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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/09/20 19:27:37」(JST)

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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

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

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

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

"Cerebritis". Medcyclopaedia. GE. Archived from the original on 2012-02-05.

^ "Cerebritis (Brain)". Retrieved 2010-04-20.
^ "Lupus cerebritis: a case study". Retrieved 2010-04-20.
^ "Lupus Cerebritis". Retrieved 2010-04-20.
^ "Lupus Cerebritis". Retrieved 2010-04-20.
^ "Lupus". Retrieved 2010-04-20.
^ "Cerebritis Symptoms and Treatment Alternatives". 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". Retrieved 2010-04-20.
^ "Systemic Lupus Erythematosus: Treatment & Medication". Retrieved 2010-04-20.

UpToDate Contents

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1. 脳膿瘍の病因、臨床症状、および診断 pathogenesis clinical manifestations and diagnosis of brain abscess
2. リステリア菌感染の臨床症状および診断 clinical manifestations and diagnosis of listeria monocytogenes infection
3. 細菌性脳膿瘍の治療および予後 treatment and prognosis of bacterial brain abscess
4. 全身性エリテマトーデスの神経症状 neurologic manifestations of systemic lupus erythematosus
5. 新生児における細菌性髄膜炎：神経学的合併症 bacterial meningitis in the neonate neurologic complications

English Journal

Pneumococcal meningitis: Clinical-pathological correlations (meningene-path).

Engelen-Lee JY1, Brouwer MC1, Aronica E2,3, van de Beek D4.
Acta neuropathologica communications.Acta Neuropathol Commun.2016 Mar 22;4(1):26. doi: 10.1186/s40478-016-0297-4.
Pneumococcal meningitis is associated with substantial mortality and morbidity. We systematically assessed brain histopathology of 31 patients who died of pneumococcal meningitis from a nationwide study (median age 67 years; 21 (67 %) were male) using a pathology score including inflammation and v
PMID 27001057

Mycoplasma pneumoniae, a trigger for Weston Hurst syndrome.

Magun R1, Verschoor CP1, Bowdish DM1, Provias J1.
Neurology® neuroimmunology & neuroinflammation.Neurol Neuroimmunol Neuroinflamm.2016 Jan 21;3(1):e187. doi: 10.1212/NXI.0000000000000187. eCollection 2016.
OBJECTIVE: We report a case of Mycoplasma pneumoniae infection as one possible trigger for Weston Hurst syndrome (acute hemorrhagic leukoencephalitis), a rare disorder of microvascular injury often described as a postinfectious complication of an upper respiratory illness.METHODS: This is a case of
PMID 26819961

Implant Site Infection and Bone Flap Osteomyelitis Associated with the NeuroPace Responsive Neurostimulation System.

Wei Z1, Gordon CR2, Bergey GK3, Sacks JM4, Anderson WS5.
World neurosurgery.World Neurosurg.2015 Dec 29. pii: S1878-8750(15)01775-1. doi: 10.1016/j.wneu.2015.11.106. [Epub ahead of print]
BACKGROUND: The NeuroPace RNS System is a method recently approved by the U.S. Food and Drug Administration for closed-loop direct brain stimulation in selected patients with drug-resistant partial seizures. The long-term risks of implant site infection and accompanying bone flap osteomyelitis assoc
PMID 26743382

Japanese Journal

Multiple Brain Abscesses in Neonate Caused by Edwardsiella Tarda

TAKEUCHI Hayato,FUJITA Yuri,OGAWA Hiroshi,SHIOMI Kozue,TOYOKAWA Youichi,YAMAMOTO Toru,FURUKAWA Taizo,EBISU Toshihiko
Neurologia medico-chirurgica 49(2), 85-89, 2009-02-15
… Serial changes in magnetic resonance imaging findings including diffusion-weighted imaging demonstrated the development from the late cerebritis to late capsule stages. …
NAID 110007124654

侵襲型副鼻腔アスペルギルス症の1例

横川恭子,佐藤慎太郎,林田精一郎,倉富勇一郎,井之口昭
耳鼻と臨床 53(4), 214-220, 2007
眼窩内および頭蓋内浸潤を来し、不幸な転帰をたどった侵襲型副鼻腔アスペルギルス症の1例を経験したので報告する。症例は76歳、男性で、基礎疾患として糖尿病があった。副鼻腔真菌症の術後、約半年を経過した後に急激な視力障害と頭痛を来し、眼球摘出を含む病変の摘出・清掃と抗真菌剤の全身投与を行ったが、急速に症状の進行を認め不幸な転帰をたどった。診断後早期に病変の徹底除去を目的とした拡大手術を行い、併せて継続的 …
NAID 130004405081

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