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07-SEPTEMBER-2008 03:17:44 - Encephalopathy March 2008 Encephalopathy Classification and external resources Image: Image:Structural.gif |190px|center| Para-sagittal MRI of the head in a patient with benign familial macrocephaly. MeSH D001927 Encephalopathy literally means disease of the brain. In some contexts it refers to permanent brain injury, and in others it is reversible. It can be due to direct injury to the brain, or illness remote from the brain. In medical jargon it can refer to a wide variety of brain disorders with very different etiologies, prognoses and implications. For example, prion diseases, all of which cause transmissible spongiform encephalopathies, are nearly always fatal and have an infectious origin, but other encephalopathies are reversible and can be caused by nutritional deficiencies, toxins, and several other causes. Contents 1 Types 2 Causes 3 Diagnosis 4 Therapy 5 Prognosis 6 References 7 See also Types There are many types of encephalopathy. Some examples include: Mitochondrial encephalopathy - Metabolic disorder caused by dysfunction of mitochondrial DNA. Can affect many body systems, particularly the brain and nervous system. Glycine encephalopathy - A pediatric metabolic disorder Hepatic encephalopathy - Arising from advanced cirrhosis of the liver Hypoxic ischemic 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 caused by infection, organ failure, or intoxication. Transmissible spongiform encephalopathy - A collection of diseases all caused by prions, and characterized by spongy brain tissue riddled with holes, impaired locomotion or coordination, and a high fatality rate. Includes bovine spongiform encephalopathy mad cow disease, scrapie, and kuru among others. Causes 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, exposure to toxins including solvents, drugs, alcohol, paints, industrial chemicals, and certain metals, radiation, trauma, poor nutrition, or lack of oxygen or blood flow to the brain. The hallmark of encephalopathy is an altered mental state. Depending on the type and severity of encephalopathy, common neurological symptoms are loss of cognitive ability, subtle personality changes, inability to concentrate, lethargy, and depressed consciousness. Other neurological signs may include myoclonus involuntary twitching of a muscle or group of muscles, asterixis abrupt loss of muscle tone, quickly restored, nystagmus rapid, involuntary eye movement, tremor, seizures, and respiratory abnormalities such as Cheynes-Stokes respiration cyclic waxing and waning of tidal volume and post-hypercapnic apnea. Diagnosis 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. Diagnosis is frequently clinical. That is, no set of tests give the diagnosis, but the entire presentation of the illness with nonspecific test results informs the experienced clinician of the diagnosis. Therapy Treatment 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. Prognosis 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. References 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 Brain damage Neurobiology Neurobiological brain disorder v d e Pathology of the nervous system, primarily CNS G00-G47, 320-349 Inflammatory Meningitis Arachnoiditis, Aseptic meningitis, Tuberculous meningitis - Encephalitis - Myelitis - Encephalomyelitis Acute disseminated - Tropical spastic paraparesis - Cavernous sinus thrombosis Systemic atrophies Huntington's disease - Spinocerebellar ataxia Friedreich's ataxia, Ataxia telangiectasia, Herary spastic paraplegia - Spinal muscular atrophy: Werdnig-Hoffman - Kugelberg-Welander - Fazio-Londe - MND ALS, PMA, PBP, PP, PLS Extrapyramidal and movement disorders Parkinson's disease - Neuroleptic malignant syndrome - Postencephalitic parkinsonism - Pantothenate kinase-associated neurodegeneration - Progressive supranuclear palsy - Striatonigral degeneration - Dystonia/Dyskinesia Spasmodic torticollis, Meige's, Blepharospasm - Essential tremor - Myoclonus - Lafora - Chorea Choreoathetosis - Restless legs - Stiff person Other degenerative/ demyelinating diseases dementia: Alzheimer's - Pick's - Dementia with Lewy bodies - Frontotemporal lobar degeneration mitochondrial disease: Leigh's demyelinating: Multiple sclerosis - Devic's - Central pontine myelinolysis - Transverse myelitis - Marchiafava-Bignami disease - CAMFAK syndrome - Alpers' Seizure/epilepsy Focal - Generalised - Status epilepticus - Myoclonic epilepsy Headache Migraine Familial hemiplegic - Cluster - Vascular - Tension Vascular Transient ischemic attack Amaurosis fugax, Transient global amnesia Cerebrovascular disease MCA, ACA, PCA, Foville's, Millard-Gubler, Lateral medullary, Weber's, Lacunar stroke Sleep disorders Insomnia - Hypersomnia - Sleep apnea Obstructive, Ondine's curse - Narcolepsy - Cataplexy - Kleine-Levin - Circadian rhythm sleep - Delayed sleep phase - Advanced sleep phase Intracranial hypertension Hydrocephalus Normal pressure - Idiopathic intracranial hypertension Other encephalopathy Brain herniation - Cerebral edema - Reye's Other spinal cord disease Syringomyelia - Syringobulbia - Morvan's syndrome - Spinal cord compression Retrieved from http://en..org/wiki/Encephalopathy Categories: Neurology | Neurotrauma | Greek loanwordsHidden category: Articles needing additional references from March 2008 Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Deutsch Français Bahasa Indonesia Italiano Nederlands Polski РуÑ?Ñ?кий Simple English This page was last modified on 16 July 2008, at 17
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