Encephalopathy
Encephalopathy is a diagnosis that causes well-founded concern in the person to whom it was exposed. This statement is especially true for the parents of a child who have the word "encephalopathy" on their card.
Content:
- What is encephalopathy?
- Perinatal encephalopathy in a child (PEP)
- Vascular encephalopathy
- Encephalopathy due to trauma
- Toxic encephalopathy
- Why is encephalopathy dangerous?
What is encephalopathy?
Encephalopathy is a syndrome that can be caused by many diseases. With encephalopathy, the cells of the brain suffer, as a result of which its functioning is disrupted. Encephalopathy is most often slow onset and responds well to therapy. A fundamental factor in successful treatment is the impact on the cause of the disorder. Although not every encephalopathy ends well. So, its hepatic, diabetic or toxic form can result in coma and death of the patient.
The brain begins to die 6 minutes after the cessation of oxygen supply to it. Also, this organ is very sensitive to the toxic effects of any pathogenic factors. Against the background of an acute or chronic lack of oxygen, its cells begin to die off, which affects the functioning of the brain.
Oxygen starvation can be caused by the following factors:
- Termination of the work of the heart.
- Cessation of lung function.
- Violation of cerebral circulation for a long time.
Factors leading to toxic effects on the brain:
- Reception of substances that contribute to the intoxication of the body. These can be alcoholic drinks or drugs.
- The production of toxins by the body itself, for example, against the background of liver, kidney diseases, with severe infectious lesions.
Any factors leading to a malfunction of the body can adversely affect the functioning of the brain.
There are several forms of encephalopathy:
- Hypoxic, which develops with insufficient oxygen supply to the brain. Hypoxic encephalopathy includes the following subspecies: postresuscitation, perinatal and asphyxial encephalopathy.
- Toxic, which develops against the background of poisoning the body with poisonous substances, alcoholic beverages, drugs.
- Vascular, which develops against the background of circulatory disorders in the vessels of the brain. It includes the following subspecies: hypertensive encephalopathy, atherosclerotic encephalopathy, venous encephalopathy.
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Toxic-metabolic, which develops when the brain is intoxicated with metabolic decay products. There are the following subspecies: bilirubin (triggered by hemolytic disease in newborns), hepatic (triggered by cirrhosis or hepatitis of the liver), uremic (triggered by renal failure), hyperglycemic and hypoglycemic (triggered by diabetes mellitus).
- Post-traumatic, which develops against the background of brain damage. It can be delayed in time.
- Radiation, which develops after a person has suffered exposure to ionizing radiation.
Perinatal encephalopathy in a child (PEP)
AED or ischemic encephalopathy is characterized by impaired brain function, which occurs due to the influence of negative factors on the fetus from the 28th week of pregnancy, either during childbirth, or in the first 8-10 days of the child's life.
There are three degrees of severity of AED: severe, moderate and mild.
Depending on the timing of recovery, there are: an acute period (up to a month), an early recovery period (3-4 months) and a late recovery period (12-24 months).
Statistical data vary widely, according to information obtained from various sources, such a diagnosis is made by 30-70% of newborns.
Causes of perinatal encephalopathy
Causes of AED in a child:
- During the intrauterine development of the fetus, it was influenced by negative factors. It can be a chronic illness of the mother, for example, diabetes mellitus, inflammation of the kidneys, heart disease, etc. The past infectious diseases (tuberculosis, flu, rubella), the presence of bad habits in a woman, and strong emotional upheavals have a negative effect. Encephalopathy can develop in children whose mothers suffered from early or late toxicosis, from chronic placental insufficiency. It is possible that the fetus was infected during intrauterine development, or there was a threat of termination of pregnancy.
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The baby experienced negative factors during birth. In this regard, the danger is birth asphyxia, a long time the fetus is without water, infection of the amniotic fluid, the ingress of amniotic fluid into the baby's respiratory tract, prolonged or too rapid childbirth, early placental abruption.
- The child was exposed to negative factors in the early postpartum period. It could be an infection of the infant, previous operations, hemolytic disease of the newborn.
