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Inflammatory brain disorders

Brain infections (meningitis and encephalitis) and autoimmune encephalitis

Understanding the disorder and its importance

Inflammatory brain disorders encompass a range of conditions characterised by inflammation of the brain or its surrounding tissues. This category includes infections like meningitis (inflammation of the membranes covering the brain and spinal cord) and encephalitis (inflammation of the brain tissue itself), as well as autoimmune encephalitis, where the body’s immune system mistakenly attacks the brain. These disorders are of critical importance due to their potential for rapid progression and severe neurological consequences. Quick recognition and treatment are essential to prevent long-term complications or life-threatening outcomes.

Signs and symptoms

The signs and symptoms of inflammatory brain disorders can vary but often include fever, severe headache, and altered mental status. Patients may experience neck stiffness, sensitivity to light and nausea or vomiting. Seizures are common, particularly in encephalitis. In infants, symptoms may include irritability, poor feeding and a bulging fontanelle. Autoimmune encephalitis can present with a wide range of neuropsychiatric symptoms, including behavioural changes, memory problems and movement disorders. As the condition progresses, patients may develop decreased consciousness, focal neurological deficits or status epilepticus.

When to seek neurological assessment

Neurological assessment should be sought immediately if there’s any suspicion of an inflammatory brain disorder. This includes the sudden onset of high fever accompanied by severe headache, confusion or neck stiffness. Any rapid change in mental status, new onset of seizures, or unusual behavioural changes, especially in the context of a recent illness or fever, warrant urgent evaluation. In infants and young children, excessive crying, irritability or refusal to eat combined with fever, should prompt immediate medical attention.

Investigation and treatment strategies

Investigation of inflammatory brain disorders typically begins with a thorough clinical examination, followed by laboratory tests including blood work and analysis of cerebrospinal fluid obtained through lumbar puncture. Neuroimaging, such as MRI, is crucial to visualise brain inflammation and rule out other causes. In cases of suspected autoimmune encephalitis, specific antibody tests may be performed. EEG can help detect seizure activity or encephalopathic changes.

Treatment strategies depend on the underlying cause but often involve a combination of supportive care and targeted therapies. For bacterial meningitis or encephalitis, intravenous antibiotics are crucial. Viral causes may be treated with antiviral medications. Autoimmune encephalitis typically requires immunosuppressive therapies including corticosteroids, intravenous immunoglobulin or plasma exchange. Anticonvulsants may be necessary to control seizures. Close monitoring in an intensive care setting is often required, with ongoing neurological assessments to track progress and adjust treatment as needed. Long-term follow-up is essential to manage any residual neurological deficits and support recovery.

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