusual complication of Klebsiella pneumoniae". Retrieved 2010-04-20. 
  12. ^ "Systemic Lupus Erythematosus: Treatment & Medication". Retrieved 2010-04-20. 

Original courtesy of Wikipedia: http://en.wikipedia.org/wiki/Cerebritis — Please support Wikipedia.
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35 news items

American Live Wire

American Live Wire
Fri, 19 Dec 2014 17:52:30 -0800

The bacterial infection affects the central nervous system, which then causes diseases such as meningitis, meningoencephalitis, brain abscess, and cerebritis. The current outbreak has been linked to three cases of invasive meningitis in healthy ...
 
Standard-Examiner
Wed, 19 Nov 2014 15:03:45 -0800

LAYTON — A fundraiser for Dottie Murdock, who was diagnosed with lupus cerebritis, will be held from 5:30 p.m. to 7 p.m. Friday, Dec. 5, at Lady Fitness, 1916 N. 700 West. In an effort to offset her sister's medical costs, Lady Fitness instructor ...

Irish Medical Times

Irish Medical Times
Fri, 26 Sep 2014 02:13:34 -0700

The rules are simple, says Dr Garrett FitzGerald, and you can apply them every year: very cold weather in winter plus respiratory pathogens equals chaotic trolley numbers. But he does have some survival tips for his readers. This long summer of great ...
 
Shanghai Daily (subscription)
Tue, 22 Jul 2014 10:15:00 -0700

The immunocompromised such as the elderly, pregnant women and newborns are vulnerable to listeriosis which can cause infections of the central nervous system (meningitis, meningoencephalitis, brain abscess, cerebritis) and bacteremia. The efficient way ...
 
ModernMedicine
Wed, 27 Nov 2013 11:16:12 -0800

Major mental illness including acute psychosis should remain on the differential as well as autoimmune diseases, including systemic lupus erythematosus cerebritis, antiphospholipid antibody syndrome, Sjögren syndrome, and autoimmune encephalitis.4,5.
 
Houston Chronicle
Fri, 20 Sep 2013 18:49:11 -0700

The teen was treated at Memorial Hermann Hospital, where she was diagnosed with lupus cerebritis, a brain inflammation associated with systemic lupus, an auto-immune disorder. According to the warrant, the doctor who made the diagnosis said the girl's ...
 
Washington Post
Mon, 18 Feb 2013 15:13:26 -0800

Tests revealed that Liu also had cerebritis, a brain infection responsible for his worsening confusion, as well as osteomyelitis and diskitis, which were the reasons for his back pain. Liu's infection was caused by Streptococcus viridans, bacteria ...
 
AJNR (subscription)
Fri, 01 Oct 2004 13:35:11 -0700

The formation of a brain abscess follows a typical evolution that can be divided into four contiguous stages: early cerebritis (days 1–3), late cerebritis (days 4–9), early capsule (days 10–14), and late capsule (day 14 or later). The evolution ...
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