Symptoms of perinatal encephalopathy
The following symptoms will indicate that the baby develops encephalopathy:
- Mild encephalopathy: hyperexcitability, prolonged and frequent crying attacks, refusal to breastfeed, short sleep, frequent awakenings and regurgitation, increased or decreased muscle tone, squint.
- Moderate severity: impaired motor function, depression of the nervous system, increased tone, hydrocephalus, convulsions. All these symptoms can be presented both in combination and separately. Muscle tone will first be reduced, and then increase, the baby will constantly keep his hands pressed to the body. Often, children have squint, a protruding fontanelle, excessive pallor of the skin, sleep is disturbed by screaming, the crying of the child is long, shrill and monotonous.
- Severe: The infant is in a coma or pre-coma.
Diagnostics
Immediately after birth, each child is examined by a neurologist and ophthalmologist. An examination by a neurosurgeon is also possible, but only if there are grounds for it.
Tests to confirm PEP:
- Lumbar puncture with collection of cerebrospinal fluid.
- KOS - blood test for acid-base state
- Blood test for gas composition.
- Neurosonography.
- Duplex scanning of the vessels of the head.
- X-ray of the skull.
- EEG.
- CT or MRI of the brain.
Naturally, the full range of diagnostic procedures is not carried out, they are carried out as needed.
When the baby is discharged from the maternity hospital, a neurologist will examine him in 2 months. In the future, the growing child will have to visit a speech therapist, psychologist and psychiatrist. Although, if encephalopathy has a mild course, then there is no need to see these specialists.
Treatment of perinatal encephalopathy
If a child is diagnosed with AED, then treatment should be started immediately, it boils down to the following measures:
- The child is injected with anticonvulsants, drugs aimed at improving metabolic processes in the brain, to relieve intoxication. These can be drugs such as: Pantogam, Cinnarizin, Solcoseryl, Phenibut, Actovegin, Piracetam, etc.
- To reduce intracranial pressure, the following drugs are prescribed: Diacarb, Mannitol.
- When acute encephalopathy is eliminated, physiotherapy is possible. A good effect is given by massage, physiotherapy exercises, manual therapy, swimming, acupuncture.
Why is AED dangerous?
If encephalopathy had a mild course, then it disappears without a trace for the child. Development of hyperactivity, increased distraction, difficulty concentrating, etc. is also possible. Such a symptom complex is called ADHD or attention deficit hyperactivity disorder.
If the encephalopathy was difficult, then it is possible that the child lags behind in mental and psychomotor development, the formation of astheno-vegetative disorders.
The most dangerous and severe consequences of encephalopathy are: hydrocephalus, epilepsy and cerebral palsy.
Long-term consequences of PEP. If a child suffered encephalopathy at an early age, then in the future he may develop vegetative-vascular dystonia. Migraine attacks, epilepsy are not excluded. All of these consequences are evident in adolescence.
AED can manifest itself in adulthood in the form of a high risk of early stroke.
Vascular encephalopathy
The diagnosis of vascular encephalopathy may also sound like DEP or discirculatory encephalopathy. This condition is revealed most often in people of old age. People who have crossed the threshold of 70 years old encounter DEP very often. Almost every 5 people at a doctor's appointment indicate characteristic symptoms.
A variety of causes can lead to vascular encephalopathy, including:
- In 60% of cases, atherosclerosis of the carotid arteries and atherosclerotic lesions of the aorta contribute to the formation of an atherosclerotic form of encephalopathy.
- Stable high blood pressure is a prerequisite for the development of hypertensive encephalopathy.
- Venous thrombosis, lung diseases, cardiopulmonary insufficiency - all these pathologies become the main pathologies for the formation of venous encephalopathy.
- The combined form of vascular encephalopathy develops after a stroke, against the background of chronic heart failure, with heart rhythm disturbances, against the background of cervical osteochondrosis or diabetes mellitus.
