The Brain on Ice
While CIRS patients are often marked by inflammation in the brain in the form of swelling — the so-called “brain on fire” — some patients exhibit a different pattern on their NeuroQuant results: one dominated by widespread atrophy rather than swelling.
This is sometimes referred to as the “brain on ice” profile. It can reflect a combination of factors, including advanced progression of CIRS due to biotoxins, in addition to other stressors such as tick borne infections, prescribed antifungal use, pathogenic colonization in the nasal cavities, and Traumatic Brain Injury.
In this post, we’ll explore what this pattern means, how it shows up in NeuroQuant data, and what factors might contribute to its development.
What Is a “Brain on Ice”?
In contrast to swelling, atrophy means shrinkage — brain tissue that has lost volume. On a NeuroQuant report, this is typically seen as:
Per the Triage Brain Atrophy, brain regions with a percentile score around or below 5
Per the Surviving Mold NeuroQuant analysis, any brain regions listed under “atrophic nuclei”
In CIRS, atrophy of the cortical gray matter and caudate nucleus are common
This can confuse patients who are showing widespread atrophy, since the scoring index (known as Mold Score) included in the Surviving Mold NeuroQuant analysis for CIRS only accounts for patterns of swelling. That is, the Surviving Mold NeuroQuant analysis was created to detect primarily patterns of swelling (with the exception of the caudate). However, when atrophy is the dominant pattern, this will bring the Mold Score down, even though the brain is showing signs of advanced progression of CIRS.
This is why it is important for practitioners to educate patients on the different patterns of brain abnormalities that can be found in CIRS.
Possible Contributors to Atrophy
While brain atrophy can occur as a byproduct of multiple factors, there are aspects of CIRS that may accelerate or contribute to this pattern:
Chronic exposure to actinobacteria and/or endotoxins
Long-term use of antifungal medications (e.g., itraconazole, fluconazole)
History of traumatic brain injury (TBI) or concussion
Co-existing conditions, such as tick-borne infections or autoimmune disorders like Multiple Sclerosis
The “brain on ice” profile may indicate that the illness has been active for an extended period of time.
Treatment Considerations
Just like with the “brain on fire,” the Shoemaker Protocol — especially with the use of Vasoactive Intestinal Polypeptide (VIP) — has been observed to help reverse or stabilize brain atrophy, although improvements may occur earlier in the protocol.
Patients dealing with this pattern may require:
More time on VIP
Careful review of other contributing factors (e.g., actinobacteria colonization in the body, history of medication use, TBI history, chronic tick borne infections)
Supportive therapies to aid brain recovery alongside the standard protocol
Tracking Progress Over Time
NeuroQuant provides a way to track brain volume changes longitudinally. For patients in the “brain on ice” phase, success may look like a reduction in the number of atrophied regions, as well as a return of volumes toward normal ranges. For example, patients may start with six or seven regions flagged as atrophied per the Surviving Mold NeuroQuant report and, over time, reduce those numbers as they advance through treatment.
Key Takeaways
The “brain on ice” pattern is marked by shrinkage in multiple brain regions, often seen in later stages of CIRS.
Scoring indexes created for CIRS may not account for widespread atrophy, which is why it is important for patients to seek out medical assessment from practitioners who understand how to read a NeuroQuant report in the context of CIRS.
Contributing factors can include antifungal use, TBI, chronic exposure to actinobacteria and/or endotoxins, as well as chronic tick-borne infections like Lyme, Bartonella, and Babesia.
The Shoemaker Protocol — especially VIP — is central to addressing widespread brain atrophy.
