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Encyclopedia > Encephalopathy

Encephalopathy literally means disease of the brain. In medical jargon it can refer to a wide variety of disorders with very different etiologies, prognoses and implications. For example, anoxic encephalopathy commonly refers to permanent brain damage with often severe impairment of consciousness and mental abilities caused by cessation of oxygen delivery to the brain. In contrast, toxic-metabolic encephalopathy, which has protean causes, is generally completely reversible given reversal of the underlying toxic (infectious) or metabolic insult. Because the word encephalopathy is used in so many contexts, it has no direct synonyms. Contrast to dementia which refers to a permanent reduction in mental abilities from a previously higher level (c.f. mental retardation), always in the absence of acute illness or alteration of consciousness. Also contrast to delirium which refers to an acute confusional state, frequently, but not always, in the setting of acute illness. Because toxic-metabolic encephalopathy is frequently a confusional state in the setting of illness, and delirium is a confusional state, often, but not always, in the setting of illness, the two intergrade seamlessly into each other. The term disease refers to an abnormal condition of an organism that impairs function. ... In animals the brain, or encephalon (Greek for in the head), is the control center of the central nervous system, responsible for thought. ... For other uses, see Dementia (disambiguation). ... “Delirious” redirects here. ...

A descriptive example may clarify the distinctions between these entities. An elderly person with Alzheimer's disease, manifested by mild dementia (forgetfulness and impaired judgment) develops pneumonia, a severe infection. They then manifest depressed consciousness, myclonic jerks, jactitation (restless tossing in bed, picking at things), and Cheyne-Stokes respirations (rhythmic increase and decrease in respiratory frequency and depth). These are symptoms (not exclusively) of toxic-metabolic encephalopathy. Because of the severity of their illness they are admitted to the intensive care unit, intubated with an endotracheal tube, mechanically ventilated, and sedated with medications. After a week their infection is cured and they are extubated and breathe independently. At this point they sleep during the day and are awake and agitated at night, have hallucinations, have alternating periods of lucidity and confusion, and manifest paranoia. This is delirium, arising from multiple previous insults (reduced baseline mental faculties, infection, psychoactive medications, altered environment, etc.). With cessation of psychoactive medications, enforcement of normal day/night dark/light cycles, and frequent, gentle, re-orientation to their surroundings, their confusion clears, leaving them mentally with their previous baseline dementia. For other uses, see Dementia (disambiguation). ... Cheyne-Stokes respiration is an abnormal pattern of breathing characterized by periods of breathing with gradually increasing and decreasing tidal volume interspersed with periods of apnea. ... “Delirious” redirects here. ... For other uses, see Dementia (disambiguation). ...



There are many types of encephalopathy. Some examples include:

  • Glycine encephalopathy - A pediatric metabolic disorder
  • Hepatic encephalopathy - Arising from advanced cirrhosis of the liver
  • Hypoxic encephalopathy - Permanent or transitory encephalopathy arising from severely reduced oxygen delivery to the brain
  • Static encephalopathy - Unchanging, or permanent, brain damage
  • Uremic encephalopathy - Arising from high levels of toxins normally cleared by the kidneys -- rare where dialysis is readily available
  • Wernicke's encephalopathy - Arising from thiamine deficiency, usually in the setting of alcoholism
  • Hashimoto's encephalopathy - Arising from an auto-immune disorder
  • Hypertensive encephalopathy - Arising from acutely increased blood pressure
  • Toxic-Metabolic encephalopathy - A catch-all for brain dysfunction in the setting of, and explained by, an infectious, organ failure, or intoxicant insult

Glycine encephalopathy, which is also known as nonketotic hyperglycinemia or NKH, is a genetic disorder characterized by abnormally high levels of the amino acid glycine. ... Hepatic encephalopathy is a condition (usually caused by liver cirrhosis and its resultant portal hypertension) where brain cells are damaged by a build-up of toxic substances in the blood. ... This article or section is in need of attention from an expert on the subject. ... Cerebral palsy or CP is a group of disorders associated with developmental brain injuries that occur during fetal development, birth, or shortly after birth. ... Wernickes encephalopathy is a severe irreversible syndrome characterised by loss of short-term memory. ... Hashimotos Encephalopathy is a very rare condition associated with Hashimotos Thyroiditis. ... Encephalopathy literally means disease of the brain. ...


Encephalopathy alters brain function and/or structure. It may be caused by an infectious agent (bacteria, virus, or prion), metabolic or mitochondrial dysfunction, brain tumor or increased intracranial pressure, prolonged exposure to toxic elements (including solvents, drugs, alcohol, radiation, paints, industrial chemicals, and certain metals), chronic progressive trauma, poor nutrition, or lack of oxygen or blood flow to the brain. It is also known that concomitant use of lithium with other neuroleptics may, in rare cases, cause encephalopathy. Phyla/Divisions Actinobacteria Aquificae Bacteroidetes/Chlorobi Chlamydiae/Verrucomicrobia Chloroflexi Chrysiogenetes Cyanobacteria Deferribacteres Deinococcus-Thermus Dictyoglomi Fibrobacteres/Acidobacteria Firmicutes Fusobacteria Gemmatimonadetes Nitrospirae Omnibacteria Planctomycetes Proteobacteria Spirochaetes Thermodesulfobacteria Thermomicrobia Thermotogae Bacteria (singular, bacterium) are a major group of living organisms. ... Groups I: dsDNA viruses II: ssDNA viruses III: dsRNA viruses IV: (+)ssRNA viruses V: (-)ssRNA viruses VI: ssRNA-RT viruses VII: dsDNA-RT viruses A virus (from the Latin noun virus, meaning toxin or poison) is a microscopic particle (ranging in size from 20 - 300 nm) that can infect the... A prion (IPA: [1] ) — short for proteinaceous infectious particle (-on) that lacks nucleic acid (by analogy to virion) — is a type of infectious agent composed only of protein. ... A few of the metabolic pathways in a cell. ... In cell biology, a mitochondrion is an organelle found in the cells of most eukaryotes. ... A brain tumor is any intracranial tumor created by abnormal and uncontrolled cell division, normally either found in the brain itself (neurons, glial cells (astrocytes, oligodendrocytes, ependymal cells), lymphatic tissue, blood vessels), in the cranial nerves (myelin-producing Schwann cells), in the brain envelopes (meninges), skull, pituitary and pineal gland... Intracranial pressure, (ICP), is the pressure exerted by the cranium on the brain tissue, cerebrospinal fluid (CSF), and the brains circulating blood volume. ... Functional group of an alcohol molecule. ... General Name, Symbol, Number oxygen, O, 8 Chemical series nonmetals, chalcogens Group, Period, Block 16, 2, p Appearance colorless (gas) very pale blue (liquid) Standard atomic weight 15. ... General Name, Symbol, Number lithium, Li, 3 Chemical series alkali metals Group, Period, Block 1, 2, s Appearance silvery white/grey Atomic mass 6. ...

The hallmark of encephalopathy is an altered mental state. Depending on the type and severity of encephalopathy, common neurological symptoms are progressive loss of memory and cognitive ability, subtle personality changes, inability to concentrate, lethargy, and progressive loss of consciousness. Other neurological symptoms may include myoclonus (involuntary twitching of a muscle or group of muscles), nystagmus (rapid, involuntary eye movement), tremor, muscle atrophy and weakness, dementia, seizures, and loss of ability to swallow or speak. Myoclonus is brief, involuntary twitching of a muscle or a group of muscles. ... Nystagmus is involuntary eye movement that can be part of the vestibulo-ocular reflex (VOR), with the eyes moving first in the direction of the lesioned side (slow phase) followed by a quick correction (fast phase) to the opposite side or away from the lesioned side. ... Atrophy is the partial or complete wasting away of a part of the body. ... For other uses, see Dementia (disambiguation). ... This article is about the medical term, epileptic seizure, as distinct from psychogenic non-epileptic seizure. ...


Blood tests, spinal fluid examination by lumbar puncture, imaging studies, electroencephalograms and similar diagnostic studies may be used to differentiate the various causes of encephalopathy. Blood tests are laboratory tests done on blood to gain an appreciation of disease states and the function of organs. ... A patient undergoes a lumbar puncture at the hands of a neurologist. ... Girl wearing electrodes for electroencephalography Person wearing electrodes for electroencephalography Portable recording device for electroencephalography Electroencephalography is the neurophysiologic measurement of the electrical activity of the brain by recording from electrodes placed on the scalp or, in special cases, subdurally or in the cerebral cortex. ...

Encephalopathy due to acute liver failure is vitally important to define because emergency liver transplantation and/or artificial liver support can save a life. The diagnosis is given by low level of factors of coagulability (V), intense jaundice and brain edema. Electroencephalogram can be useful. Encephalopathy due to chronic liver failure is also easy to recognize and is frequently triggered by protein intake or gastrointestinal bleeding.


Treatment is symptomatic and varies, according to the type and severity of the encephalopathy. Anticonvulsants may be prescribed to reduce or halt any seizures. Changes to diet and nutritional supplements may help some patients. In severe cases, dialysis or organ replacement surgery may be needed. The anticonvulsants, sometimes also called antiepileptics, belong to a diverse group of pharmaceuticals used in prevention of the occurrence of epileptic seizures. ...


Treating the underlying cause of the disorder may improve or reverse symptoms. However, in some cases, the encephalopathy may cause permanent structural changes and irreversible damage to the brain. Some encephalopathies can be fatal.


  • Adapted from http://www.ninds.nih.gov/disorders/encephalopathy/encephalopathy.htm

The Diagnosis of Stupor and Coma by Plum and Posner ISBN 0195138988 remains one the of best detailed observational references to the condition

See also

  Results from FactBites:
Transmissible spongiform encephalopathy - Wikipedia, the free encyclopedia (922 words)
Transmissible spongiform encephalopathies (TSEs) are fatal, incurable degenerative diseases of the brain transmitted by prions.
Note that not all encephalopathies are caused by prions, as in the cases of PML (caused by the JC virus), CADASIL (caused by abnormal NOTCH3 protein activity), and Krabbe disease (caused by a deficiency of the enzyme galactosylceramidase).
PSL -- which is a spongiform encephalopathy -- is also probably not caused by a prion, although the adulterant which causes it among heroin smokers has not yet been identified ([1], [2], [3], [4]).
Dr. Koop - Hepatic Encephalopathy- Health Encyclopedia and Reference (503 words)
Hepatic encephalopathy is the result of biochemical abnormalities associated with liver failure.
Although disturbed ammonia metabolism is one component of hepatic encephalopathy, it is clear that ammonia is not solely responsible for the disturbed mental status.
Current clinical management of hepatic encephalopathy in acute liver failure is derived from experience in chronic liver disease.
  More results at FactBites »



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