Encephalopathy

[Joselyn-Ramos-MD]

Encephalopathy

ENCEPHALOPATHY is a brain disorder that affects a person's mental state and brain function. In cases of encephalopathy, an alteration in the brain's structure or chemistry results in an altered mental state. This condition may be present from birth or may present with age.

Encephalopathy: Causes

Most of the time, the alteration in the cerebral morphology is due to an external agent, be it an infection type that can be viral, bacterial, fungal, parasitic— or due to exposure to toxic substances such as industrial products, metals, medicines, and chemicals. Encephalitis may also develop due to brain trauma, or, alterations in cerebral blood flow. Any of these factors can alter the structure and function of the brain, which may lead to development of encephalitis.

This article has been medically reviewed by Joselyn Ramos, MD — 2023-01-16

ENCEPHALOPATHY: SYMPTOMS

Clinical manifestations:

Psychiatric

Behavioral changes

Aggressive/irrational behavior

Paranoid schizophrenia

Depression

Hypomanic episodes

Dementia

Delirium attacks

Motor

Myelopathies

Parkinson's

Epileptic seizures.

Neurological

Intellectual capacity changes

Level of consciousness

ENCEPHALOPATHY: DIAGNOSIS

The different causes and types of Encephalopathy make it necessary to carry out an extensive, detailed clinical history in studying patients with disorders and symptoms of brain damage. First, the doctor should investigate a history of pre-existing diseases such as diabetes mellitus, liver disorders, and drug use—infectious diseases history before the onset of symptoms. The battery of laboratory tests should include complete blood count, liver and kidney function tests, blood gas tests, and Ph. Urinalysis, and if a nervous system infection is suspected, lumbar puncture and cerebrospinal fluid studies. Cultures of blood and urine. Imaging studies oriented to the type of Encephalopathy. Computerized axial tomography images and abdominal ultrasound.

ENCEPHALOPATHY: TREATMENT

The different treatment options will depend on the type of Encephalopathy. In general, cases of Encephalopathy usually require prolonged hospital stays for in-depth analysis and diagnosis. In general, fluid and electrolyte management is essential. Steroids and antibiotics are possible treatment options depending on the type of Encephalopathy.

Things to watch out for to determine possible treatment options:

• Unexplained behavioral changes
• Drowsiness or agitation
• Delirium
• Hallucinations
• Headaches
• Dizziness
• Alterations in the urine test

ENCEPHALOPATHY PREVENTION

Encephalitis is an unexpected disorder; therefore, it is hard to prevent.

In some people, such as those with liver damage, physicians may be able to prevent a case of Encephalopathy by managing the condition that puts the person at a higher risk.

Reducing alcohol consumption can prevent liver damage that causes Encephalopathy and decrease the risk of Wernicke's Encephalopathy.

What to do in case of suspected encephalitis?

Patients exhibiting symptoms affecting their mental state or psychomotor abilities should seek immediate medical attention.

Encephalitis occurs insidiously; symptoms such as confusion and incoherent language can be very mild. Education about this pathology and its symptoms is the first step toward preventing further damage. Alterations caused by Encephalopathy can be reversible if diagnosis and treatment take place in the early stages.

 

[Joselyn-Ramos-MD]

Types of Encephalopathy

Post-traumatic Encephalopathy:

The alteration of the mental state originates from the damage caused to the brain structure by constant microtrauma. The diagnosis is only possible by autopsies that demonstrate the presence of lesions. Studies show a possible correlation between Encephalopathy and some sporting activities; for example, studies show possible correlations with the practice of high-contact sports like boxing, football, and certain military activities.

Glycine encephalopathy

Glycine is an amino acid that is part of the structure of the cells of different body organs. An enzyme called glycine decarboxylase is involved in its formation and replacement process. The glycine decarboxylase complex has the function of unfolding glycine molecules. Since it does not break down, it accumulates in tissue cells, especially in the brain, causing damage to the cellular structure, which gives rise to the symptoms. It occurs in children and might be inherited as an autosomal recessive disorder. In the child, it manifests itself at an early age; the symptoms can be: lethargy, tremors, seizures, and psychomotor development disorders.

Hashimoto's Encephalopathy

It is a is a rare form of Encephalopathy where the affected individual experiences mental state disorders due to an alteration in the thyroid gland, that is, due to an excess of thyroid hormones. It presents as an autoimmune pathology that occurs with thyroiditis. The alteration occurs insidiously with cognitive alterations, changes in consciousness, and seizures, among others.

Hepatic Encephalopathy

Hepatic encephalitis alters mental state and thoughts due to insufficient cleaning of the blood of toxic metabolites that are processed or eliminated in the liver. The liver is responsible for removing toxins produced by the body (such as ammonia) and byproducts of metabolic processes. The liver might lose function for different reasons, leading to liver failure. These toxic metabolites, especially at the brain level, can lead to a case of Encephalopathy.

Causes of hepatic Encephalopathy

Disorders that affect liver function, such as hepatitis B

Liver failure due to cirrhosis

Primary or metastatic neoplasms in the liver

Irrigation disorders in the liver

Circulatory disorders

Metabolic Toxic Encephalopathy

This type of Encephalopathy has its anatomical causes in the damage to the brain cell by waste substances from brain metabolic processes. It is usually acquired and secondary to the following grounds:

• Infections
• Dehydration
• Malnutrition
• Alcohol toxicity
• Metabolic imbalances
• Hepato/kidney disease

There is always an underlying condition, such as chronic urinary infection or uncontrolled diabetes mellitus.

For its diagnosis, it must be related to previous underlying factors and diseases. The following laboratory tests might help rule out possible causes:

• Kidney function tests
• Liver function tests
• Blood tests to assess acid-base status
• Complete blood counts and cultures

A review of the individual's (and relatives') clinical history, and laboratory tests, are fundamental in the diagnosis.

Some medications, such as anticonvulsants, can alter and exacerbate cognitive deficits and cause confusion.

Infectious Encephalopathy

Bacterial, viral, and other infections may cause brain dysfunction in one or more of its roles: alterations in the level of consciousness, confusion, seizures, and acute focal syndromes.

These alterations in brain functioning can result from an inflammatory response to metabolites or other substances. Symptoms are generally reversible with supportive therapy and specific antibiotics and antivirals. In the recent SAR Covid epidemic, one of the common presentations and complications were encephalitis and Encephalopathy. Studies showed that these complications were treatable with specific therapeutic measures.

Hypoxic-ischemic Encephalopathy

Hypoxic-ischemic Encephalopathy is a condition related to a deficit in cerebral blood flow during the perinatal period, before or during labor or birth. Depending on the severity of the blood flow deficit, a certain degree of brain damage may occur. Common brain function alterations in Hypoxic-ischemic Encephalopathy are retardation in psychomotor development, cognitive impairment, and cerebral palsy. This disorder is also known as BIRTH ASPHYXIA, PERINATAL ASPHYXIA, and NEONATAL ENCEPHALOPATHY.

Wernicke's encephalopathy

Is a type of Encephalopathy related to alterations in the thiamine cycles.

The brain functions alterations are partial ophthalmoplegia, nystagmus, and ataxia. Symptoms usually present in acute form.

Studies show a positive correlation between high alcohol consumption, or malabsorption syndrome, with cases of Wernicke's Encephalopathy. The affected areas of the brain are usually the lower areas of the thalamus-hypothalamus. In some cases, the damage may be irreversible (Korsakoff's syndrome).