encephalopathy. Vascular encephalopathy - foci of necrosis in the brain

Encephalopathy of the brain is not a separate disease, but a whole set of types of organic non-inflammatory brain damage. The most common encephalopathy is dyscirculatory, it is also vascular.

It occurs when there is an insufficiency of cerebral circulation, which leads to noticeable damage. It is this discirculatory form that will be considered further as the main one, but the rest will also be affected.

Varieties

The disease has a number of varieties at once.

She happens:

Toxic. This form of pathology is caused by complex and long-term neuropsychiatric disorders that occur when a person is poisoned with neurotoxic poisons, such as manganese, lead or mercury. When they enter the body, they enlarge the ventricles, create edema and plethora - and all this leads to numerous consequences of an extremely negative nature.
Radiation. Occurs when the body is exposed to ionizing radiation. This problem can be identified by psychological and asthenic disorders.
Hypoxic. This is a general term that combines varieties of the disease that are associated with oxygen starvation. The cause of the problem can be not only pathology, but also a lack of oxygen in the environment. This subtype is associated with sleep and memory disorders, increased excitability, and so on.
Discirculatory. Occurs due to insufficiency in the functioning of cerebral circulation. The discirculatory form is provoked by injuries, infections, tumors and vascular pathology.
Wernicke/alcoholic. Occurs with alcohol damage, or other damage from a lack of vitamin B1. It is a severe form of alcoholic psychosis, which usually develops in the third stage of alcoholism.
. This is not a very progressive deficiency of the neurological type, which appears under the influence of diseases and various pathological factors. It is characterized, in particular, by vegetovascular dystonia, fainting, cognitive decline, and so on. Due to the presence of mental disorders during this problem, sometimes the disease is mistakenly diagnosed as mental. It is especially difficult to diagnose this pathology in children. The problem is also that the first signs may appear at a young age, and the disease will make itself felt only years later.
Post-traumatic. It appears when the head is injured or bruised. This is usually accompanied by behavioral and neuropsychological disorders. The difficulty lies in the fact that a number of symptoms, including impaired thinking and attention, problems with memory and behavior control, occur only some time after the traumatic impact.
. This encephalopathy appears in chronic circulatory disorders of the brain, which coexists with uncontrolled hypertension of the arterial type. It is even more aggravated when atherosclerosis of the cerebral vessels is additionally manifested, but worst of all, when there is also diabetes mellitus, the patient has a lipid metabolism disorder or is a heavy smoker.
Hypoxic ischemic. Occurs when oxygen abruptly stops flowing to the brain area. An example of a situation that can provoke this problem is a myocardial infarction, or cardiac arrest for any reason. Asphyxia can also be the cause, for example, by suffocation, drowning, and a number of similar causes. The result is often extremely negative and very destructive.

Symptoms

The disease can have different symptoms depending on what stage of the disease is developing at the moment.

The first stage is compensated. During its course, the body can still cope with problems, cerebral circulation is maintained at a sufficient level, but the first consequences are already manifesting, therefore, treatment must begin. In particular, memory deteriorates, headaches become more frequent, dizziness begins, and heaviness appears in the head. Sleep is disturbed, becoming more anxious.

Emotional instability appears, mood can change.

May also appear:

decreased visual acuity and hearing;
noise in ears;
irritability;
vegetative disorders;
general fatigue;
lethargy during the day, trouble sleeping at night.

The second stage is subcompensated. On it, the condition of the brain tissues worsens even more, encephalopathy develops, the symptoms become more pronounced, they almost never recede. Headache, dizziness. The latter factor can have a very negative effect on stability while walking.

In addition, there is a lot of noise in the head. The patient becomes less physically active. The mood becomes depressed, attention decreases. But worst of all, the swallowing reflex, coughing and sneezing reflexes, and speech impairment often begin.

The head and hands may shake, vision and hearing are also impaired, a person is often discoordinated, which makes it much more difficult for him to cope with various everyday tasks.

The third stage is decompensated. The most difficult and problematic stage. On it, encephalopathy develops to such an extent that the brain can no longer be provided with a sufficient amount of oxygen, and therefore its tissues begin to collapse, in especially problematic situations, atrophy of the cerebral cortex can even begin. The patient may begin to suffer from severe epileptic seizures.

The consequences can be strong - up to deep dementia. Neurological syndromes are revealed, in particular, parkinsonian and pseudobulbar.

The reasons

Cerebral encephalopathy can have different causes depending on whether it is congenital or acquired. In the first case, problems occur before the baby is born or during the first week after the baby is born. The causes of congenital disease are usually:

complications and diseases during childbearing;
childbirth that occurred ahead of time;
problematic development of the birth canal;
excessively large body weight in the fetus;
cord entanglement;
neuroinfections and much more.

When the disease is acquired, the key causes are:

intoxication of the body;
tumors;
ischemia;
traumatic brain injury;
tumors;
atherosclerosis;
changes in the brain of the vascular type;
vegetovascular dystonia;
liver failure and more.

But it is important to understand that all processes in the body are interconnected, because one child, under the influence of the above reasons, may not suffer from the disease at all, while in another, even without their presence, the disease manifests itself to a noticeable degree.

The reason may be an abundance of small, hidden problems in the body, which together weaken the central nervous system to a noticeable degree.

Diagnostics

The disease can be diagnosed by various methods. In the beginning, basic clinical studies should be carried out during viewing: tests for memory status, psychological state, motor coordination, and so on. There is a possibility of changes in the mental state of the patient.

