Encephalopathy — is a brain disease, in which dystrophic changes the nervous tissue of the brain, that leads to a decrease in its normal volume and impairment of its function.
There are several reasons causing encephalopathy
- atherosclerosis (plaque)
- vascular discirculation, against a background of hypertension
- after traumatic brain injury (TBI, concussion, brain contusion)
- radiotherapy (radiation damage)
- ischemia (chronic oxygen starvation of the brain)
- diabetes mellitus
- toxic (alcohol, poisoning, poisons)
- venous (increased intracranial pressure), etc.
Types of encephalopathy by origin:
- Wernicke's encephalopathy (with a lack of food)
- toxic encephalopathy
- progressive multifocal leukoencephalopathy
- progressive vascular leukoencephalopathy
- progressive leukoencephalopathy with vascular hypertension
- hypertensive encephalopathy
- mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS) syndrome
Hypertensive encephalopathy is characterized by acute syndrome characterized by severe hypertension accompanied by headache, nausea, vomiting, seizures, confusion, stupor and coma. Sometimes you can see, or focal neurological symptoms of hemi-type transient or prolonged nature. These symptoms point to other forms of vascular lesions of the brain (hemorrhage, embolism or atherosclerotic thrombosis).
At the time of occurrence of neurological symptoms of hypertension in a patient usually becomes malignant and is accompanied by hemorrhages in the fundus retinal vessels, effusions (exudates), swelling of the optic nerve papilla (stage IV hypertensive retinopathy), kidney damage and signs of heart.
The pressure of the cerebrospinal fluid (CSF), and its content of protein in hypertensive encephalopathy often raised. The protein in the cerebrospinal fluid sometimes exceeds 1000 mg /l. The protein content in the lumbar cerebrospinal fluid normally is 0.22–0.33 g/l.
Hypertension may be essential or caused by chronic kidney disease, acute glomerulonephritis, acute toxemia of pregnancy, pheochromocytoma, Cushing's syndrome or toxic ACTH. Lowering blood pressure antihypertensive drugs leads to regression of clinical symptoms of hypertensive encephalopathy 1–2 days. If hypertension is not uncontrollable, the outcome can be fatal.
With postmortem studies of the brain in these patients may be normal, but it is commonly found swelling and/or bleeding of various sizes – from massive to petechial. Pressure cerebellar cone reflects the increase in brain tissue and increased pressure in the posterior cranial fossa (PCF). In some cases, a lumbar puncture (LP) performed in a patient with high blood pressure in the posterior cranial fossa (PCF) can cause death due to brain stem herniation into the foramen magnum.
On microscopic examination, in addition to small hemorrhages exhibit accumulation of microglial cells, minor cerebral infarction, and necrosis of the walls of the arterioles.
The term "hypertensive encephalopathy" should be used for the above syndrome, but not for chronic recurrent headaches, chronic vertigo with vertebral-basilar insufficiency (VBI), seizures, transient ischemic attack (TIA) is often observed at elevated blood pressure.
Magnetic resonance imaging (MRI) performed for suspected encephalopathy in the brain.
In the diagnosis of encephalopathy, its manifestations are very diverse. The most frequent of them is a disorder of memory and consciousness, lack of initiative, headaches, dizziness, depression, etc. Also, patients with encephalopathy, often complain of fatigue, confusion, irritability, tearfulness, poor sleep, general weakness.
In the diagnosis of encephalopathy during examination by a doctor in the patient may show apathy, the viscosity of thought, prolixity, narrowing the circle of interest and criticism, daytime sleepiness and difficulty pronouncing certain words, etc.
- cerebrovascular Doppler ultrasonography, REG, EhoEG
- brain MRI
- brain CT
- cerebrovascular MR-angiography
- cervical spine MRI
- lumbar puncture (LP) for cerebrospinal fluid (CSF) analysis
Treatment of encephalopathy disease is a long course with nature because of its severity and duration of flow, as well as age and concomitant disease in the patient.
Treatment of encephalopathy is constructed taking into account the neurological status, psychological status, as well as results of various blood tests, urine, cerebrospinal fluid, MRI of the brain. Such treatments are carried out as an outpatient and inpatient requires 2-3 times per year, depending on the severity of encephalopathy.
Depending on the severity of symptoms and causes of encephalopathy in a patient, the following therapeutic action: