Encephalopathy - Causes, symptoms and treatment. MF.

Encephalopathy ( encephalopathia, anate encephalon brain + Greek pathos suffering, disease; synonym: pseudoencephalitis, cerebropathy, encephalosis) - a syndrome of diffuse brain damage, which is based on the mechanism of ischemia( impaired blood supply),hypoxia( oxygen starvation) of the brain tissue and, as a consequence, the phenomenon of death of nerve cells caused by various diseases and pathological conditions.

There are congenital and acquired encephalopathies. Congenital encephalopathies can be caused by genetic defects in metabolism, brain development abnormalities or associated with the impact of damaging factors in the perinatal period, primarily such as brain hypoxia and intracranial trauma.

Acquired encephalopathy occurs due to the impact on the brain of damaging factors in the postnatal period. Depending on the etiology and pathogenesis, there are several types of acquired encephalopathies. Post-traumatic encephalopathies are late or long-term consequences of craniocerebral trauma. Toxic encephalopathies are a consequence of the systematic influence of neurotropic substances: ethyl alcohol, chloroform, barbiturates, lead, etc.( see Alcohol encephalopathies, Poisonings), as well as bacterial toxins( see Botulism, Diphtheria, Measles, Tetanus).Radiation encephalopathy is caused by the effect on the brain of ionizing radiation( see Radiation sickness, radiation damage).Isolate encephalopathy, caused by metabolic disorders in diseases of internal organs. With various liver diseases, accompanied by necrosis of the liver cells, a change in the vascular system of the liver, toxic substances are not rendered harmless by the liver and enter the large circulation, causing toxic effects on the brain and causing hepatic encephalopathy( see Liver failure).Metabolic encephalopathies include encephalopathy associated with renal pathology, uremia( uremic encephalopathy), postdialysis dementia, and dialysis imbalance syndrome( see Renal failure).Pancreatic pathology is associated with pancreatic encephalopathy, which occurs more often as a complication of acute Pancreatitis, as well as hypoglycemic, hyperosmolar, hyperglycaemic encephalopathy( see Diabetes Sugar).

Encephalopathy can develop with water retention in the body, reducing osmotic pressure and hyponatremia due to increased secretion of antidiuretic hormone in various tumor diseases, bleeding, trauma, lung diseases. With encephalopathy caused by hyperthermia, dysfunction of the hypothalamus with subsequent metabolic changes is noted.

A separate group consists of so-called vascular encephalopathies, etiologically associated with chronic impairment of blood supply to the brain. Discirculatory encephalopathy can develop with atherosclerosis( atherosclerotic encephalopathy), hypertensive disease( hypertensive encephalopathy), venous outflow disorders of the brain( venous encephalopathy).Acute hypertensive encephalopathy is noted in the malignant course of hypertension, secondary arterial hypertension, which occurs with various kidney diseases and nephropathy of pregnant women. Acute development of metabolic encephalopathies is observed during hypoxia caused by disorders of pulmonary ventilation, blood circulation, tissue metabolism, for example, with a prolonged decrease in blood pressure during cardiac surgery, large vessels. An example of hypoxic encephalopathy is postresuscitative encephalopathy.

The most common mechanism of development of any type of encephalopathy is hypoxia of the brain, which is a consequence of the deterioration of its blood supply, venous congestion, edema, as well as microhemorrhagia, exogenous and endogenous toxins that exacerbate brain metabolism disorders. The presence of common( along with specific) pathogenetic mechanisms of encephalopathy causes similar morphological changes of varying degrees. This diffuse brain atrophy with a decrease in the number of neurons and degenerative changes in them, small foci of necrosis and demyelination in white matter with proliferation of glial cells, cerebral edema, microhemorrhagia in the brain substance, sometimes with signs of blood stasis, puffiness and fullness of the meninges. Features of various types of encephalopathy are the severity and predominant localization of the lesion, the predominant lesion of white or gray matter of the brain, the degree of cerebral blood flow disturbance.

