ENCEPHALOPATHY

TYPES

Encephalopathy secondary to Liver failure

 This usually occurs after the liver has sustained a significant injury after having been exposed to harmful substances such as high doses of alcohol and drugs.

Encephalopathy secondary to Uncontrolled or poorly controlled blood pressure

This occurs in specific subsets of patients that fail to comply with their blood pressure-lowering medications. When a persons’ blood pressure is not controlled, it causes an elevated pressure within the brain and its meninges causing symptoms of increased intracranial pressure which can result to seizure (involuntary movements of the extremities).

Encephalopathy secondary to metabolic causes

An imbalance in the sugar levels and impaired excretion of the toxic products of necessary actions of the body can lead to its accumulation within the brain which can lead to decrease in alertness, stupor or even coma

Encephalopathy secondary to infection

Viral, bacterial and fungal infections, especially in an immunocompromised host (persons with the weak immune system) usually have their brain affected by such pathogens.

Encephalopathy secondary to a nutritional deficiency

Vitamin B which is readily absorbed in the body with the help of the intrinsic factor present in the stomach is deficient among persons who are habitual alcohol beverage drinkers can result to the condition called Wernicke’s Encephalopathy.

SYMPTOMS

The symptoms of encephalopathy vary from the organ system involved. Some of the apparent features are as follows: 

• Inability to focus on poor memory
• The difference in muscle strength on one side of the body compared to the other
• Failure to decide on something, the presence of hesitancy when faced with a problem
• Presence of unnecessary movements which cannot be controlled
• Involuntary tremors of the upper extremities (most commonly observed on both hands or we call it flapping tremors)
• The unease of articulation of words and difficulty in swallowing
• Seizures 

DIAGNOSIS

Diagnosis is made after a thorough history and physical examination. The patient must tell the medical practitioner about the medications or their habits. Anyone or a combination of the following may be done:

• Mini-mental status examination- a test usually done to assess memory and concentration
• Blood tests such as creatinine and blood urea nitrogen (renal function tests) to evaluate and rule in the presence of uremic encephalopathy
• Urine analysis for toxicology studies
• Computed Tomography scans (CT scans) or Magnetic Resonance Imaging (MRI) to visualize the brain and rule out any other causes of seizures, stupor or decrease in sensorium

TREATMENT

Treatment is dependent upon the causative factor or factors, and these may include any of the following:

• Anti-seizure medications 
• Laxatives to hasten the removal of ammonia from the body
• Diet modification
• Elimination of harmful habits such as alcoholism and recreational drug use.