Encephalopathy: what is this disease, symptoms, treatment, prognosis

What is encephalopathy?

Encephalopathy Is a term for any diffuse brain disease that alters the function or structure of the brain. Encephalopathy can be caused by an infectious agent (bacteria, virus, or prion), metabolic or mitochondrial dysfunction, a brain tumor, or increased intracranial pressure, long-term exposure to toxic elements (including solvents, drugs, radiation, paints, metals, industrial chemicals and some other substances), chronic progressive trauma, poor nutrition or lack of oxygen or blood flow in the head brain.

The hallmark of encephalopathy is an altered mental state. Depending on the type and severity of encephalopathy, common neurological symptoms are progressive memory loss. and cognitive abilities, subtle personality changes, inability to concentrate, lethargy, and progressive loss consciousness. Other neurological symptoms may include myoclonus (involuntary twitching of a particular muscle or muscle group),

nystagmus (rapid involuntary eye movement) tremor, weakness and muscle atrophy, dementia, seizures and loss of ability to swallow (dysphagia) or speak.

Blood tests, cerebrospinal fluid tests, imaging tests, electroencephalogram and similar diagnostic tests can be used to differentiate between different causes encephalopathy.

Signs and symptoms

The hallmark of encephalopathy is an altered mental state or delirium. An altered mental state is characterized by a violation of cognition, attention, orientation, the sleep-wake cycle and consciousness. An altered state of consciousness can range from lack of selective attention to drowsiness. Increased alertness may be present; with or without cognitive deficits, headaches, epilepsy, myoclonus (involuntary short-term contractions of certain muscles or entire muscle groups) or asterixis ("trembling tremor" of the hand with an extended wrist).

Depending on the type and severity of encephalopathy, common neurological symptoms are loss of cognitive function, subtle personality changes, and inability to concentrate. Other neurological signs may include:

• speech disorder (dysarthria);
• weakening of facial expressions (hypomimia);
• movement disorder (they can be clumsy or slow);
• ataxia;
• tremor.

Other neurological signs may include involuntary grasping and sucking movements, nystagmus (rapid involuntary eye movement), restless throwing in bed and respiratory problems such like Cheyne-Stokes breathing * (intermittent breathing), apnea breathing and post-hypercapnic apnea. Focal neurological disorders are less common.

* Cheyne-Stokes breathing - breathing in which superficial and infrequent respiratory movements are gradually become more frequent and deeper and, having reached a maximum of 5-7 breaths, again weaken and decrease, after which there is a pause.

Wernicke's encephalopathy can be combined with alcoholic dementia (Korsakov's syndrome), characterized by amnestic-confabulatory syndrome: retrograde amnesia, anterograde amnesia, confabulations (made up memories), poor memory and disorientation.

Anti-NMDA receptor encephalitis is the most common autoimmune encephalitis. It can cause paranoid illusions and expansive delusions, agitation, visual and auditory hallucinations, strange behavior, fear, panic attacks, short-term memory loss and confusion.

HIV encephalopathy can lead to dementia.

Causes and risk factors

There are many types of encephalopathy and each has its own cause. Here are some examples:

