Encephalopathy

Classification according to ICD-10
G93.4	Encephalopathy, unspecified
ICD-10 online (WHO version 2019)

The encephalopathy ( Greek ἐγκέφαλος enképhalos , German , brain ' and ancient Greek πάθεια pátheia , German , suffering' ) is a collective term for morbid states of the brain with different causes and characteristics.

Since structural lesions are absent in many cases, reversibility is often possible, but not always given. The term is generally only used for changes that affect the brain as a whole and not just individual parts of the brain. The development of symptoms is based on dysfunction of nerve cells (neurons) and glial cells . They are caused by changes in the internal milieu of an organism and impairment of cerebral homeostasis with the consequence of disturbances in neurotransmitter and membrane functions.

Long-term damage such as cognitive disorders after encephalopathies can probably also be related to secondary neuroinflammatory processes, for example after sepsis , burns, prolonged operations.

Classification and causes

• Anti-NMDA receptor encephalitis , antibodies against the NMDA receptor
• Chronic traumatic encephalopathy , after repeated blows or bumps, also after epilepsy
• Glycine encephalopathy , due to excessive production of glycine
• hepatic encephalopathy , liver disease, presumably by brain-damaging substances such as ammonia causes
• Hashimoto's encephalopathy , in autoimmune thyroiditis
• HIV encephalopathy, seen in some HIV patients
• High pressure encephalopathy due to high blood pressure
• Hyperammonaemia , due to high levels of ammonium in the blood
• Cerebral hypoxia , due to a lack of oxygen
• Lyme encephalopathy , in chronic stages of borreliosis .
• Mitochondrial encephalopathy , due to disruption of the mitochondrial DNA
• subcortical arteriosclerotic encephalopathy (Binswanger's disease), due to arteriosclerosis
• TSEs (Transmissible Spongiform Encephalopathy, TSE abbreviated), presumably by prions such as the bovine spongiform encephalopathy (BSE), also Creutzfeldt-Jakob disease
• uremic encephalopathy, in renal failure
• " Wernicke encephalopathy ", due to a lack of vitamin B ₁ ( thiamine )

Encephalopathies can be caused by abnormal levels of toxic substances, certain drugs and electrolytes , pathogens, or circulatory disorders , among other things .

Drugs and medication also play a role in terms of toxic influences on the brain ( Toxidrome ).

Poisoning, such as lead poisoning, can also cause encephalopathies.

A traumatic encephalopathy is dementia pugilistica , also known as chronic traumatic encephalopathy (CTE).

Clinical manifestations

The neuropsychiatrically dominated symptoms of encephalopathy are not specific to the cause and are diverse: disorders of consciousness , movement disorders , vegetative dystonia often occur as parts of the characteristic so-called general cerebral syndrome . Cerebral focus symptoms and brainstem signs are less common , e.g. B. in hypoglycemia or Wernicke encephalopathy.

diagnosis

As a test for encephalopathies, the clinical examination is used in comparison with electroencephalography (EEG), neuroradiological methods and laboratory diagnostics ( serum and liquor ). Other acute and chronic CNS diseases such as strokes , infections, trauma and epilepsy should be carefully delineated before a diagnosis of encephalopathy can be made.

In individual cases, such as suspected prion disease, the technique of Protein Misfolding Cyclic Amplification (PMCA) is used.

Individual evidence

1. ↑ ^{a b} Hans-Christian Hansen: chap. 8 pathophysiology of encephalopathies . In: Hans-Christian Hansen (Ed.): Disturbances of consciousness and encephalopathies . 1st edition. Springer Verlag, Berlin 2013, ISBN 978-3-642-36915-5 , pp. 129 ( limited preview in Google Book search).
2. ↑ AV Klimenko, IV Rozmaiiski: Salvarsan encephalopathy. In: Vestnik Venerologii i Dermatologii. Volume 4, 1954, p. 54 f.
3. ^ Heinz Lüllmann, Klaus Mohr & Lutz Hein: Pharmacology and Toxicology. Understand the effects of drugs - use drugs specifically . 17th edition. Thieme, Stuttgart 2010, ISBN 978-3-13-368517-7 , p. 562 ( limited preview in Google Book search).
4. ↑ AC McKee, RA Stern, CJ Nowinski, TD Stein, VE Alvarez, DH Daneshvar, HS Lee, SM Wojtowicz, G Hall, CM Baugh, DO Riley, CA Kubilus, KA Cormier, MA Jacobs, BR Martin, CR Abraham, T Ikezu, RR Reichard, BL Wolozin, AE Budson, LE Goldstein, NW Kowall, RC Cantu: The spectrum of disease in chronic traumatic encephalopathy . In: Brain . 136, 2013, pp. 43-64. PMID 23208308 .
5. ↑ Hans-Christian Hansen: chap. 5 and 6 spectrum of causes and differential diagnosis of encephalopathies . In: Hans-Christian Hansen (Ed.): Disturbances of consciousness and encephalopathies . 1st edition. Springer Verlag, Berlin 2013, ISBN 978-3-642-36915-5 , pp. 87 ( limited preview in Google Book search).
6. ↑ Frank Erbguth: chap. 19 and 23.2. Encephalopathies in acquired / triggered metabolic disorders . In: Hans-Christian Hansen (Ed.): Disturbances of consciousness and encephalopathies . 1st edition. Springer Verlag, Berlin 2013, ISBN 978-3-642-36915-5 , pp. 369 ( limited preview in Google Book search).

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !