Reduction in Forebrain Parenchymal and Cortical Grey Matter Swelling across Treatment Groups in Patients with Inflammatory Illness Acquired Following Exposure to Water-Damaged Buildings

Exposure to the complex mixture of inflammagens and toxigenic microbes growing in water-damaged buildings (WDB) can lead to a chronic inflammatory response syndrome (CIRS). Many CIRS patients exhibit a neurological component of illness that includes structural brain changes. This study shows some of those structural brain changes are potentially reversible when patients are removed from the WDB environment and follow sequential steps of a published treatment protocol. We evaluated MRIs from 91 subjects classified into four groups: controls, untreated, partially treated and fully treated/recovered CIRS-WDB patients using the MRI volumetric software NeuroQuant®. The current study reinforced previous findings of increased forebrain parenchymal, cortical gray matter and pallidum volumes, as well as decreased caudate nucleus volumes in untreated CIRS patients compared to controls. All changes were found bilaterally. When an ANOVA was performed on brain structures across all patient classes, statistically significant decreases were seen in forebrain and cortical gray matter between untreated and fully treated/recovered patients as these structures trended towards control levels after sequential treatment. Both the caudate and pallidum volumes also trended towards control values but were not significant by ANOVA. These data are consistent with clinical improvement of executive functioning seen in patients as they progressed through the treatment steps, suggesting that volumetric brain imaging is a useful tool for monitoring therapy longitudinally.