Classification of encephalopathies

Encephalopathy is a common name for diseases of the brain characterized by its dystrophic changes.
Encephalopathy is azotemic psychotic acute( eg azotaemica psychotica acuta) - see Delirium acutum.
Anoxic encephalopathy( e., Anoxic, syn., Encephalopathy, hypoxic) is an encephalopathy that occurs on the soil of hypoxia due to disorders of pulmonary ventilation, circulation, tissue metabolism, for example, as a result of prolonged arterial hypotension in surgical operations on the heart and large vessels.
Arteriosclerotic encephalopathy( e. Arteriosclerotica) - dyscirculatory encephalopathy in diffuse atherosclerosis of the brain, manifested by focal neurological disorders and a decrease in the level of mental activity.
Encephalopathy bilirubin( e. Bilirubinica) - encephalopathy in severe jaundice caused by the toxic effect of bile pigments and acids on the cells of the basal nuclei of the brain.
Venous venous encephalopathy( e. Venosa) is a dyscirculatory encephalopathy in the elderly, especially in cases of cardiopulmonary insufficiency due to impairment of venous outflow from the brain.
Congenital encephalopathy( e. Congenita) is a common name for encephalopathies due to abnormalities in the development of the brain.
Hypertonic encephalopathy( e. Hypertonica) - dyscirculatory encephalopathy in hypertension, especially in malignant form, manifested by pulsating headache, focal, mainly pseudo-bulbar, symptoms.
Encephalopathy hypoglycaemic( e. Hypoglycaemica) - encephalopathy due to chronic hypoglycemia in pancreatic, pituitary or adrenal lesions.
Encephalopathy hypoxic( e. Hypoxica) - see Encephalopathy anoxic.
Diabetic encephalopathy( e. Diabetica) - encephalopathy in diabetes mellitus, manifested by migraine-like headaches, asthenic syndrome, often focal neurological symptoms, decreased vision.
Dyscirculatory encephalopathy( e., Dyscirculatoria, synovial encephalopathy vascular) - encephalopathy due to chronic impairment of blood supply to the brain, for example, in atherosclerosis, hypertension;characterized by a combination of cerebral and focal symptoms.
Radiation encephalopathy( with radialis) - encephalopathy due to exposure to ionizing radiation on the body;characterized by asthenic disorders, and with a more severe lesion - different in depth manifestations of the organic psychosyndrome.
Encephalopathy of the hepatic( hepatica) - see Hepatergia.
Portosystemic encephalopathy( e. Portosystemica) - see Gepatargia.
Encephalopathy postoxic( e. Postanoxica) - see Encephalopathy resuscitation-conditioned.
Post-traumatic encephalopathy( e posttraumatica) - see Traumatic encephalopathy.
Encephalopathy resuscitation-conditioned( syn. E. decaic) - anoxic encephalopathy, developed after resuscitation;the nature and degree of brain damage are due to the length of the period of clinical death.
Encephalopathy vascular( e. Vascularis) - see Encephalopathy dyscirculatory.
Encephalopathy toxic( e. Toxica) - encephalopathy, which develops under the systematic influence of neurotropic substances.
Traumatic encephalopathy( ie traumatica, syne encephalopathy, post traumatic) - encephalopathy, developing as a late or distant complication of craniocerebral trauma;manifested ch.an asthenovegetative or hypertensive syndrome, epileptic seizures.
Encephalopathy of traumatic boxers( syn: dementia of boxers, Martland syndrome) - encephalopathy, which occurs in boxers after multiple craniocerebral injuries( knockouts);is manifested by an organic psychosyndrome in combination with neurological disorders by the type of parkinsonism.

