• Wednesday April 8,2020

encephalopathy

An encephalopathy marks pathological states of the brain, which are caused by different causes. The symptoms of functional disorders of the brain are independent of the underlying diseases. At least initially, there are no structural changes in the brain, so after the causes of the neurological deficits have been resolved, the symptoms can often regress.

What is encephalopathy?

Encephalopathies are characterized by rapid behavioral changes. There is a cognitive and motor slowdown.
© Christos Georghiou - stock.adobe.com

Encephalopathy is a collective term for pathological processes in the brain, which are not due to brain organic structural changes. This means that external influences such as poisoning, viruses, prions or high blood pressure initially disturb certain functional processes in the brain. However, it is difficult to clearly differentiate encephalopathies from other brain diseases.

For example, according to this definition, inflammatory processes in the brain are not among the encephalopathies. Furthermore, in an encephalopathy, not only parts of the brain, but the entire brain, the functional disorders are subject. Cause of the symptoms occurring in this disease complex are dysfunctions in the interaction of nerve and glial cells.

Internal changes in the organism lead to disturbances of the cerebral equilibrium, as a result of which the functions of neurotransmitters and membranes are impaired. In general, the processes are reversible after the underlying processes have ended. However, long-term damage can be caused by inflammatory processes that develop as a result of dysfunctions.

causes

Causes of the development of encephalopathies may be increased concentrations of potentially toxic substances from metabolic processes or poisoning, electrolyte disturbances, pathogens or circulatory disorders. This applies, among other things, when toxic substances accumulate in the blood due to certain organ damage and can no longer be broken down.

A well-known example is hepatic encephalopathy. In hepatic encephalopathy, the liver can no longer perform its detoxification function. Thus, in cirrhosis of the liver, the concentration of ammonia in the blood increases because ammonia derived from protein degradation can no longer be sufficiently converted into urea.

In the brain, ammonia alters the levels of certain messengers, disrupting communication between the various nerve and glial cells. The reason for this is a swelling of the astrocytes due to the influence of ammonia. It creates a brain edema, which affects the neurotransmitter function.

Encephalopathies, which are the result of toxic influence, include uremic encephalopathy, bilirubin encephalopathy and dialysis encephalopathy. Uremic encephalopathy is caused by renal failure. The kidneys are no longer able to remove urinary or creatinine from the blood.

These substances disturb the function of nerve cells in the brain. Bilirubin encephalopathy is again associated with an increased concentration of unconjugated bilirubin in the blood. This disease mainly affects newborns with severe neonatal jaundice. In dialysis encephalopathy, aluminum intoxication through the use of aluminum-containing dialysis fluids is suspected.

Other forms of encephalopathy include hypertensive encephalopathy, bovine spongiform encephalopathy (BSE, Creutzfeldt-Jakob disease), HIV encephalopathy, Wernicke's encephalopathy, Hashimoto's encephalopathy, MELAS syndrome, and Binswanger's disease.

Hypertensive encephalopathy is caused by a sudden increase in arterial blood pressure. The cause of Creutzfeldt-Jakob disease is the so-called prions, which were detected for the first time in the bovine brain. In Wernicke's encephalopathy there is hypovitaminosis with vitamin B1, which is caused by malnutrition or high alcohol consumption.

Hashimoto's encephalopathy is caused by autoimmune processes that target the brain. MELAS syndrome is a mitochondrial disorder. Binswanger's disease, in turn, is an arteriosclerotic encephalopathy.

Symptoms, complaints & signs

Encephalopathies are characterized by rapid behavioral changes. There is a cognitive and motor slowdown. Furthermore, there are disturbances of consciousness from mild dizziness to coma. Added to this are drive, orientation, attention and memory disorders. Sometimes the patient also suffers from hallucinations and delusions.

The overall picture also includes such symptoms as tremor, paralysis, speech disorders, blurred vision or even epileptic seizures. Also, vegetative symptoms such as cardiac arrhythmia, difficulty breathing or temperature regulation disorders and blood pressure changes may occur. Not all symptoms have to appear. In many cases, combinations of individual symptoms are observed.

diagnosis

Based on the symptoms, the cause of the present encephalopathy can not yet be determined. It is important first of all to carry out a comprehensive medical history. Of course, other symptoms must also be considered to diagnose the underlying condition.

Laboratory tests can identify potential toxins or pathogens. In brain imaging, encephalopathies do not detect any changes in the brain organism. In terms of differential diagnosis, other central nervous system disorders such as strokes, traumas, infections or epilepsies must be distinguished.

complications

Encephalopathy can have a variety of causes, so different complications are possible. On the one hand, it comes in the brain disease to a variety of paralysis, but also convulsions or sensory disturbances. On the other hand, encephalopathy can be caused by an increased concentration of ammonia, as is the case, for example, with kidney failure (renal insufficiency).

This can result in a life-threatening coma. In addition, there is a reduced excretion of potassium (hyperkalemia) in renal insufficiency, which promotes the development of cardiac arrhythmias. Also fewer acids are excreted, which also leads to an increase in the potassium concentration in the blood. Kidney failure also causes painful edema, especially in the leg area.

Also, cirrhosis of the liver, as it occurs with increased alcohol consumption, leads to the development of encephalopathy. These produce fewer proteins for the body, increasing the likelihood of edema and ascites. In addition, disorders in the blood clotting are conceivable.