But the diagnosis is made only if mental problems are identified in conjunction with another, physiological diagnosis, for example, a chronic disease, and so on.

As a rule, one study is not enough, therefore, several different approaches are used at once to identify the presence of the disease and its root cause. Suppose the dyscirculatory (vascular) form is detected by one method, and the traumatic form is detected by another.. Here are just some of the tests that will help identify the root cause of the disease and establish exactly the fact of its presence:

a complete blood count, which can help identify infections or blood loss
measurement of pressure (arterial), which will help identify deviations from the norm;
creatinine, which helps determine how well the kidneys are functioning;
levels of drugs and toxins, including cocaine, alcohol, and amphetamines;
metabolic tests, which will help determine the levels of ammonia, lactic acid, electrolytes, glucose and oxygen in the blood, as well as the total amount of liver enzymes;
MRI and CT, which will help to identify anatomical abnormalities, tumors and infections;
encephalogram, which will help identify brain dysfunction;
ultrasound dopplerography, which reveals abscesses and circulatory pathology;
an autoantibody test to determine the cause of dementia, if any.

These are just some of the possible tests that the attending physician may resort to. In fact, the list is much wider, and, on the contrary, not all tests are necessary to make a diagnosis and determine which treatment will be used. Their exact list is revealed depending on the specific symptoms identified in the patient.

Treatment

First of all, in order for effective treatment to be possible, it is necessary to find out what kind of root cause provoked this disease - and it is with it that it is necessary to deal with it first of all. It is the elimination of the underlying disease that can improve and eliminate the problem, or minimize its impact on the human body.

It is also necessary to identify the main symptoms - treatment should eliminate them on an individual basis. Only a qualified specialist can prescribe treatment after a detailed examination has been carried out and all relationships have been identified, the symptoms have been assessed in detail.

It is important to understand that treatment, as a rule, does not allow you to get rid of the disease completely - it is too problematic. However, timely treatment can stabilize the general condition of the patient and significantly improve his well-being.

Several key therapies are used:

physiotherapy;
bioresonance;
medical;
massage.

Artificial ventilation of the lungs, hemodialysis and other measures to counteract the acute manifestation of the disease can also be used. Breathing exercises and reflexology are also often used to reduce symptoms.

It is medical treatment that is considered the key. A doctor can prescribe a number of drugs, thanks to which the disease and its consequences can be minimized to the maximum extent.

The main types of drugs used to combat the described problem include:

antihypertensive, designed to relieve symptoms of hypertension;
hypocholesterolemic and hypolipidemic, which are used for lesions of atherosclerotic vessels;
means to compensate for violations of venous outflow;
angioprotectors;
means for improving microcirculation;
means to prevent vascular spasms and improve cerebral blood flow.

These are the key types of drugs that are usually taken when an illness occurs. But doctors may prescribe other medications.

It is important to understand here that personal treatment is unacceptable, in particular, when encephalopathy is dyscirculatory (vascular), you, having chosen the wrong medicines, can only aggravate the situation.

Usually various drugs are prescribed in combination, and their courses are repeated after a while, usually after 1-3 months. The prognosis depends on the extent to which tissues are damaged, how much the disease has progressed, how realistic it is to carry out one or another specific treatment. In some situations, the maximum that can be achieved is the stabilization of the patient's condition, while in other cases, the prognosis can be more optimistic and the treatment can give a tangible result.

The vascular form of encephalopathy is a general lesion of the brain, which is caused by insufficient supply of blood to the organ, causing ischemic changes, oxygen deficiency, causing hypoxia, and a number of diseases. Violations of cerebral circulation and, as a result, hypoxia have a detrimental effect on neuronal cells. At the initial stage of the pathological process, a small focus of neuronal death occurs, but in the absence of appropriate therapy, more and more new areas of the brain are affected, the symptoms intensify, leading to irreversible changes.

In recent years, vascular encephalopathy has become a hot topic, as the age threshold for the disorder has noticeably decreased, practitioners are increasingly diagnosing it in young patients who complain of symptoms characteristic of brain pathologies. In addition, a similar state of the brain develops against the background of common ailments: hypertension, atherosclerosis, venous thrombophlebitis.

According to the nature of the origin of encephalopathy are divided into:

Congenital- caused by intrauterine brain development disorders, intracranial trauma that the child received during childbirth, hereditary metabolic disorders, etc.
Acquired- develop throughout a person's life due to the impact of negative external factors, injuries, various diseases, metabolic disorders.

Reasons for the development of the disorder

As we have already said, a pathological condition can occur in a child during fetal development or during childbirth. At different periods of life, the violation can be caused by:

Hypertension associated with pressure surges, pathological hypotension.
Exposure to toxic compounds.
Traumatic brain injuries.
Kidney and liver diseases, disorders of the pancreas, causing an increase in the content of toxic substances in the blood and their penetration into the brain tissue.
Effects on the brain of radioactive radiation.
The development of malignant neoplasms.
resulting in hypoxia.

With encephalopathy, the number of fully functioning neurons in the brain decreases, small foci of necrosis appear, blood stasis develops, swelling of the meninges of the hemorrhage is observed. Pathological foci are most often localized in white or gray matter.