Symptoms of encephalopathy

Clinical manifestations of encephalopathy are diverse. Early signs of encephalopathy are a decrease in mental performance, memory( especially in recent events), difficulty in changing activities, sleep disturbance, lethargy during the day, general fatigue. There are frequent complaints of diffuse headaches, noise in the ears, general weakness, unstable mood, irritability. Neurologic examination can reveal nystagmus, decreased visual acuity and hearing, increased muscle tone and tendon reflexes, the presence of pathological pyramidal and oral reflexes, coordination disorders, vegetative disorders. These disorders can progress as the underlying disease progresses, accompanied by encephalopathy. In such cases, in the late stages, clear neurological syndromes are revealed: parkinsonian, pseudobulbar( see Pseudobulbar paralysis, Weakness).Some patients may have mental disorders.

With severe generalized brain damage, significant disturbances of microcirculation, edema of the brain, acute development of the clinical picture of encephalopathy is possible;general anxiety, severe headache, more often in the occipital region, nausea, vomiting, vision disorder, dizziness, staggering, sometimes numbness of fingertips, nose, lips, tongue. Then anxiety is replaced by lethargy, sometimes a confusion of consciousness. Disturbances of consciousness, sometimes convulsive seizures can occur with acute renal, hepatic, pancreatic encephalopathy. Acute development of encephalopathy with intense headache, nausea, vomiting, nystagmus, paresis, mental disorders, less frequent cramps is observed with thromboembolism of pulmonary arteries, infarct pneumonia, in some cases and with exacerbation of chronic pneumonia.

Diagnosis of encephalopathy

For the diagnosis of encephalopathy and the determination of its form, the history data are of great importance: perinatal pathology, intoxication, craniocerebral trauma, hereditary or acquired metabolic disorders, severe atherosclerosis, hypertension, kidney, liver, pancreas, lungionizing radiation.

With electroencephalography( EEG), disorganization of the main rhythms, appearance of pathological slow waves, signs of epileptic activity are recorded.

Computed tomography( CT) and MRI imaging shows signs of diffuse brain atrophy: widening of the ventricles of the brain, subarachnoid space, deepening of the brain grooves. Symptoms of diffuse small-focal lesion can be detected by tomography using nuclear magnetic resonance( NMR).

Biochemical studies of blood, urine, cerebrospinal fluid, the detection of toxic substances allow us to clarify the etiology and pathogenesis of encephalopathy.

Treatment of encephalopathy

Complex treatment of encephalopathy is aimed both at the underlying disease that caused encephalopathy and on common elements of pathogenesis and symptomatology. In acute encephalopathy, various life support systems are used: hemodialysis, artificial lung ventilation( ALV), hemoperfusion, prolonged parenteral nutrition. It often takes measures to reduce intracranial pressure, the elimination of convulsive syndrome. In the future, prescribe drugs that improve the metabolism of the brain: the nootropic nucleus( pyriditol, pyracetam), amino acids( cerebrolysin, alvezin, methionine, glutamic acid), lipotropic compounds( essenciale, lecithin), vitamins A, E, group B, ascorbic and folic acid:by indications - angioprotectors( cinnarizine, xanthinal nicotinate, parmidin, cavinton, sermion), antiaggregants( pentoxifylline), biostimulants( aloe extract, vitreous).Medicines prescribe combined, repeated courses lasting 1-3 months.

As an auxiliary treatment, physiotherapy and reflexotherapy( acupuncture), walking, breathing exercises( qigong, breathing by Strelnikova, Buteyko), meditation and much more are used. Only without overload. Everything is very individual. From drug treatment at the same time you can not refuse.

Forecast

The prognosis is determined by the dynamics of the underlying disease, the degree of brain damage, the possibility of specific therapy;in a number of cases it is possible to provide only stabilization of the patients' condition.

Consequences of encephalopathy

Consequences of encephalopathy basically coincide with its symptoms and are individual for each type of encephalopathy. Especially severe consequences are noted in encephalopathies leading to irreversible severe brain damage, for example, in toxic encephalopathies.