Encephalopathy - Causes, Symptoms, Diagnosis and Treatment
Encephalopathy - Generalizing the name of the variety in its genesis of pathological processes, which are based on the degeneration of neurons in the brain due to a violation of their metabolism. Encephalopathy manifested polymorphic neurological disorders, disorders in the intellectual-mental and emotional-volitional sphere. Diagnostic search consists of a comprehensive neurological examination and establish the causal pathology. encephalopathy treatment is to remove it which caused a pathological condition, the causal treatment of the disease and maintain optimal metabolism of cerebral neurons.
Encephalopathy
perinatal encephalopathy was introduced in 1976 and involves the cerebral lesions that occur during the period from the 28th week of pregnancy before the 7th day of life. Perinatal encephalopathy manifests in children of the first months of life. Acquired encephalopathy is secondary in nature and is celebrated mainly in adults, often in middle-aged and elderly persons, in the presence of chronic diseases, after injuries, intoxications, and so on. N. Encephalopathy is a multidisciplinary pathology, according to the etiology requiring attention from specialists in neurology, pediatrics, traumatology, gastroenterology, Addiction, cardiology, endocrinology, toxicology, urology.
fetal hypoxia, intrauterine infection and intoxication, Rhesus-conflict, birth asphyxia, birth trauma, genetically determined metabolic disorders and developmental abnormalities (eg, congenital heart disease). The risk of perinatal pathology increases in abnormalities of labor, a large fetus, preterm labor and preterm infants, narrow pelvis, cord entanglement.
Acquired encephalopathy can develop as a result of craniocerebral trauma, exposure to ionizing radiation, intoxication with neurotropic chemicals (ethyl alcohol, lead, chloroform, drug, barbiturates) and bacterial (for diphtheria, tetanus, botulism, and others.) Toxins. Widespread encephalopathy caused by vascular disorders: atherosclerosis, hypertension, venous distsirkulyatsii, cerebral angiopathy vessels in amilomidoze leading to chronic cerebral ischemia. Large group of encephalopathy associated with exposure to endotoxins and is a complication of various diseases somatic organs: acute pancreatitis, acute and chronic renal failure, cirrhosis of the liver and liver failure.
Diseases of the lungs, leading to the breakdown of pulmonary ventilation (pneumonia, pulmonary tuberculosis, lung abscess, atelectasis, bronchiectasis, pulmonary embolism), provoke encephalopathy hypoxic genesis. It has a similar genesis encephalopathy observed in some patients after resuscitation. Important in the cerebral metabolism is glucose. Encephalopathy can develop both in its lowered level (hypoglycaemia), and when it is increasing (hyperglycemia), which is often observed in diabetes. The cause of metabolic disorders is cerebral vitamin deficiencies (especially lack of vitamin c. V). In some cases, an encephalopathy is a consequence of the fall of the osmotic pressure and hyponatremia have arisen due to water retention with hypersecretion of antidiuretic hormone (hypothyroidism, adrenal insufficiency, tumor processes, and so forth.). It is rarely encountered relates leukoencephalopathy, having a viral etiology and notes in immunocompromised patients.
Pathogenesis and morphology encephalopathy
Encephalopathy is a diffuse any origin, ie. E. Affecting different cerebral structures, processes. It is based on an oxygen deficiency (hypoxia) and metabolic disorders neurons. The latter can be caused by hypoxia itself (if distsirktsulyatornyh and hypoxic encephalopathy), shortage of certain metabolites, and exposure to toxins (for metabolic and toxic encephalopathies). These disorders cause cerebral degeneration and death of neurons.
By morphological features that characterize encephalopathy include: degeneration and decrease in the number of neurons in the medulla, and thus its diffuse atrophy; foci of demyelination and necrosis and glial proliferation, localized in white matter; mikrogemorragii cerebral edema and tissue; hyperemia cerebral membranes. The preferential localization of these changes and their degree of severity can vary depending on the type of encephalopathy.
alcoholic encephalopathy, observed in chronic alcoholism, as well as brain damage resulting in drug addicts. Metabolic options: liver (porto, bilirubin), uremic (azotemicheskaya), diabetic, pancreatic, hypoglycemic, hypoxic, anoxic (postresuscitation) encephalopathy and Gaye-Wernicke syndrome. Encephalopathy is subdivided into atherosclerotic, hypertension, venous. A special form of hypertensive encephalopathy Binswanger's disease appears.
In clinical practice, a gradation in the severity of encephalopathy, however, this distinction is very conditional. I mean severity of subclinical, t. E. The absence of manifestations of the presence of cerebral changes recorded by instrumental methods of diagnosis. In this step, the pathology can be diagnosed during outpatient examination of patients with chronic primarily vascular, diseases. The presence of mild to moderate neurological symptoms, often having a transitory nature, characterizes the severity II. At III level there are severe neurological disorder, in most cases acting cause of disability of the patient.
hepatic encephalopathy, Gayet-Wernicke syndrome, hypoxic encephalopathy with PE.