Types of pathology

Identification of the types of disorders is based on what vascular pathology caused the disorder. The most common encephalopathies are:

atherosclerotic- develops as a result of clogging of the cerebral vessels with atherosclerotic plaques and the occurrence of hypoxia. The disorder is more often diagnosed in older people, but it is also possible at a young age with elevated cholesterol levels caused by various reasons. This type of encephalopathy develops over a long period of time, but, in the absence of timely diagnosis and treatment, it can manifest itself in a sharp form, leading to serious complications.
Hypertensive- occurs as a result of acute nephritis, eclampsia, sudden jumps in blood pressure or hypertensive crisis, which is the most dangerous. The encephalopathy that develops during a crisis and the changes associated with it are irreversible and have a poor prognosis.
Venous- develops gradually, due to stagnation of blood, after the appearance of the first symptoms, may not cause a noticeable deterioration in well-being for several years. In the case of effective treatment in the early stages, the violation is quite reversible, but in the absence of therapy it progresses rapidly and leads to serious consequences.

Other forms of violation

There are a number of less common types of encephalopathy:

Hypoxic-ischemic- the above types of disorders can also be attributed to this form, since circulatory disorders entail the development of ischemic changes in brain tissues and hypoxia. A characteristic difference of this type of disorder is its frequent manifestation in children in the first month of life. It can occur during fetal development or during childbirth, leading to both minor brain damage, manifested in hyperactivity and absent-mindedness, and serious pathologies.
Leukoencephalopathy- the most severe variant of the disorder, with which the patient can live for a maximum of two years. Acute forms usually end fatally within a month. Focal lesions of the white matter are not treatable and are of a viral nature. Most often, the disease is diagnosed in people of advanced age, with a weakened immune system.

To date, there is no method of therapy for leukoencephalopathy. This is due to the presence of a kind of protective barrier on the approaches to the brain, through which drugs aimed at eliminating the pathogenic virus do not penetrate. The reason lies in the fact that the barrier passes only fat-soluble pharmaceuticals, while the drugs indicated in this case are mostly water-soluble.

Signs of a disorder

Common for different forms of violation are the following symptoms:

Migraine-like headache and dizziness.
Tinnitus.
Decreased hearing and visual acuity.
Sudden mood swings.
Fast fatiguability.
Psycho-emotional disorders - increased irritability, depression, tearfulness.
Sleep disorders.
Deterioration of short-term memory.
Inability to concentrate, distraction.
Coordination disorders.
Numbness of fingers and toes.

There are three stages of encephalopathy:

Compensated- the body more or less copes with the developing pathology, the painful symptoms are mild. A person suffers from headache, dizziness, feeling of heaviness in the head. At night, a person cannot fall asleep, but during the day, on the contrary, he suffers from drowsiness and lethargy.
Subcompensated- vascular pathology progresses, lesions of the brain tissue become more extensive. The patient has an unsteady gait, constant tinnitus, symptoms of diseases that cause encephalopathy appear.
Decompensation- due to increasing hypoxia, atrophic phenomena develop in the cerebral cortex, the symptoms are very pronounced, therapeutic measures do not bring a tangible effect.

How to diagnose

First of all, the doctor examines the patient, listens to his complaints and studies the anamnesis. To clarify the diagnosis, the following methods are used:

Computed and magnetic resonance imaging.
Ultrasound examination - ultrasonic dopplerography, duplex and.
Electroencephalography.
Nuclear magnetic resonance.
Biochemical analysis of blood, cerebrospinal fluid and urine.

Treatment methods for the disorder

After cerebrovascular encephalopathy has been diagnosed, treatment is prescribed, primarily aimed at eliminating the cause of the disorder. In the future, a course of complex drug therapy is selected, lasting from one to three months. To relieve painful symptoms and improve the condition of blood vessels, the following drugs are used:

Angioprotectors - Etamzilat, Vasobral.
Lipid-lowering agents that normalize elevated levels of saturated fatty acids and reduce the likelihood of atherosclerosis - Polysponin, Miscleron.
Vasoactive agents - Cinnarizine, Cavinton.
Phlebotonics used for vein pathologies - Troxevasin, Aescusan.
Nootropics - Nootropil, Piracetam.
Vitamin and mineral complexes.

Physiotherapy, therapeutic exercises and other procedures have a positive effect. However, you should always remember that these are auxiliary methods that work only in combination with the main therapeutic course.

Today, many people are worried about all sorts of vascular diseases. And this is not at all just like that, because statistics speak of millions dying from these ailments. This article will discuss vascular encephalopathy. You probably need to know what symptoms of the disease exist, how treatment is performed.

It should immediately be said that with this disease it is affected. It can be not only congenital, but also acquired.

How can you get sick? First of all, abuse of alcohol. Anything can happen after an injury. All this leads to brain damage. The elderly are at particular risk.

Causes of vascular encephalopathy

How the disease is formed

The disease is formed due to the fact that the brain does not receive the necessary amount of blood. That is why often or hypertension often leads to the problem in question. As for injuries, infections and pathologies, they are not so often the causes. It's more of an exception to the rule.

How to determine the presence of a disease

The disease can be divided into several stages. Compensatory, subcompensatory, decompensatory. The first is considered the most initial. The symptoms here are the simplest. But this is very bad, as many can simply ignore them and not go to the doctor. So what are these symptoms? The patient begins to feel pain in the head, hears noises. He begins to lose his memory, forgets about some noticeable moments. Insomnia is noted, bad thoughts climb into the mind. Yes, and increased fatigue.

Many people have these symptoms. They are not willing to go to the doctor, so very often it is not possible to fix the disease at the initial stage.

