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Encephalopathy of various origin

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What is encephalopathy?

Encephalopathy is a syndrome of diffuse disease of the brain of dystrophic origin (disturbance in brain metabolism and nutrition) due to various diseases and pathological conditions.

What is the cause of the disease?

The mechanism of any type of encephalopathy is based on brain hypoxia (a reduction in the oxygen supply to the brain) because of its worsened blood supply and due to the effect produced by toxins on the brain that worsen the brain metabolism.

What types of encephalopathy are known?

There are congenital and acquired types of encephalopathy. The congenital encephalopathy is caused by genetic disturbances of the metabolism, abnormal brain development and effect produced by damaging factors on the fetus during pregnancy (first and foremost, it is fetal hypoxia and birth trauma). Depending on the cause and mechanism of brain damage, we differentiate between several types of acquired encephalopathy. Toxic encephalopathy result from systemic effect of ethyl alcohol, barbiturates, lead and bacterial toxins on the brain. Posttraumatic encephalopathy is a consequence of craniocerebral injury. Radiation encephalopathy is developed under the influence of ionizing radiation. A large group includes encephalopathies caused by metabolic disturbances in the diseases of internal organs such as liver (hepatic encephalopathy), kidneys (uremic encephalopathy), pancreas (pancreatic encephalopathy as a complication of acute pancreatitis), hypoglycemic (low blood sugar), and hyperglycemic (high blood sugar). A separate group is formed by dyscirculatory encephalopathies that can be developed in atherosclerosis (atherosclerotic encephalopathy), hypertension (hypertensive encephalopathy), and disturbed venous outflow (venous encephalopathy)

What can be the course of the disease and how is it manifested?

Clinical manifestations of encephalopathy are numerous. Three degrees of severity of the disease make it easy to evaluate the severity of patients’ conditions.

The first degree is characterized by certain changes in the brain tissue found using the instrumental methods of diagnosis. Pronounced clinical manifestations of the disease are lacking. Patients often have performance impairment, general fatigue, mood swings, memory impairment (short-term memory), difficulties when changing types of activity, sleep loss, irritation. Common complaints on diffuse headache, tinnitus.

The second degree is accompanied by subjective disorders. However, they are more pronounced as compared with the first degree. Objective latent disorders occur. The doctor can usually find the leading neurological syndrome and choose symptomatic therapy on its basis. A neurological examination shows inability to focus vision and worse hearing acuity, change in the muscle tone, reflexes, imbalance, and loose walking. As the disease progresses, the disturbances tend to be more severe.

The third degree is accompanied by stable and well pronounced neurological syndromes such as disturbed motor function, sensitivity, swallowing, changes in the craniocerebral nerves, severe memory and attention failures, and mental disorders.

What is the treatment?

The principle of treatment is equivalent to that used in chronic brain ischemia.

Treatment must be complex and consist of etiotropic therapy (effect on the cause of the disease), pathogenetic (effect on the principal mechanisms of the disease) and symptomatic (treatment of disease symptoms) therapy.

Treatment of the underlying disease is of primary importance. A set of activities is diverse. A neurologist should cooperate with other specialists (cardiologists, endocrinologists, therapists, gastroenterologists, etc.).

Patient should carefully monitor blood sugar, cholesterol levels, and main hepatic enzymes. Blood pressure control, keeping a low-cholesterol diet and following specialists’ recommendations are a must. If necessary, antihypertensive drugs, antiplatelet drugs (medicines that prevent blood clots), statins (drugs that lower the level of cholesterol in the blood), and drugs that normalize blood sugar levels are taken on a constant basis.

Neurometabolic medicines, peptides with a multimodal effect and capable of launching all internal mechanisms of pathological process compensation including antioxidative and neuroprotective mechanisms, and antioxidants (medicines that slow down oxidation) are used to treat encephalopathy. Medicines that improve brain blood supply are used as well.

Activities to reduce intracranial pressure and remove the convulsive disorder are often necessary. Sedating medications are indicated in agitation, antidepressant drugs are taken in low mood. In case of low mood, fear and anxiety a behavioral therapist’s consultation can be useful.

K. R. Badalyan

Department of Neurology, Faculty of Additional Professional Education

of Pirogov Russian National Research Medical University

Practical guidelines are similar to those in chronic brain ischemia as the nosologies have common pathogenetic mechanisms.

First, the patients must strictly follow their doctor’s recommendations. Blood pressure, sugar, cholesterol levels must be controlled. Biochemical blood assay is done every 3 months. Neurometabolic and vasoactive agents are taken up to 4 times per year.

Refuse consumption of alcohol and tobacco. Follow a diet. The diet type will depend on the basic disease. Thus, if encephalopathy is developed due to diabetes, the patients must keep to diet 9. The diet 9 pack includes: vegetables, fruits, lean fish, sea products, whole grains, coarse bread. No sugar and sweets are allowed. Use sugar substitute products for sweet dishes and beverages. Reduce salt intake. Food is boiled and roasted, it must be rarely fried and stewed. In case of cardiovascular diseases, hypertension, atherosclerosis, and nephritis keep to diet 10 reducing the intake of salt, greasy food, and free fluid including soups, jelly-like soft drinks, etc. (up to 1.2 liters). This diet excludes substances that activate CNS and cardiovascular system such as alcoholic beverages, strong tea, proper coffee, cacao, chocolate, rich meat, fish and mushroom broth, highly seasoned dishes, smoked products, products rich in cholesterol. Alkaline products and dishes (milk and dairy products, fruits, vegetables and juices thereof) are recommended.

It is important to do domestic chores, be socially active and sociable, go to cultural events and exhibitions. Intellectual functions are to be developed. In case of memory disturbances, keep a respective diary and make a plan of activities for a day.

Daily gymnastics is recommended. If possible, go to the pool and take a walk for a breath of fresh air.

Patients are often terrified by their disease, especially at its late stages. Support of friends and relatives is important in this case. Cooperation of a patient, treating physician and psychotherapist is crucial. They will explain the causes and mechanisms of the disease, select a set of activities that will help normalize the mood, overcome anxiety and fears, and get back to normal life.

K. R. Badalyan

Department of Neurology, Faculty of Additional Professional Education

of Pirogov Russian National Research Medical University

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