Chronic encephalopathy in the early stages is shown difficulties when trying to remember recent events or newly obtained information, reduced alertness and mental performance, fatigue, sleep disturbance, lack of flexibility when changing the type of activity, psychological and emotional lability. Patients may observe increased irritability, daytime sleepiness, ringing in the head, headache, having no definite localization. Symptoms may vary in different patients. In the neurological status of possible nystagmus, hyperreflexia and muscle moderate hypertension, the presence of reflexes of oral automatism and jog marks, the instability in Romberg, discoordination, FSK insufficiency (reduced vision, hearing loss, light ptosis, paresis of the eye) symptoms of autonomic dysfunction. Progression encephalopathy accompanied by worsening of symptoms with the formation of a clearly dominant neurological syndrome: vestibular-atactic, Parkinson, hyperkinetic, pseudobulbar. Increasing violations of intellectual and emotional-volitional sphere leads to the formation of dementia. There are mental disorders.
Acute encephalopathy debuts sudden agitated with intense headache, visual disturbances, nausea and vomiting, unsteadiness, in some cases - numbness of the tongue, the distal portions of the hands and feet, mental disorders. Enough excitement quickly gives way to apathy, impaired consciousness often occurs with different depths: stupor, disorientation, stupor and coma. There may be different kinds of epipristupov. Acute encephalopathy refers to urgent conditions and without medical emergency can lead to death due to cerebral edema, dysfunction of vital cerebral centers.
neurologist in a survey and neurological examination. In addition, it conducted a comprehensive neurological examination tool: electroencephalography, echoencephalography, rheoencephalography or Doppler ultrasound of brain vessels. EEG usually reveals diffuse disorganization of bioelectrical activity of the brain with the appearance of slow waves. Perhaps epi-detection activity. Echo-EG allows us to estimate intracranial pressure. Vascular studies provide information on the status of cerebral blood flow. To analyze the degree of morphological changes can be using brain MRI. This method also allows you to differentiate between cerebral encephalopathy from other diseases: Alzheimer's disease, intracranial tumors, encephalitis, disseminated encephalomyelitis, stroke, cortico-basal degeneration, Creutzfeldt - Jakob disease, etc.
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Critical to the understanding of the etiology of encephalopathy has a medical history, physical examination and consultation bodies related specialists: cardiologist, nephrologist, gastroenterologist, endocrinologist, pulmonologist, psychiatrist. According to the testimony conducted hormonal studies to determine the level of cholesterol and blood sugar, urinalysis, blood biochemistry and urine, liver ultrasound, ultrasound of the pancreas, excretory urography, ultrasonography of the urinary system, CT scan of the kidneys, chest X-ray, CT scan, and so on. N.
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hypertension, atherosclerosis. Recommended diet, corresponding to underlying pathology, and the regime of adequate patient.
The presence of a component in the pathogenesis of ischemic encephalopathy is an indication for vascular therapy appointment: pentoxifylline, ticlopidine, vinpocetine, nicergoline. Atherosclerotic encephalopathy requires the inclusion in the scheme of treatment of lipid-lowering pharmaceuticals (eg, simvastatin, gemfibrozil). Therapy of hypertensive encephalopathy carried out with the purpose of antihypertensives and blood pressure monitoring numbers. If encephalopathy is caused by occlusion of the carotid or vertebral arteries, possibly surgery: reconstruction or prosthesis of the vertebral artery, carotid endarterectomy, carotid-subclavian bypass, creating extra-intracranial anastomosis.
It is mandatory held neuroprotective and metabolic therapy. It includes nootropics (hopantenic-ta, piracetam, Pyritinol, Lutset), amino acids (glycine, glutamic acid), vitamins (B1 B6 C, E), GABA drugs (pikamilon, Phenibutum). When psychiatric disorders are necessary psychotropic drugs: diazepam, bromides, droperidol, fenozepam. In convulsions held anticonvulsant therapy nootropics contraindicated. Pharmacotherapy is carried out repeated courses 2-3 times a year. As an adjuvant treatment used physiotherapy techniques: reflexology, electrophoresis, magnetic therapy.
of pregnancy, compliance with the rules of care for a newborn. Prevention of secondary encephalopathy is early detection and adequate treatment of vascular, urological, gastrointestinal diseases, pulmonary diseases, endocrine and metabolic disorders. As preventive measures can be considered proper nutrition, an active lifestyle, quitting smoking, drugs and alcohol.