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Encephalopathy

What is encephalopathy?

Encephalopathy is a general term describing a disease that affects the function or structure of your brain. There are many types of encephalopathy and brain disease. Some types are permanent and some are temporary. Some types are present from birth and never change, while others are acquired after birth and may get progressively worse.

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Types and causes

What are the types and causes of encephalopathy?

The following are some major types of encephalopathy, along with their causes.

Chronic traumatic encephalopathy

This type of encephalopathy occurs when there are multiple traumas or injuries to the brain. These blows to the head lead to nerve damage in the brain. It’s usually found in boxers, football players, or members of the military who have been injured in explosions.

Glycine encephalopathy

Glycine encephalopathy is a genetic, or inherited, condition in which there are abnormally high levels of glycine (an amino acid) in the brain. Symptoms of glycine encephalopathy usually appear in infants soon after birth.

Hashimoto’s encephalopathy

This is a rare type of encephalopathy that’s linked to an autoimmune condition known as Hashimoto’s disease. In Hashimoto’s disease, your immune system mistakenly attacks your thyroid gland. Your thyroid gland is responsible for producing many of your body’s regulating hormones. Scientists don’t yet know exactly how the two conditions are linked.

Hepatic encephalopathy

Hepatic encephalopathy is a result of liver disease. When your liver isn’t functioning properly, the toxins that your liver usually removes from your body are instead allowed to build up in your blood, and can eventually reach your brain.

Hypertensive encephalopathy

Hypertensive encephalopathy is a result of severely high blood pressure that goes untreated for too long. This can cause your brain to swell, leading to brain damage and hypertensive encephalopathy.

Hypoxic ischemic encephalopathy

This condition is a type of brain damage that is caused when the brain doesn’t get enough oxygen. This can result in permanent brain damage or dysfunction. It can be caused by a lack of oxygen to the brain, such as when a developing baby is exposed to alcohol in the womb.

Toxic-metabolic encephalopathy

Toxic-metabolic encephalopathy is a result of infections, toxins, or organ failure. When the electrolytes, hormones, or other chemicals in the body are off their normal balance, they can impact the brain’s function. This can also include the presence of an infection in the body or presence of toxic chemicals. The encephalopathy usually resolves when the underlying chemical imbalance is restored or offending infection/toxin removed.

Infectious encephalopathies

Transmissible spongiform encephalopathies are also known as prion diseases. Prions are proteins that occur naturally in the body, but they can mutate and cause diseases that gradually damage and deteriorate your brain (neurodegenerative diseases). Prion diseases include:

Uremic encephalopathy

Uremic encephalopathy is a result of kidney failure. It is believed to be caused by the buildup of uremic toxins in the blood. This condition can cause mild confusion to deep coma.

Wernicke encephalopathy

Also known as Wernicke’s disease, this condition is a result of vitamin B-1 deficiency. Long-term alcoholism, poor nutritional intake, and poor food absorption can cause a vitamin B-1 deficiency. If Wernicke encephalopathy isn’t treated quickly, it can lead to Wernicke-Korsakoff syndrome.

Symptoms

What are the symptoms of encephalopathy?

Your symptoms will depend on the cause and severity of your encephalopathy.

Mental changes

You may have difficulty with memory or focusing. You may also have trouble with problem-solving skills.

Other people may notice symptoms in you before you do. A changing personality is one such symptom. For example, you may be more outgoing than you were before the encephalopathy. You may be more or less calm than you were before the disease.

You could also be lethargic and drowsy.

Neurological symptoms

Possible neurological symptoms include:

  • muscle weakness in one area
  • poor decision-making or concentration
  • involuntary twitching
  • trembling
  • difficulty speaking or swallowing
  • seizures
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Warning signs

When should I seek medical help?

You should see a doctor right away if you experience symptoms of encephalopathy. If you are already receiving treatment for brain disease, be aware of the following signs:

  • severe confusion
  • severe disorientation
  • coma

These can be signs of a medical urgency. They may mean that your condition is getting worse.

Diagnosis

How is encephalopathy diagnosed?

To diagnose encephalopathy, your doctor will ask you questions about your medical history and your symptoms. They will also perform a medical exam to check for mental and neurological symptoms.

If your doctor suspects that you have brain disease, they may conduct tests to determine the causes and severity of your disease. Tests may include:

  • blood tests to detect diseases, bacteria, viruses, toxins, hormonal or chemical imbalance, or prions
  • spinal tap (your doctor will take a sample of your spinal fluid to look for diseases, bacteria, viruses, toxins, or prion)
  • CT or MRI scan of your brain to detect abnormalities or damage
  • electroencephalogram (EEG) test to measure the electrical activity in your brain
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Treatments

How is encephalopathy treated?

The treatment for encephalopathy varies depending on what caused it. Treatment may include medications to treat your symptoms and medications or surgery to treat the underlying cause.

Your doctor may recommend nutritional supplements to slow the damage to your brain, or a special diet to treat underlying causes. In some cases of the disease, such as when the brain does not receive enough oxygen, you may slip into a coma. In severe cases like this, your doctor may put you on life support to keep you alive.

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Prevention

Is encephalopathy preventable?

Some types of encephalopathy — such as hereditary types — are not preventable. However, other types are preventable.

Making the following changes can reduce your risk of developing many of the underlying causes of encephalopathy:

  • avoiding excess alcohol
  • reducing exposure to toxic substances like drugs
  • eating a healthy diet
  • seeing your doctor regularly

Living a healthy lifestyle can help reduce your risk factors for brain disease.

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Long-term outlook

Long-term outlook

Your long-term outlook depends on the cause and severity of your encephalopathy. Many forms of encephalopathy are reversible if the cause can be identified and treated. All types can be fatal if severe enough. Some types are always fatal.

According to the National Institute of Neurological Disorders and Stroke, transmissible spongiform encephalopathy usually results in death within three months to a few years from the onset of the disease.

Treatment for the cause of your brain disease may improve your symptoms or may get rid of the encephalopathy. Depending on the type of encephalopathy, you may or may not have permanent damage to your brain. Your healthcare team can work with you and your loved ones regarding ongoing treatment and plans for therapy to support your day-to-day life in the case of brain damage.

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