DEP symptoms
Depending on how long the patient has been developing vascular encephalopathy, its symptoms will differ:
- At an early stage of development of encephalopathy, this syndrome is disguised as overwork. A person begins to get tired more often and faster, becomes more irritable, his mood often changes. During the day, such patients want to sleep, but at night they cannot have quality rest, suffering from insomnia. Memory deteriorates, it becomes difficult to concentrate one's own attention, dizziness periodically occurs, small flashes may appear before the eyes.
- As encephalopathy progresses, neurological symptoms become more pronounced. The gait becomes shaky, stability is lost, during movement a person begins to shuffle his feet, tremors of the hands join, the muscles are in increased tone. Urination becomes impossible to control. Mental disorders are expressed in increased tearfulness and resentment, possibly manifestations of aggression. The patient's memory is disturbed, which affects the quality and volume of mental work performed.
- The last stage of encephalopathy is expressed in the fact that the patient loses the ability to navigate in space and time, mental development suffers greatly, and gross mental disorders appear. A person loses the opportunity to work, cannot take care of himself on his own.
DEP diagnostics
To make the correct diagnosis, the doctor prescribes the following tests and studies for the patient:
- Donation of blood for general and biochemical analysis, determination of blood sugar and cholesterol levels.
- Delivery of urine for general analysis.
- Conducting REG, to obtain information about the vascular system of the brain.
- ECG and ultrasound of the heart.
- Performing duplex scanning of the carotid arteries, intracranial arteries and veins.
- MRI of the cervical spine, X-ray of the spine.
- MRI of the brain.
DEP treatment
Treatment of vascular encephalopathy begins with identifying the cause of the disease.
To lower blood pressure, drugs such as Concor, Hartil, Prestarium, etc. are shown.
To reduce blood cholesterol levels, Atorvastatin, Rosuvastatin, etc. are prescribed.
Diacarb, Lasix, Indapamide are used as diuretic drugs.
If the patient has diabetes mellitus, then he is shown a diet and insulin therapy.
To improve cerebral blood supply, it is necessary to use drugs such as: Cavinton, Cinnarizin. The improvement of metabolic processes in the brain is facilitated by drugs such as Piracetam, Nootropil, Pantogam, Neurox, Cerepro, etc. To maintain performance, antioxidants are taken Actovegin, Mexidol, vitamin E, Solcoseryl, vitamin C and E. Therapy can last for several months.
Encephalopathy due to trauma
Traumatic brain injury can lead to the development of encephalopathy, and this does not depend on the age or gender of the person. It can develop both immediately and several months or even years after the incident. Encephalopathy is manifested to one degree or another in 80% of people who have suffered a concussion or other brain injury.
If a person has received a mild concussion, then such an injury will not lead to the development of encephalopathy. As a rule, the development of this syndrome can provoke a concussion of the 2nd degree of severity, contusion, skull fracture and crushing of the brain. Most often, people receive such injuries in an accident, during a fight, after falling from a height.
Symptoms of post-traumatic encephalopathy
The fact that after injury a person develops encephalopathy will be indicated by the following signs:
- Intense headache, nausea, constant desire to sleep. Taking analgesics can relieve pain only for a short period of time, but they can be completely stopped by changing body position.
- Loss of consciousness is possible.
- A person begins to suffer from dizziness, frequent falls, and gait changes.
- Memory, attention, reaction speed suffers, the opportunity for analysis and inferences is lost.
- Patients develop depression, they become lethargic and inhibited.
- Convulsive seizures are characteristic.
Treatment of post-traumatic encephalopathy
To identify developing encephalopathy, the patient should undergo an MRI. Auxiliary diagnostic techniques are: X-ray, electrocardiogram, blood tests.
The patient must be hospitalized immediately after the injury. When he is discharged from the hospital, he needs to go to see a neurologist. If encephalopathy is acute, then the patient is hospitalized again.
Antioxidants, vascular drugs, and nootropics are prescribed to treat the effects of trauma.
Toxic encephalopathy
In toxic encephalopathy, the brain is damaged by toxins that enter it from the outside, or are produced by the body itself.
The following reasons can lead to the development of toxic encephalopathy:
- Hemolytic disease, a woman taking drugs or alcohol during pregnancy, treatment with anticonvulsants, antipsychotics or antidepressants. All these factors contribute to the development of toxic encephalopathy in a newborn child.
