Our Neurological Infections and Inflammatory Diseases Services

Diseases and conditions we care for:

  • Lyme disease: Borrelia burgdorferi is a spirochete that is carried by the deer tick and transmitted to humans to cause Lyme disease. This is an acute infection that can affect the nervous system by causing meningitis (inflammation of the covering of the brain), radiculitis (inflammation of the nerve roots coming out of the spinal cord), or cranial neuropathy (damage to the nerves of the face, most commonly the seventh cranial nerve, also known as “Bell’s Palsy”). Lyme disease of the nervous system does not cause isolated fatigue, cognitive clouding, and generalized pain. It is only diagnosed by FDA-approved testing (screening ELISA and confirmatory Western Blot), and it does not require prolonged antibiotics for treatment. In fact, warnings have been issued against use of alternative diagnostics and prolonged antibiotics.
  • Neurologic complications of HIV: HIV affects the nervous system in a variety of ways and can do so either directly by the virus itself or indirectly through opportunistic infections or dysregulated inflammatory reactions. Direct effects the virus has on the nervous system include cognitive disorders causing memory loss, sensory neuropathy causing pain in the hands and/or feet) spinal cord disease causing difficulty walking, meningitis causing headaches, muscle wasting causing weakness and/or muscle pain. Sometimes HIV can be the cause of strokes or seizures, as well.
  • Neurologic opportunistic infections: These diseases are infections that take hold when the immune system has been weakened by HIV, chemotherapy, steroids, or other medications used to treat autoimmune diseases or to prevent transplant rejection. These include organisms such as Cryptococcus, toxoplasmosis, tuberculosis, progressive multifocal leukoencephalopathy, varicella zoster (shingles virus), cytomegalovirus, non-tuberculous mycobacteria, Epstein-Barr virus, Candida, or histoplasmosis, to name a few.
  • CNS Immune Reconstitution Inflammatory Syndrome (IRIS): This is most commonly a complication of starting antiretroviral therapy in the setting of HIV whereby prior infections of the nervous system are rekindled or discovered once the immune system regains enough strength to attack the infecting organism. This can lead to destruction of normal nervous system tissue if severe. Most organisms implicated are those seen in opportunistic infections, such as Cryptococcus, progressive multifocal leukoencephalopathy, and tuberculosis, but many agents have been reported.
  • Meningitis: This is an inflammation of the covering around the brain, or meninges. Many infectious agents can cause meningitis, including bacteria, viruses, fungi, Lyme disease (Borrelia burgdorferi), or mycobacteria. Additionally, inflammatory conditions, such as rheumatoid arthritis or sarcoidosis, can result in meningitis, as well, along with other noninfectious and noninflammatory conditions.
  • Encephalitis, myelitis, or encephalomyelitis: This refers to infection or inflammation of the brain (encephalitis), spinal cord (myelitis), or both (encephalomyelitis) and can relate to a variety of viruses or bacteria, including herpes simplex virus, West Nile Virus, enterovirus, Eastern equine encephalitis virus, cytomegalovirus, Listeria monocytogenes, mycoplasma, influenza virus, or varicella zoster virus (shingles virus), to name a few. In addition to infectious causes, autoimmunity is an important cause of encephalomyelitis whose approach differs from infectious encephalomyelitis. Acute disseminated encephalomyelitis (ADEM) is an example of this.
  • Abscess: Just as abscesses can form anywhere else in the body, they can affect the nervous system, as well, and are often emergencies when they do. Many abscesses are the result of bacterial infections of the blood, the heart valves, or the bones and soft tissues juxtaposed with the brain and spinal cord and can cause a variety of symptoms as such. 
  • Neurocysticercosis: This is an infection of the brain resulting from larval forms of the pork tapeworm, Taenia solium, imbedding in the brain. This is endemic to many countries outside the US and is one of the most important causes of seizure in the world.
  • Neurological infections in travelers/immigrants: Many infectious diseases that affect the nervous system can be acquired from other parts of the United States or other parts of the world. In the United States, several regional viruses and fungi can cause encephalitis and/or meningitis that individuals coming from endemic regions may have been exposed to. Worldwide, neurocysticercosis, poliomyelitis, malaria, schistosomiasis, rabies, chikungunya virus, dengue fever, leptospirosis, Tick-Borne encephalitis virus, cycloviruses, and melioidosis are some of the infections that can be acquired which affect the nervous system.
  • Neurological complications of rheumatologic conditions: Systemic lupus erythematosis (SLE), rheumatoid arthritis, Sjogren syndrome, and mixed connective tissue disease are a few of the rheumatologic conditions that can affect the nervous system, and they can do so in a variety of ways. Additionally, many parts of the nervous system can be involved, from the muscle to the peripheral nerve all the way to the cerebral cortex. For instance, some patients can have abnormal blood clotting as a complication of SLE, which can affect the brain. Additionally, these conditions may place patients at risk for opportunistic infections, as mentioned above, usually due to the longstanding immune therapy required to treat these diseases.
  • Sarcoidosis: This is an autoimmune condition that often affects the lungs but can involve any part of the body, especially the nervous system. Patients with sarcoidosis of the nervous system can have protean signs and symptoms, but a frequently encountered neurologic complication is due to inflammation of the meninges at the base of the brain and around the spinal cord.
  • Paraneoplastic syndromes: In certain types of malignancies, and sometimes even without evidence of cancer, the immune system can launch an attack on the brain, spinal cord, peripheral nerves, neuromuscular junction, or the muscles. These conditions are very rare but can cause very debilitating disease. Symptoms vary by the part of the nervous system involved. Examples of this include paraneoplastic cerebellar degeneration, limbic encephalitis, myelopathy, or ganglionopathy, to name a few.
  • Vasculitis: This is an inflammation of the blood vessels that can be due to infections, such as varicella zoster virus, cytomegalovirus, or fungal infections such as Aspergillus, or it can be due to a dysregulation in the immune system, such as in temporal arteritis, primary angiitis of the central nervous system, or Wegener’s granulomatosis. 

 

LEARN MORE ABOUT BRIGHAM AND WOMEN’S HOSPITAL


For over a century, a leader in patient care, medical education and research, with expertise in virtually every specialty of medicine and surgery.

About BWH