Inflammation of the brain (or Encephalitis) can cause permanent brain damage. Assoc Prof Kevin Tan, Senior Consultant, Department of Neurology at National Neuroscience Institute (NNI), shares more.
Inflammation of the brain (also known as Encephalitis) can affect anyone at any age. It causes swelling and damage to the brain and surrounding membranes as well.
In mild cases, patients recover well and return to normal. Some recover without treatment – for example, in encephalitis caused by various viruses for which no specific medicine is available or effective, and where the immune system clears the infection.
In more serious cases, patients can develop memory problems or seizures. In worst cases, some end up bedridden, comatose or lose their lives.
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Causes of brain inflammation (encephalitis)
“Inflammation of the brain can be caused by
infections from outside the body, or by the
body’s own immune system attacking the brain”, said
Assoc Prof Kevin Tan, Senior Consultant from the
Department of Neurology at
National Neuroscience Institute (NNI), a member of the
SingHealth group. “Well over 100 types of viruses and bacteria can cause the infection. This makes it challenging to track down the culprit.”
Brain infections can occur in a few ways:
“Any infection around the head or face can potentially enter the brain because of the close proximity. Sometimes bacteria from certain infections in other parts of the body get transported by blood to the brain, causing the brain infection,” Prof Tan added.
Another way is autoimmune encephalitis – a condition when brain inflammation is caused by the body’s own immune system attacking the brain. There are many subtypes of autoimmune encephalitis and doctors are still trying to understand it.
How to know if it’s brain inflammation (encephalitis)
Symptoms of encephalitis include:
Weakness focused on one part of the body
However, these symptoms may also be seen in other brain conditions, hence making initial diagnosis difficult.
“Doctors would consider other clues, such as fever, to help with the diagnosis. A fever suggests an infection somewhere in the body. In evaluating patients, we also look for infections in other parts of the body. We would suspect encephalitis if we do not find infections in the common sites and the patient is still confused,” said Prof Tan.
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How is brain inflammation (encephalitis) diagnosed
Time is of the essence when it comes to diseases of the brain. Encephalitis can progress quickly, within hours or days. Taking symptoms and features as a whole, if doctors suspect encephalitis, various tests are done to try and identify the cause.
“Usually we start off with brain scans, either CT (computer tomography) or MRI (magnetic resonance imaging) scans.” Prof Tan said.
MRI scans offer better resolution and more detailed information about the brain than CT scans. But CT scans are more readily available and can yield quick answers, such as whether it would be safe to do a lumbar puncture.
In a lumbar puncture, a fine needle is used to extract fluid from the space around the spinal cord in the lower back region. This fluid is then tested for infections or antibodies that may suggest that the condition is autoimmune in nature.
“However, a lumbar puncture would not be carried out if CT scans show significant swelling in the brain, because it could worsen the condition,” warned Prof Tan.
Blood tests are also important as sometimes they are useful in providing the answers to the diagnostic question.
Unfortunately, there are no tests available for all bacteria and viruses that can cause encephalitis.
“We test for the ones we know about and can be tested for. If we get a positive result, we know how to treat the patient. However, if the encephalitis is caused by one of the others that we do not have a test available, then we will not know for sure,” Prof Tan explained.
Is brain inflammation (encephalitis) treatable and preventable?
If encephalitis is caused by an infection, antibiotics are usually prescribed for up to a few weeks. However, brain surgery may be required if complications arise, such as swelling in the brain.
Prevention in the form of vaccines is available but limited to a few specific types of encephalitis, such as the Japanese encephalitis, which is caused by a virus and transmitted by infected mosquitoes.
“It (Japanese encephalitis) is extremely rare in Singapore, but travellers who are heading to parts of the world where this form of encephalitis is prevalent may need to get vaccinated,” Prof Tan advised.
The Japanese encephalitis virus, is only one of a myriad of viruses and bacteria that can cause encephalitis. “There is no single vaccine to prevent all types of encephalitis,” said Prof Tan, who hopes that more research can be done on the disease so that diagnosis can be made more quickly and accurately.
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