As for the next stage, it is marked by incessant pains in the head. In addition, all this is accompanied by fainting. Memory worsens even more. Often, professional skills and knowledge that have been acquired over the years are lost. In addition, movement and speech disorders can be observed. The limbs become weak. Such symptoms are already significantly more significant. It is simply impossible to ignore them.

Now consider the decompensation stage. As you understand, all the signs already listed are aggravated. The patient almost completely loses the ability to think. Independent movement is difficult. Service person needed. Naturally, the treatment in this case will be much more complicated.

Diagnostics

dopplerography

Modern equipment allows you to easily identify the disease at the initial stage. In this case, Doppler ultrasound can help you. This is a duplex scan. It is enough just to look at the vessels of the neck, the column of the brain. An x-ray is required to obtain complete information. This won't take much of your time. It is only important to contact trusted clinics. Those that are equipped with modern equipment. So you can easily avoid mistakes when making a diagnosis. Yes, and save your time. Indeed, in most public medical institutions there are abundant queues.

Naturally, an MRI is required. The vessels of the brain, as well as the neck, are examined. Urine blood should be taken for analysis. A spinal cord puncture is almost always necessary.

How to deal with illness

As you understand, in no case should you treat yourself. Even if you choose the right drugs, there is still a great chance that you will mix up the dosages. You end up with even more damage than before. But you can change your lifestyle to make the treatment more effective.

Initially, you should change your diet. It should contain as little salt as possible. It is important to avoid fatty foods. All this leads to an increase in cholesterol. It is necessary to control its content on an ongoing basis. Be sure to follow the 8-hour sleep schedule. Arrange for a walk. At least a few thousand steps. This will not only improve your internal state, but also improve your mood. In addition, you can get rid of excess weight, if any.

Naturally, it is impossible to cope with the problem without taking drugs. First of all, they should be directed to lower blood pressure. As you know, cholesterol actively contributes to the development of the disease. So you should take drugs that lower its level. You should take medications that relieve headaches. Preparations for the improvement of blood vessels are required by absolutely all patients. Don't forget the B vitamins.

Any professional doctor will confirm that you need to take medicines throughout your life that normalize the chemical composition of the blood and remove excess cholesterol. So do not think that you will be able to avoid the consequences. Naturally, the process will be incomplete without physiotherapy. It is electrophoresis. In addition, a massage course is prescribed in the collar zone.

Folk remedies

They also allow you to brighten up the fate of the patient. As already mentioned, vascular encephalopathy occurs due to the fact that there is a problem with the blood circulation of the brain. As you probably know, hawthorn berries can significantly help in this matter. Tomatoes and greens will also indirectly save.

beet juice

Beetroot juice helps a lot. To increase its effectiveness, add a spoonful of honey to it. If you don't like it, you can just eat this viscous product before meals. Just a couple of spoons will be enough. What other problem might be bothering you? Usually it's a pain in the head. No need to take any newfangled drugs that cost a lot, but are not effective. Much better to use clover flowers.

All these folk remedies must be taken within a month. After that, a respite is made for about 4-5 weeks and everything repeats.

Do not overdo it. Honey and berries can cause allergies when consumed in excessive amounts.

How to protect yourself

Very often the disease is acquired. All this is due to the wrong way of life. First of all, you need to give up heavy consumption of alcohol and smoking. This makes the vessels as fragile as possible. If there is not enough B vitamins in the diet, then just buy them at the pharmacy and consume them. These are the main conditions in order not to suffer from vascular encephalopathy in the future.

In addition, a balanced activity is necessary. Professional sports have never made vessels healthier. It is associated with extreme loads. The blood rushes through the vessels with incredible activity. But brisk walking, gymnastics, jogging. All this will make your cardiovascular system stronger.

And, of course, we must not forget about checks with a doctor. After the age of 40, you need to visit a doctor and undergo a diagnosis at least once a year. Although the norm is a trip to a specialist once every 6 months. Urine, blood is given, blood pressure is measured. There is no need to wait if you begin to show the first symptoms described in the paragraph earlier.

Video

This is a pathological lesion of the brain due to the death of nerve cells, which is caused by a violation of the blood supply and oxygen deficiency of the brain tissue.

Encephalopathy is not a separate disease, it is a collective concept meaning various pathological conditions and diseases. .

Encephalopathy can be observed in both adults and children.

Mixed encephalopathy is a disease with several causes of brain damage.

Types of encephalopathy

Wernicke's encephalopathy (with alcoholic brain damage, some other toxic brain damage, a pronounced lack of vitamin B1);
toxic encephalopathy;
encephalopathy;
progressive multifocal leukoencephalopathy;
progressive vascular leukoencephalopathy;
progressive vascular leukoencephalopathy with hypertension;
hypertensive encephalopathy.

Hypoxic encephalopathy

Hypoxic encephalopathy is a unifying term for a whole group of pathologies of the brain and central nervous system due to oxygen starvation of the brain. Oxygen starvation can occur both with insufficient oxygen content in the surrounding atmosphere, and with some pathological conditions. Encephalopathy can be manifested by individual symptoms, such as sleep disturbances, memory impairment, headaches, increased intracranial pressure, dizziness, irritability, and more serious diseases.

Hypoxic encephalopathy can cause the development of cerebral palsy, epilepsy, myelopathy, neuropathy, severe mental retardation, up to oligophrenia. This type of hypoxic encephalopathy, such as residual encephalopathy, may appear several years after birth trauma.

