Herdencephalitis is an inflammatory change in a part of the brain. It is usually caused by bacteria and usually occurs as a secondary disease of another inflammatory event in the body. While herdencephalitis was often fatal in the past, it can be treated comparatively well today.
What is herdencephalitis?
Septic herdencephalitis, or herdencephalitis for short, is an inflammation that occurs in one or more parts of the brain but does not affect it in its entirety. It is most often caused by bacteria, but in rare cases it can also be caused by fungi or parasites. Different forms of herdencephalitis can be distinguished. In the case of an associated brain abscess, the infected tissue is clearly demarcated from the surrounding area, while the volume of this area increases significantly. In the case of septic-embolic herdencephalitis, stroke occurs due to the carryover of infected blood clots. Septic metastatic herdencephalitis is characterized by multiple areas of the brain being affected simultaneously due to pathogens occurring freely in the blood.
Causes
Herdencephalitis occurs when bacteria or, in less common cases, other pathogens such as fungi or parasites such as Toxoplasma gondii enter the brain tissue. Only extremely rarely does this occur through direct infection, when there is open craniocerebral trauma following an accident. In the overwhelming majority of cases of disease, a wash-in of the pathogens from other parts of the body takes place. This occurs primarily when advanced inflammatory diseases are already present, especially if they are located in the respiratory tract and head. Inflammatory changes in the dental apparatus can also result in herdencephalitis. Occasionally, herdencephalitis also occurs after implantation. This is an indication that the implant was contaminated with germs. The presence of an immunodeficiency disorder is not causative for the occurrence of herdencephalitis, but it does promote it.
Symptoms, complaints, and signs
In most cases, herdencephalitis is initially manifested by nonspecific symptoms. The most common are headache, dizziness, and mild disorientation. These are a result of increasing pressure from the enlarging focus of inflammation. Fever, vomiting, convulsions, difficulty speaking and any combination of these symptoms are also possible. The symptoms associated with herdencephalitis depend in large part on where in the brain it is localized. As the disease progresses, the symptoms already present intensify. In addition to high fever, neurological deficits and even coma can then be expected in the absence of treatment.
Diagnosis and progression
To diagnose herdencephalitis with certainty, an imaging procedure is necessary. Therefore, after administration of a contrast agent, computed tomography or magnetic resonance imaging is performed. In the early stages, herdencephalitis can still be easily confused with other diseases of the brain. However, after only a few days, the disease can be clearly recognized by the inflammatory focus, the associated edema and the visible encapsulation from the surrounding tissue. In order to determine the exact pathogen, a lumbar puncture is performed and cerebrospinal fluid is taken. This is then subjected to microbiological examination in the laboratory. Subsequently, the origin of the pathogen must be found so that the primary disease can also be treated. This often involves another computed tomography scan, in which case the chest and abdomen are preferentially examined. Since herdencephalitis is an extremely rapidly progressing disease, it can be diagnosed with certainty and treatment initiated after a short time, even if the symptoms are diffuse and not clearly assignable at the beginning. In recent decades, this has had an extremely positive effect on the chance of recovery from the disease, which was previously not uncommonly lethal.
Complications
Herdencephalitis primarily causes discomfort to the brain. These are noticeable to the patient through various physical and psychological symptoms.In most cases, headaches occur as the intracranial pressure increases. It is not uncommon for this pain to spread to other areas and regions of the body and may cause pain in these as well. Furthermore, dizziness and nausea also occur. The affected person suffers from fever and severe cramps. Action and thinking are also restricted, and it is not uncommon for speech and orientation disorders to occur. In some cases, the patient loses consciousness or falls into a coma. Without treatment, life expectancy is extremely reduced by herdencephalitis and the patient dies from the disease. Similarly, paralysis and other sensory disturbances may occur on the patient’s body. Diagnosis of herdencephalitis is usually relatively quick and easy, allowing early treatment of this disease. Furthermore, there are no symptoms or complications. With the help of antibiotics, herdencephalitis can be quickly controlled. Life expectancy is not limited if treatment is quick and correct.
When should you see a doctor?
If symptoms such as headache, dizziness, and disorientation occur, herdencephalitis may be underlying. A doctor should be consulted if symptoms persist for more than two to three days. If other symptoms such as fever, nausea and vomiting, convulsions or speech disorders occur, the affected person must seek medical advice immediately. Edema and other external changes should also be clarified immediately. The sufferer should visit a hospital and have the symptoms clarified. Medical advice is required at the latest when neurological symptoms are noticed. If the affected person loses consciousness, the emergency physician must be called. Herdencephalitis usually occurs in the context of a respiratory disease or inflammatory changes in the dental apparatus. The above-mentioned complaints can also occur after an implantation or after an accident with open craniocerebral trauma. In addition, patients suffering from an immunodeficiency disease belong to the risk groups and should have the symptoms mentioned clarified by a physician in a timely manner. In addition to the family doctor, neurologists and specialists in internal medicine are among the contacts. In case of severe symptoms, it is best to call an emergency physician or contact the medical emergency service.