Also, the blood that flows through the liver is also diverted and directed to the spleen, which consequently enlarges. In addition, it also causes the formation of hemorrhoids and varicose veins in the stomach and esophagus, which can burst in the worst case and leads to internal bleeding.

When should you go to the doctor?

A visit to a doctor is necessary as soon as the person affected behaves conspicuously. In addition to the unusual behavioral changes, disorders of consciousness are considered to be particularly worrying. In case of feeling dizzy, diminishing general performance or general weakness, it is advisable to consult a doctor.

If it comes to malfunction of individual systems, a doctor is needed to clarify the cause and initiate measures of alleviation. In case of paralysis, numbness of the skin or sensory disturbances, a doctor should be consulted. Reductions in sight, hearing or speech are considered unusual and should be clarified by a doctor as soon as possible.

Disorders of the heart rhythm, tachycardia, hypertension or general malaise must be medically examined and treated. In case of breathing difficulties or respiratory failure, a doctor is needed.

It threatens a life-threatening condition, which should be examined in time and clarified. If you have orientation problems, attention deficits, or memory problems, you need to see a doctor. Hallucination or delusion also requires a doctor.

Changes in personality, emotional abnormalities or mood swings are to be presented to a doctor. A visit to a doctor is also necessary if it comes to epileptic seizures or a general formation of convulsions in the body. Pain sensation, a diffuse sense of illness or unusual apathy should be discussed with a doctor.

Treatment & Therapy

The therapy of encephalopathy depends on the underlying cause. Hepatic encephalopathy focuses on the treatment of liver disease. In order to alleviate the symptoms of encephalopathy, the ammonia concentration must be reduced.

This can be achieved inter alia by adjusting the metabolism, accelerating the urea cycle by administering ornithine aspartate, by administering the laxative lactulose and by administering antibiotics for the reduction of ammonia-producing bacteria. In case of kidney failure dialysis is indicated.

If hypovitaminosis is present with vitamin B1, thiamine (vitamin B1) must be given in high doses. Furthermore, absolute alcohol abstinence is necessary. Blood pressure-induced encephalopathies focus on the normalization of blood pressure.

Outlook & Forecast

The prognosis of encephalopathy depends on the underlying cause, the progress of the disease and the general state of health of the patient. In severe cases it comes to organ failure with fatal consequences. Hepatic encephalopathy is reversible with early treatment and good therapy. The symptoms are treated individually until relieving the symptoms.

Clinically manifest hepatic encephalopathy is associated with an episodic or chronic disease course. Every new episode results in a deterioration of the general state of health. In a chronic course, there is a continuous deterioration. For both disease courses, an increased mortality risk is to be expected. There is also the risk of a coma. If the person concerned awakens from this, severe health problems can be expected. A full recovery is not expected.

If the patient is suffering from Wernicke's encephalopathy, the progression of the disease is also crucial to the prognosis. With immediate treatment, a significant relief of the existing symptoms can be achieved. Within a few weeks there is an improvement in linguistic or motor disorders. In about 40% of cases persistent impairments persist. These have a significant impact on the quality of life. ¾ of all patients suffer psychological complications. Often, patients are dependent on lifelong support or care.

prevention

The risk of encephalopathy can generally be significantly reduced by a healthy lifestyle with a balanced diet, lots of exercise and avoiding high alcohol consumption. Many underlying diseases can be prevented.

aftercare

In most cases, those with encephalopathy have very few or even no direct measures and options for follow-up care. The disease must first be detected very early and then treated so that it does not lead to further complaints or complications in the life of the person concerned.

An early diagnosis with a subsequent treatment always has a positive effect on the further course of the disease and can prevent a further worsening of the symptoms. A self-healing can usually not occur. In most cases, encephalopathy requires patients to take medication. In particular, antibiotics are prescribed. These should always be taken exactly as directed by the doctor to relieve the symptoms.

The use of alcohol should be avoided in order not to reduce the effect of antibiotics. Furthermore, a healthy lifestyle with a healthy diet always has a positive effect on the further course of encephalopathy. Patients should regularly check their blood pressure and if necessary, reduce it to normal. Whether encephalopathy reduces life expectancy can not generally be predicted.

You can do that yourself

Encephalopathy is a collective term for pathological states of the brain, which are triggered by different causes. Whether and what a patient can contribute to the improvement of his or her condition depends on which underlying disease encephalopathy is due to.

Disorders of the brain can be triggered for example by high blood pressure. In this case, the patient can take a number of self-help measures. In addition to a regular control of blood pressure usually a change in lifestyle and consumption habits is inevitable. Obesity is a central risk factor, which is why sufferers with body mass index (BMI) must first lose weight permanently.

The permanent weight reduction usually requires a change in dietary habits, which most people do not manage without external support. Therefore, patients should consult not only a doctor but also a nutritionist and, if they lack motivation, join a support group.

Even in brain disorders that are due to hypovitaminosis, for example, a lack of thiamine (vitamin B1), the patient himself can contribute much to the improvement. For example, through a healthy diet and, if necessary, the use of nutritional supplements. If the vitamin deficiency has been caused by abuse of alcohol or other drugs, the patient should start a withdrawal regimen with adjunctive therapy.


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