The main causes of hypoxic encephalopathy are various cephalohematomas resulting from birth trauma, intrauterine infections, or cerebral hypoxia obtained during childbirth. An oxygen deficiency of 50% can cause severe consequences for the development of the child.

Circulatory encephalopathy

There are also circulatory encephalopathy, in which a progressive change in the brain tissue develops, with the formation of a pseudoneurasthenic syndrome. In transient perinatal encephalopathy, episodic cerebrovascular accidents occur, which can cause a number of complications, such as transient ischemic attacks, hypertensive cerebral crises, or attacks of cerebrovascular disease.

Hypoxic ischemic encephalopathy

This common and often devastating condition is caused by lack of oxygen to the brain due to hypotension or respiratory failure. Sometimes both of these factors play a pathogenic role, and it is impossible to identify the predominant significance of any of them - hence the dual references to a history of cardiorespiratory failure.

Conditions most commonly associated with anoxic (ischemic) encephalopathy include:

myocardial infarction;

cardiac arrest of various origins;

hemorrhage with shock and circulatory collapse, in these cases the blood supply to the brain suffers before the respiratory function;

infectious and traumatic shock;

asphyxia (during drowning, strangulation, aspiration of vomit or blood, compression of the trachea by hemorrhage or a surgical swab, ingress of a foreign body into the trachea);

diseases leading to paralysis of the respiratory muscles and dysregulation of breathing by the central nervous system (traumatic, vascular lesions of the brain, epilepsy) with respiratory failure, followed by heart failure;

poisoning with carbon monoxide (CO), in which respiratory depression occurs first, and then the functions of the cardiovascular system.

Experimental data confirm that hypoxia is able to induce various clinical and pathological conditions by itself, and not only in combination with low perfusion (ischemia).

Hypertensive encephalopathy

Hypertensive encephalopathy is a slowly progressive diffuse and focal lesion of the brain substance due to chronic circulatory disorders in the brain associated with long-term uncontrolled arterial hypertension. Accession of atherosclerosis of the cerebral vessels contributes to a further deterioration of the blood supply to the brain, which leads to the progression of the disease. In this case, they speak of dyscirculatory encephalopathy of mixed genesis: hypertensive and atherosclerotic. The combination with diabetes mellitus, lipid metabolism disorders and smoking also have a damaging effect on the vascular system of the brain.

There are three stages of hypertensive encephalopathy. At the 1st stage, subjective complaints predominate, at the 2nd-3rd stage, clinical neurological syndromes are formed:

vestibulocerebellar in the form of dizziness, staggering, instability when walking;

pseudobulbar in the form of slurred speech, violent laughter and crying, choking when swallowing;

extrapyramidal in the form of trembling of the head, fingers, hypomimia, muscle rigidity, slowness of movements;

vascular dementia in the form of impaired memory, intelligence, emotional sphere.

Combined syndromes are more often observed.

Toxic encephalopathy

Toxic encephalopathy is a diffuse organic lesion of the brain that can develop both after severe acute poisoning with neurotropic poisons and in chronic occupational neurointoxications.

The following symptoms are characteristic of the initial form of toxic encephalopathy: complaints of persistent headaches, dizziness, memory loss, general weakness, increased fatigue, sleep disturbance, etc. Against the background of sharp asthenia, diffuse organic symptoms appear that do not fit into the picture of any clearly defined nosological unit (asymmetry of facial innervation, deviation of the tongue, mild hypomimia, reflexes of oral automatism, high tendon reflexes, often anisoreflexia, weakening or disappearance of skin reflexes). Along with this, there are violations of the psycho-emotional sphere: a decrease in memory, attention and mental performance, slowness, lethargy, apathy, unmotivated anxiety, depressed mood, pronounced emotional lability.

Post-traumatic encephalopathy

Post-traumatic encephalopathy is a pathological condition resulting from severe or moderate brain injury. In all cases, this type of vomiting is accompanied by both behavioral and neuropsychological disorders. In the case of post-traumatic encephalopathy, most often there is a violation of both thinking and attention, memory and control over personal behavior. It should also be noted that all these unpleasant symptoms make themselves felt not so much immediately after the injury, but after a certain period of time after the cure. All these deviations are not immediately noticed by patients. As a rule, they become noticeable only when a person notices that he does not have the strength or ingenuity to solve any vital problems. Along with these disorders, patients also have excessive aggressiveness, epileptic seizures, insomnia, sexual disorders, and neurological disorders.

Discirculatory or vascular encephalopathy

Dyscirculatory encephalopathy (vascular encephalopathy) is an organic brain lesion of a non-inflammatory nature, due to cerebrovascular insufficiency. Vascular encephalopathy can occur as a result of a number of reasons: past infection, tumors and injuries, pathologies of cerebral vessels.

Alcoholic encephalopathy

Alcoholic encephalopathy is a severe form of alcoholic psychosis that develops mainly in the third stage of alcoholism. In fact, this is a group of several diseases, united by a similar clinical picture and cause. This disease is characterized by a complex combination of neurological and somatic manifestations with mental symptoms, which are in the first place in the picture of the disease. Depending on the rate of development and course of the disease, acute and chronic types of alcoholic encephalopathy are distinguished, but there may be transitional forms between them. Very often, people with alcoholic encephalopathy have a history of abuse of various kinds of alcoholic surrogates.