- Poisoning with drugs, alcoholic beverages, inhalation of gasoline or mercury vapors. These factors can provoke the development of encephalopathy in children of early and adolescence. By the age of 3 years, brain cells can be damaged even by flu, intestinal infection or SARS. This condition is called neurotoxicosis.
- Mature people most often suffer from encephalopathy against the background of poisoning with carbon monoxide, lead, manganese, mercury, gasoline, pesticides, drugs. If a person often abuses alcohol, then this becomes an additional risk factor in the development of toxic encephalopathy. This statement is especially true for low-quality alcohol.
Symptoms of toxic encephalopathy
Jaundice of newborns is common, with about 65% of babies born. At the same time, bilirubin in the blood rises to high levels in no more than 1-5% of children. It is in these babies that toxic encephalopathy develops.
The following symptoms will indicate it:
- Lethargic sleep of a newborn;
- Reflex disorders;
- Respiratory dysfunction;
- Cardiac disorders;
- Spasm of the occipital muscles;
- Loud cry of a child.
If a baby develops a severe form of the disease, then he may fall into a coma. Encephalopathy against the background of opioid or drug poisoning develops in a child according to a similar clinical picture.
If an older child or an adult has undergone acute poisoning with poisons, then he develops a state of mild stunnedness and lethargy. Seizures, respiratory depression, circulatory disorders are also possible. In case of severe poisoning, a person dies.
If the poisoning is chronic, then this is expressed by the following symptoms:
- Severe headaches.
- Nausea and vomiting.
- Blood pressure surges.
- Uncontrolled bowel movements and urination.
- Sensory impairment.
- Delirium, aggression, convulsions, fainting - all these symptoms are characteristic of a severe degree of brain damage by toxic substances.
If a person develops encephalopathy against the background of acute poisoning with alcohol, then this is characterized by the following symptoms:
- Hallucinations, both visual and auditory.
- Refusal to eat.
- Going into your own consciousness, disconnecting from the real world.
- Limb tremor.
- Muscle weakness.
- Impossibility of independent movement in space.
If the disease has a rapid course, then after 3-5 days a coma occurs and the person dies.
Encephalopathy against the background of chronic alcohol poisoning is characterized by the following symptoms:
- Increased anxiety.
- Depressed mood.
- Sleep disturbance.
- Tremor of the eyelids, tongue, hands.
- Nightmares.
- Weakening of the will.
- Deterioration of mental performance.
- Depression.
- Loss of consciousness.
- Convulsive seizures.
When alcoholism reaches the terminal stage, personality degradation and dementia are observed.
Treatment of toxic encephalopathy
To find out what kind of substance the poisoning of the body took place, blood and urine are taken from the patient for analysis. To determine the degree of brain damage, CT or MRI is indicated.
Bilirubin encephalopathy requires transfusion of blood plasma to the infant, taking nootropics and antioxidants.
In case of poisoning of the body of an acute or chronic nature with developing encephalopathy, the patient is prescribed vascular drugs and nootropics. The patient must be hospitalized. Alcoholism requires mandatory interaction of the patient with the narcologist.
Why is encephalopathy dangerous?
Making a prognosis for patients with encephalopathy is a rather problematic exercise. The human brain is designed in such a way that extensive compensatory capabilities are available to it.
However, if the syndrome has a severe course, then it threatens the following complications:
- Dementia or senile dementia develops in 10-15% of people in old age.
- In 11-20% of cases, epilepsy develops after post-traumatic encephalopathy.
- An infant who has suffered from bilirubin encephalopathy may later have problems with vision, hearing, and it is possible that it is not ruled out and paralyzed.
If the brain is severely damaged, then its edema, coma and death of the patient develop.
Author of the article: Sokov Andrey Vladimirovich | Neurologist
Education: In 2005 completed an internship at the IM Sechenov First Moscow State Medical University and received a diploma in Neurology. In 2009, completed postgraduate studies in the specialty "Nervous diseases".
