Cerebritis
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Cerebritis is the
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
The symptoms of cerebritis may range from mild to severe.[3]
The severity of the symptoms varies based on the degree of
Severe lupus cerebritis symptoms include
Causes
Systemic lupus erythematosus (SLE) 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.
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.[5]
- 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.[6]
- neutrophils in brain tissue. Two cytokines, interferon alpha and interleukin-6, have been found in the CSF of SLE patients with psychosis.[8]
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.[9]
One other reason to develop cerebritis is an infection caused by
Diagnosis
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Lumbar pancture to establish the cause
Treatment
Lupus is a condition with no known cure. Lupus cerebritis, however, is treated by suppressing the autoimmune activity.[10]
When it is caused by infections, treatment consists of medication that will primarily cure the infection. For inflammation,
References
- ^ "Cerebritis (Brain)". Archived from the original on 2010-04-23. Retrieved 2010-04-20.
- ^ "Lupus cerebritis: a case study". Retrieved 2010-04-20.
- ^ "Lupus Cerebritis". Archived from the original on 2010-07-06. Retrieved 2010-04-20.
- ^ "Lupus Cerebritis". Archived from the original on 2010-07-06. Retrieved 2010-04-20.
- ^ "Mechanisms of CNS Involvement in SLE". Retrieved 2010-04-20.
- ^ "Anti-neuronal Antibodies". Retrieved 2010-04-20.
- ^ "Antiphospholipid Antibodies". Retrieved 2010-04-20.
- ^ "Cytokine Release". Retrieved 2010-04-20.
- ^ "Cerebritis: An unusual complication of Klebsiella pneumoniae". Archived from the original on 2011-01-27. Retrieved 2010-04-20.
- ^ "Systemic Lupus Erythematosus: Treatment & Medication". Retrieved 2010-04-20.