• Mitochondrial encephalopathy: a metabolic disorder caused by dysfunction of mitochondrial DNA. May affect many systems in the body, especially the brain and nervous system.
• Glycine encephalopathy: a genetic metabolic disorder associated with excess glycine production.
• Hepatic encephalopathy: occurs at a late stage cirrhosis of the liver.
• Hypoxic ischemic: persistent or transient encephalopathy resulting from a severe decrease in oxygen delivery to the brain.
• Static: permanent or permanent brain damage, usually caused by prenatal exposure ethanol.
• Uremic: Occurs due to the build-up of high levels of toxins that are normally excreted by the kidneys - rare if dialysis is available.
• Wernicke encephalopathy: occurs due to a deficiency of thiamine (B1), usually in the presence of alcohol addictions.
• Hashimoto's encephalopathy: occurs as a result of an autoimmune disorder.
• Anti-NMDA receptor encephalitis: autoimmune encephalitis, arises from an inadequate immune system.
• Hyperammonemia: a condition caused by a high level of ammonia, which occurs against the background of congenital metabolic disorders (including a violation of the cycle urea or multiple carboxylase deficiency), diets with excessive protein levels, deficiencies of certain nutrients, such as arginine or biotin, or organ failure.
• Hypertensive encephalopathy: occurs due to a sharp increase in blood pressure.
• Chronic Traumatic: A progressive degenerative disease associated with multiple concussions and other forms of brain injury.
• Lyme encephalopathy: caused by bacteria Lyme diseaseincluding Borrelia burgdorferi.
• Toxic encephalopathy: A form of disease caused by chemicals, often resulting in permanent brain damage.
• Toxic-metabolic: a universal brain disease caused by infection, organ failure, or intoxication.
• Transmissible spongy: a collection of diseases, all caused by prions and characterized by "spongy" brain tissue (pierced with holes), impaired locomotion or coordination and 100% level mortality. Includes bovine spongiform encephalopathy (mad cow disease), sheep and chickens.
• Neonatal (hypoxic-ischemic encephalopathy): an obstetric form that often occurs due to a lack of oxygen in the blood flow to the fetal brain tissue during labor or childbirth.
• Salmonella: a form of encephalopathy caused by food poisoning (especially peanuts and rotten meats), often leading to permanent brain damage and nervous system disorders.
• Encephalomyopathy: a combination of encephalopathy and myopathy. Reasons may include mitochondrial diseases (especially MELAS syndrome (eng. Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes - "mitochondrial encephalomyopathy, lactic acidosis, stroke-like episodes ") or chronic hypophosphatemia, as it may occur at cystinosis.
• Creutzfeldt-Jakob disease (CJP; transmissible spongiform encephalopathy).
• HIV encephalopathy (a disease associated with HIV infection and AIDSohm, characterized by atrophy and indistinct white matter hyperintensity).
• Septic (this type of disease can occur against a background of obvious sepsis, trauma, severe burns, even without clear identification of the infection).
• Epileptic:
  • Early childhood epileptic encephalopathy (acquired or congenital anomaly of cortical development).
  • Early myoclonic epileptic encephalopathy (possibly due to metabolic disorders).
• Gluten Encephalopathy: Focal white matter abnormalities (usually areas of low perfusion) are assessed using magnetic resonance imaging. Migraine Is the most common symptom.

Diagnostics

The diagnosis is based primarily on symptoms, examination findings, and treatment response. Clinicians ask about possible causative factors for encephalopathy (such as infection or drug) to identify possible causes. Blood tests are taken to identify causative factors, especially disorders that can be treated (such as infections or bleeding in the digestive tract), and to confirm the diagnosis. Ammonia levels are also measured. This level is usually abnormally high (indicating abnormal liver function), but measuring ammonia levels is not always a reliable way to diagnose a disease.

Clinicians may conduct mental function tests to detect subtle changes that occur in the early stages of the disease. Electroencephalography (EEG) may also be done. An EEG can detect abnormalities in brain activity, but cannot distinguish between encephalopathy and other possible causes.

Older people may have difficulty recognizing encephalopathy early because its initial symptoms (eg, sleep disturbance and mild disorientation) may be attributed to dementia or mistakenly considered delirium.

Treatment

Treatment is symptomatic and varies depending on the type and severity of the disease. Anticonvulsants may be prescribed to reduce or stop seizures. Some patients may benefit from dietary and supplementation changes. Severe cases may require dialysis or organ replacement surgery.

Sympathomimetic drugs can increase motivation, cognition, motor activity and alertness in people with encephalopathy due to brain injury, chronic infections strokes, brain tumors.

When the condition is caused by untreated gluten enteropathy (celiac disease) or gluten intolerance, a gluten-free diet stops the progression of brain damage and relieves migraines.

Forecast

Treating the underlying cause of the disorder can improve symptoms. However, the disease can cause irreversible structural changes and irreversible brain damage. Some encephalopathies can be fatal.