Treatment and therapy
In cases of herdencephalitis, it is first essential to normalize the pressure in the brain to prevent further damage. This can be achieved, for example, by hypobaric oxigenation. In this form of treatment, pure oxygen is used at an elevated ambient pressure. This is done in a specially designed pressure chamber. If this is possible due to the location in the brain, the inflamed area is then surgically removed. If an important brain region such as the speech center or brain stem is affected, this must be omitted. Antibiotics are used instead or if additional surgery has been performed previously. Antibiotic therapy may be used before the final diagnosis of herdencephalitis. In this case, broad-spectrum antibiotics are used first. After the responsible pathogen has been determined, a switch is then made to an antibiotic tailored to that pathogen. Infection with Toxoplasma gondii can also be treated with antibiotics. If the pathogen is a fungus, an antimycotic must be used. In addition to treatment of the herdencephalitis, however, therapy also includes treatment of the actual underlying disease. In particular, foci of pus in the body must be thoroughly eliminated. Therefore, it may be necessary to surgically sanitize infected wounds, abscesses in the area of the teeth, and suppurations in the ear, nose, and throat.
Outlook and prognosis
A few years ago, the prognosis for diagnosed herd encephalitis was always negative: the disease resulted in death in most cases. Today, however, modern treatment methods and a better understanding of the disease have made a much more favorable prognosis possible in most cases. The general condition of the patient is important for the success of treatment and thus for the patient’s prospects of recovery. Certain pre-existing conditions such as diabetes or AIDS have a negative impact on the prognosis. Underlying diseases such as an existing inflammation of the inner lining of the heart can also have a negative effect.If the patient’s general condition is otherwise good, herd encephalitis is easily treatable, provided the patient receives appropriate medical care. Thus, a rapid start of therapy with antibiotics and possibly necessary surgery has a positive effect on the prognosis. For this, it is necessary that the patient visits a hospital that can provide the necessary specialist departments and facilities, in particular with computer tomograph, laboratory, neurosurgery and microbiology. This is because then, in addition to consistent therapy, rapid intervention is possible in the event of any complications that may arise, such as an increase in intracranial pressure or the development of further foci of inflammation.
Prevention
To prevent herdencephalitis, in addition to generally strengthening the immune system and avoiding people with infectious diseases, all inflammatory diseases should generally be treated promptly if immunodeficiency is present. This applies in particular to infections in the area of the teeth, ears and sinuses. Prolonged foci of pus should be avoided if possible. This can prevent the corresponding diseases from being carried over and the pathogens from spreading via the bloodstream to the brain, where they can trigger herdencephalitis.
Follow-up
In most cases, those affected by herdencephalitis have no direct or special measures or options for aftercare. The primary focus is on early detection of the disease so that further complications can be avoided. Therefore, a doctor should be consulted already at the first symptoms and signs of this disease. In most cases, treatment is carried out directly in a hospital. Those affected are always dependent on the help, care and support of their own family and friends. This can also prevent psychological upsets or depression. Furthermore, herdencephalitis is also treated by taking medication. Affected persons should pay attention to the correct dosage and to the regular intake of the medicines, so that the complaints can be alleviated. Alcohol should not be taken with antibiotics, as this can weaken the effect of the medication. In most cases, regular examinations by a doctor should be done during treatment to properly monitor the symptoms of herdencephalitis. In some cases, the life expectancy of the affected person is reduced due to this disease.
Here’s what you can do yourself
Herdencephalitis can be prevented by taking some steps. If the affected person suffers from a weak immune system or an immunodeficiency, infections and inflammations must be avoided at all costs. This includes observing a high standard of hygiene and treating all illnesses at an early stage. Especially in the area of the ears, teeth and nose, infections should be investigated very quickly. This can prevent the spread of pathogens to the brain. However, special self-help options are not possible or necessary for herdencephalitis. In most cases, the disease can be treated by a doctor relatively quickly and easily. Those affected are dependent on taking antibiotics. Possible interactions with other medications should be taken into account. Therefore, if the affected person is not sure whether medications influence each other, a doctor should always be contacted. Alcohol must also be avoided while taking antibiotics. In some cases, surgical interventions must take place. After such procedures, it is important for those affected to take it easy and not to perform any heavy activities.
