Encephalopathy: Understanding Causes, Symptoms, Diagnosis, and Management

What is Encephalopathy

Encephalopathy is a general term used to describe damage or disease affecting brain function.

Types of Encephalopathy

There are two main types of encephalopathy, acute (reversible) and includes: hepatic, uremic, hypertensive, Hashimoto's, and Wernicke's and chronic (irreversible) which includes, chronic traumatic encephalopathy (CTE), hypoxic-ischemic, and spongiform

Hashimoto`s Encephalopathy

Hashimoto's encephalopathy is associated with Hashimoto's thyroiditis. Symptoms include seizures, confusion, and dementia. Paranoid delusions, visual hallucinations and psychosis are also known to be associated with Hashimoto's encephalopathy

Hypoxic-Ischemic Encephalopathy

Hypoxic-ischemic encephalopathy is also known as global hypoxic-ischemic injury. This occurs when the brain does not get enough oxygen, permanent brain damage can result. Multiple areas of the brain are affected by low oxygen at once, hence differ from stroke, whereby an area supplied by one blood vessel becomes affected

Hypertensive Encephalopathy

Hypertensive encephalopathy is a generalized brain dysfunction as a result of prolonged hypertension. When it is left untreated can cause the brain to swell resulting in neurological damage. Symptoms include headaches, vomiting, balance problems, and confusion. It can also lead to seizures or bleeding in the back of the eye.

Infectious Encephalopathies

Infectious encephalopathies are neurodegenerative brain disorder characterized by tiny holes that give the brain a spongy-like appearance. This account for the most serious types of encephalopathies. They result from transmissible spongiform encephalopathies, also known as prion diseases, including chronic wasting disease, kuru, fatal familial insomnia, and Creutzfeldt-Jakob disease

Metabolic Encephalopathy

Metabolic encephalopathy result from toxins, infections, health condition (diabetes), organ failure (kidney failure, heart failure, or liver disease) which affects the bodys chemical balance (proteins, electrolytes, nutrients) in a way that impacts the brain's normal function. For instance, high blood sugar can lead to confusion, coma or even death

Wernicke's Encephalopathy

Wernicke encephalopathy is often caused by alcoholism associated with reduced vitamin B levels, especially thiamine. Symptoms inludes; confusion, loss of mental acuity, vision changes, and problems with muscle coordination.

Uremic Encephalopathy

Uremic encephalopathy occurs due to kidney failure, when the kidneys cannot filter harmful, this results in a buildup of uremic toxins in the brain. Symptoms include lethargy, confusion, seizures, or coma. Uremic encephalopathy is treated with dialysis or a kidney transplant.

Glycine Encephalopathy

Glycine encephalopathy is a genetic or inherited condition in which there are abnormally high levels of the amino acid glycine in the brain. Symptoms appears after birth and include lack of energy, trouble eating, low muscle tone, abnormal jerking movements, and breathing problems.

Chronic Traumatic Encephalopathy

This condition occurs due to direct injury to the brain, leading to nerve damage. This type is commonly found in athletes, boxers and footballers

Hepatic Encephalopathy

Often caused by chronic liver damage (liver cirrhosis), when the liver is not able to filter and function properly, toxins accumulate in the blood and brain.This type of encephalopathy can be acute or chronic. Sometimes, a person with hepatic encephalopathy can become unresponsive and may experience a coma.

Signs & Symptoms of Encephalopathy

The symptoms of encephalopathy vary according to the type of Encephalopathy and from person to person. The most common symptom is a change in mental state, with other problems such as;

• Memory loss
• Reduced ability to think clearly or concentrate
• Drowsiness
• Changes in personality such as irritability, aggression, impulsive behaviour or having suicidal thoughts
• Involuntary muscle twitching
• Difficulty speaking
• Difficulty swallowing
• Unusual eye movements
• Tremor
• Muscle weakness
• Dementia
• Loss of consciousness
• Tremors
• Seizures

Diagnostic Investigations of Encephalopathy

• Complete blood count
• Metabolic tests (blood levels of electrolytes, glucose, lactate, ammonia, oxygen, and liver enzymes)
• Drugs or toxin levels (alcohol, cocaine, amphetamines, and many others)
• Blood and body fluid cultures and analyses
• Creatinine or kidney function
• Brain imaging (CT and MRI scans) to determine brain swelling, anatomical abnormalities, or infections
• Doppler ultrasound (abnormal blood flow to tissues or abscesses)
• Encephalogram or electroencephalography (EEG) test, to measure the electrical activity in your brain
• Autoantibody analysis (dementia caused by antibodies that destroy neurons)
• Spinal tap or lumbar puncture.

Treatment of Encephalopathy

The treatment depends managing and relieving the underlying causing of encephalopathy. Treatment includes administration of intravenous glucose, vitamins and oxygen.

• Lactulose (Cephulac) to reduce serum ammonia level
• Glucocorticoids and immunosuppressive medications.
• Corticosteroids and other anti-inflammatory medicines to relieve inflammation and pressures within the skull.
• Antiviral medications
• Administration of glucose to treat hypoglycemia and insulin for hyperglycemic control
• Dialysis or an organ transplant if liver or kidney problems are causing your condition
• Nutritional supplementation may be recommended to manage the underlying metabolic condition and slow down brain damage
• Rehabilitation, behavior therapy, pain management, and cognitive training to improve thinking and problem-solving skills

Nursing Management of Encephalopathy

• Assess and monitor the level of consciousness.
• Monitor closely for vital signs and intervene accordingly
• Reorient the patient as necessary.
• Encourage family members to engage in the reorientation process.
• Promote a calm environment
• Provide optimal fluids and electrolytes
• Educate the patient and family members about the patient`s condition
• Assess the patient`s attention span and ability to make good decisions.
• Restore optimum fluid and electrolyte balance.
• Provide adequate nutrition
• Monitor patient closely for blood sugar levels
• Examine the patient`s general cognitive abilities and memory
• Monitor electrolyte status and intervene as indicated to correct any imbalances.
• Monitor the client closely for signs of ICP
• Administer a high cleansing enema to reduce ammonia absorption from the GI tract.
• Administer prescribed medications, which may include antibiotics and laxatives.
• Assess level of consciousness
• Monitor for restlessness and agitation

Preventions of Encephalopathy

Certain beneficial lifestyle adjustments may reduce the risk of developing encephalopathy such as

• Avoiding excess alcohol consumption
• Reducing exposure to toxins
• Monitor blood pressure; take antihypertensive medication as directed
• Eating a healthy diet, exercising, and maintaining a healthy weight
• Avoid physical contact with individuals known to be infected with organisms that may cause encephalopathy such as N. meningitidis or Shigella.
• Seeing your healthcare provider regularly
• Avoiding medications that adversely affect the nervous system
• Reducing your risk of head trauma