Residual encephalopathy

Most often, residual encephalopathy is a persistent, slightly progressive neurological deficit, which is the result of exposure to diseases and pathological factors. It is characterized by such neurological symptoms as regular headaches, paresis, reflex pyramidal insufficiency, vegetovascular dystonia, fainting, decreased cognitive function and intelligence, fatigue, and even mental disorders. Therefore, quite often, due to a medical error, residual encephalopathy is diagnosed as a mental illness, and symptomatic treatment is prescribed.

Unfortunately, residual encephalopathy in children is difficult to diagnose. Encephalopathy in children occurs as a result of perinatal and neonatal hypoxic and ischemic brain lesions, birth injuries and bruises, past vaccinations, in the presence of congenital brain anomalies and genetic mutations. The insidiousness of this disease lies in the fact that the first symptoms can appear at any age, and the disease can make itself felt several years later.

Causes of encephalopathy

There are both congenital and acquired encephalopathy. Congenital forms imply the occurrence of the disease in the perinatal period, starting at the 28th week of pregnancy and ending at the end of the first week of the child's life.

Pathological changes can be caused by oxygen starvation of the fetus, birth injuries, among other risk factors, there are:

maternal illness during pregnancy;
complicated pregnancy;
premature birth;
large body weight of the fetus;
cord entanglement;
difficult opening of the birth canal;
neuroinfections, etc.

The causes of acquired encephalopathy are usually:

various kinds of infections;

intoxication of the body;

vascular changes in the brain;

traumatic brain injury;

tumors;

atherosclerosis;

ischemia;

diabetes;

liver failure;

vegetative dystonia.

It should be borne in mind that the head does not exist by itself, with everything necessary from oxygen to proteins, minerals, stable intracranial pressure, etc. , it is provided by the whole body, or rather, all internal organs: the kidneys, and the liver, and the intestines, and the heart, and the thyroid gland, etc. Therefore, there are situations when a child after a birth injury does not have encephalopathy, and the other has not even received a birth injury. It’s just that the whole body is so strong in the first one that it allows the central nervous system (CNS) to recover quickly, and in the second, a lot of hidden problems in the body make the central nervous system unhealthy.

Symptoms of encephalopathy

The symptoms of encephalopathy are very diverse.

Early signs are:

decreased mental performance, memory (especially for recent events);

difficulty in changing activities;

sleep disturbance;

lethargy during the day;

general fatigue;

diffuse headaches;

noise in ears;

general weakness, unstable mood, irritability;

nystagmus;

decreased visual acuity and hearing;

increased muscle tone and tendon reflexes;

the presence of pathological pyramidal and oral reflexes;

violations of coordination;

vegetative disorders.

These disorders can progress as the underlying disease develops, which is accompanied by encephalopathy.

In such cases, in the later stages, clear neurological syndromes are detected:

parkinsonian;

pseudobulbar.

Some patients may have psychiatric disorders. In severe generalized brain damage, significant microcirculation disorders, cerebral edema, an acute development of the clinical picture of encephalopathy is possible:

general anxiety;
severe headache, often in the occipital region;
nausea, vomiting;
visual disturbance;
dizziness;
stagger;
sometimes numbness of the fingertips, nose, lips, tongue.

Then anxiety is replaced by lethargy, sometimes clouding of consciousness. Disorders of consciousness, sometimes convulsive seizures can occur in acute renal, hepatic, pancreatic encephalopathy. Acute development of encephalopathy with intense headache, nausea, vomiting, nystagmus, paresis, mental disorders, less often convulsions is observed with pulmonary embolism, infarct pneumonia, and in some cases with exacerbation of chronic pneumonia.

The most common symptoms of encephalopathy are:

disorders of memory and consciousness;

lack of initiative;

headache;

dizziness;

depression.

Patients with similar symptoms of encephalopathy often complain of fatigue, irritability, distraction, tearfulness, poor sleep, and general weakness. At the same time, during their examination, apathy, viscosity of thought, verbosity, narrowing of the circle of interests and criticism, daytime sleepiness, difficulty in pronouncing certain words and other symptoms of encephalopathy are noted.

Diagnosis of encephalopathy

The diagnosis of encephalopathy is usually made after clinical studies conducted during the examination - tests for psychological state, memory state, coordination of movements. Research can show changes in mental status. As a rule, the diagnosis is made if the change in mental state is accompanied by another diagnosis, such as chronic liver disease, kidney failure, hypoxia, and so on.

Thus, to identify the cause of the disease and the encephalopathy itself, doctors can use several different tests at once. This approach is practiced by most doctors due to the existing point of view: encephalopathy is a complication arising from an underlying health problem.

Listed below are the tests and tests most commonly ordered by doctors when making a diagnosis, as well as some possible underlying causes of the condition:

Complete blood count (infections, blood loss).

Measurement of blood pressure (high or low pressure).

Metabolic tests (level of electrolytes, glucose, lactic acid, ammonia and oxygen in the blood, the amount of liver enzymes).

The level of toxins and drugs (alcohol, cocaine, amphetamines).

Creatinine (kidney function).

CT and MRI (brain tumors, anatomical anomalies, infections).

Ultrasound dopplerography (pathological blood circulation in tissues, abscesses).

Encephalogram or EEG (brain dysfunction, pathological parameters of the electroencephalogram).

Autoantibody test (dementia caused by antibodies that destroy neurons).

This list is not exhaustive and not all of the above tests are needed to make a diagnosis. As a rule, the therapist prescribes certain tests based on the patient's symptoms and medical history.

Treatment of encephalopathy

To prescribe adequate treatment, the doctor must very well evaluate the patient's symptoms and the data of the studies. Usually, the complex includes drugs that improve cerebral circulation in the brain, nootropics, vitamins, adaptogens. Additional treatments are also used. The problem of encephalopathy therapy up to the present time is quite a big difficulty, in some cases it is only possible to stabilize the patient's condition to some extent.

Treatment for encephalopathy focuses on managing the symptoms as well as treating the disease that caused the damage to the brain.

In acute severe encephalopathy, hemoperfusion, hemodialysis, ventilation, parenteral nutrition are used. Use drugs that reduce intracranial pressure and prevent the development of seizures. They also prescribe drugs that improve blood circulation in the brain.

Additional treatment of encephalopathy involves the use of physiotherapy and reflexology, breathing exercises.

In acute encephalopathies, various life support systems are used: hemodialysis, artificial lung ventilation, hemoperfusion, long-term parenteral nutrition. Often, measures are needed to reduce intracranial pressure, eliminate convulsive syndrome.

Subsequently, drugs are prescribed that improve brain metabolism:

nootropic core (pyriditol, piracetam);

amino acids (cerebrolysin, alvesin, methionine, glutamic acid);

lipotropic compounds (Essentiale, lecithin);

vitamins A, E, group B;

ascorbic and folic acid: according to indications - angioprotectors (cinnarizine, xanthinol nicotinate, parmidine, cavinton, sermion);

antiplatelet agents (pentoxifylline);

biostimulants (aloe extract, vitreous body).

Medicines are prescribed in combination, repeated courses lasting 1-3 months.

The prognosis is determined by the dynamics of the underlying disease, the degree of brain damage, and the possibility of specific therapy. In some cases, it is possible to ensure only the stabilization of the condition of patients.

A generalizing name for pathological processes of various genesis, the basis of which is the degeneration of brain neurons due to a violation of their metabolism. Encephalopathy is manifested by polymorphic neurological disorders, disorders in the intellectual-mnestic and emotional-volitional spheres. Diagnostic search consists of a comprehensive neurological examination and the establishment of a causal pathology. Treatment of encephalopathy is reduced to the elimination of the pathological condition that caused it, the treatment of the causative disease and the maintenance of optimal metabolism of cerebral neurons.

Acquired encephalopathy can develop as a result of traumatic brain injury, exposure to ionizing radiation, intoxication with neurotropic chemical (ethyl alcohol, lead, chloroform, drugs, barbiturates) and bacterial (with diphtheria, tetanus, botulism, etc.) toxins. Encephalopathies caused by vascular disorders are widespread: atherosclerosis, arterial hypertension, venous discirculation, angiopathy of cerebral vessels in amylomidosis, leading to chronic cerebral ischemia. A large group consists of encephalopathy associated with exposure to endotoxins and is a complication of various diseases of somatic organs: acute pancreatitis, acute and chronic kidney failure, liver cirrhosis and liver failure.

Lung diseases leading to a disorder of pulmonary ventilation (pulmonary tuberculosis, lung abscess, bronchiectasis, pulmonary embolism) provoke encephalopathy of hypoxic origin. Encephalopathy observed in a number of patients after resuscitation has a similar genesis. Glucose plays an important role in cerebral metabolism. Encephalopathy can develop both with a decrease in its level (hypoglycemia) and with its increase (hyperglycemia), which is often observed in diabetes mellitus. The cause of metabolic cerebral disorders is hypovitaminosis (primarily a lack of vitamins gr. B). In some cases, encephalopathy is a consequence of a drop in osmotic pressure and hyponatremia, which arose due to water retention during hypersecretion of antidiuretic hormone (with hypothyroidism, adrenal insufficiency, tumor processes, etc.). The leukoencephalopathy, which has a viral etiology and is noted in immunocompromised patients, is one of the rare cases.

Pathogenesis

Encephalopathy of any genesis is a diffuse process, that is, affecting various cerebral structures. It is based on oxygen deficiency (hypoxia) and metabolic disorders of neurons. The latter can be caused by hypoxia itself (with dyscirculatory and hypoxic encephalopathies), deficiency of individual metabolites and exposure to toxins (with metabolic and toxic encephalopathies). These disorders lead to degeneration and death of cerebral neurons.

The morphological features that characterize encephalopathy include: degeneration and a decrease in the number of neurons in the medulla, which means its diffuse atrophy; foci of demyelination and necrosis, as well as glial growths localized in the white matter; microhemorrhages and swelling of cerebral tissues; plethora of cerebral membranes. The predominant localization of these changes and the degree of their severity may vary depending on the type of encephalopathy.

Classification

In accordance with the etiological factor, encephalopathy is classified into post-traumatic, toxic, metabolic, vascular (dyscirculatory), radiation. Post-traumatic encephalopathy refers to the long-term consequences of TBI and can develop several years after it. Toxic variants include alcoholic encephalopathy, seen in chronic alcoholism, as well as cerebral disorders that occur in drug addicts. Metabolic variants: hepatic (portosystemic, bilirubin), uremic (azotemic), diabetic, pancreatic, hypoglycemic, hypoxic, anoxic encephalopathy and Gaye-Wernicke syndrome. Dyscirculatory encephalopathy is divided into atherosclerotic, hypertensive, venous. A separate form of hypertensive encephalopathy is Binswanger's disease.

In clinical practice, the severity of encephalopathy is used, but this distinction is very conditional. I degree of severity implies a subclinical course, i.e., the absence of manifestations in the presence of cerebral changes recorded by instrumental diagnostic methods. At this stage, pathology can be diagnosed during a dispensary examination of patients with chronic, primarily vascular, diseases. The presence of mild or moderate neurological symptoms, often of a transient nature, characterizes the II degree of severity. At the III degree, severe neurological disorders are observed, in most cases acting as the cause of the patient's disability.

Symptoms of encephalopathy

More common is chronic encephalopathy, characterized by an asymptomatic onset and gradual development. Most often it has a dyscirculatory and post-traumatic character. Acute encephalopathy is characterized by a sudden onset and rapid aggravation of the patient's condition, the presence of impaired consciousness. It can occur with intoxication and dysmetabolic disorders. Examples are acute pancreatic, uremic, hepatic encephalopathy, Gaye-Wernicke syndrome, hypoxic encephalopathy in PE.

Chronic encephalopathy in the early stages it is manifested by difficulties when trying to remember recent events or recently received information, a decrease in attentiveness and mental performance, fatigue, sleep disturbance, lack of flexibility when changing the type of activity, psycho-emotional lability. Patients may report increased irritability, daytime sleepiness, noise in the head, and a headache that does not have a specific localization. Symptoms may vary from patient to patient. In the neurological status, nystagmus, moderate hyperreflexia and muscle hypertension, the presence of reflexes of oral automatism and foot signs, instability in the Romberg position, discoordination, insufficiency of cranial insufficiency (decreased vision, hearing loss, mild ptosis, gaze paresis), signs of autonomic dysfunction are possible. The progression of encephalopathy is accompanied by an aggravation of symptoms with the formation of one or another clearly dominant neurological syndrome: vestibulo-atactic, parkinsonian, hyperkinetic, pseudobulbar. The increase in violations of the intellectual and emotional-volitional sphere leads to the formation of dementia. Possible mental disorders.

Acute encephalopathy debuts with sudden psychomotor agitation with intense headache, visual disturbances, nausea and vomiting, unsteadiness, in some cases - numbness of the tongue, distal parts of the hands and feet, mental disorders. Quite quickly, excitement is replaced by apathy, often there is a violation of consciousness of various depths: stupor, disorientation, stupor and coma. Different types of epileptic seizures can be observed. Acute encephalopathy refers to urgent conditions and, without urgent medical care, can lead to death due to cerebral edema, dysfunction of vital cerebral centers.

Diagnosis of encephalopathy

The primary diagnosis of encephalopathy is carried out by a neurologist based on the results of a survey and a neurological examination. Additionally, a comprehensive instrumental neurological examination is performed: electroencephalography, echoencephalography, rheoencephalography or ultrasound of the vessels of the head. EEG, as a rule, reveals diffuse disorganization of the bioelectrical activity of the brain with the appearance of slow waves. It is possible to detect epi-activity. Echo-EG allows you to assess intracranial pressure. Vascular studies provide information about the state of cerebral circulation. You can analyze the degree of morphological changes using MRI of the brain. This method also makes it possible to differentiate encephalopathy from other cerebral diseases: Alzheimer's disease, encephalitis, disseminated encephalomyelitis, stroke, corticobasal degeneration, Creutzfeldt-Jakob disease, etc.

Of paramount importance in understanding the etiology of encephalopathy is the collection of anamnesis, examination of somatic organs and consultations of related specialists: cardiologist, nephrologist, gastroenterologist, endocrinologist, pulmonologist, narcologist. According to indications, hormonal studies, determination of cholesterol and blood sugar levels, urinalysis, biochemistry of blood and urine, ultrasound of the liver, hypertension, atherosclerosis are carried out. It is recommended to follow a diet corresponding to the underlying pathology and a regimen adequate to the patient's condition.

The presence of an ischemic component in the pathogenesis of encephalopathy is an indication for the appointment of vascular therapy: pentoxifylline, ticlopidine, vinpocetine, nicergoline. Atherosclerotic encephalopathy requires the inclusion of lipid-lowering pharmaceuticals (eg, simvastatin, gemfibrozil) in the treatment regimen. Therapy of hypertensive encephalopathy is carried out with the appointment of antihypertensive drugs and monitoring of blood pressure numbers. If dyscirculatory encephalopathy is caused by occlusion of the carotid arteries or vertebral artery, surgical treatment is possible: reconstruction or prosthesis of the vertebral artery, carotid endarterectomy, carotid-subclavian bypass, creation of an extra-intracranial anastomosis.

Neuroprotective and metabolic therapy is mandatory. It includes nootropics (hopantenic, piracetam, pyritinol, lucetam), amino acids (glycine, glutamic acid), vitamins (B1, B6, C, E), GABA preparations (picamilon, phenibut). In mental disorders, psychotropic drugs are needed: diazepam, bromides, droperidol, fenozepam. With convulsions, anticonvulsant therapy is performed, nootropics are contraindicated. Pharmacotherapy is carried out by repeated courses 2-3 times a year. Physiotherapy methods are used as ancillary treatment: reflexology, electrophoresis, magnetotherapy.

Forecast and prevention of encephalopathy

In many cases, the prognosis of secondary encephalopathy determines how effectively the causative pathology can be treated. The outcome of therapy also depends on the degree of cerebral changes that have occurred. In some cases, the stabilization of encephalopathy is considered a positive effect. With further progression, encephalopathy reaches grade III and leads to severe neurological and emotional and mental disorders that disable the patient. In the case of perinatal or acute encephalopathy, the outcome depends on the massiveness and severity of brain tissue damage. Acute toxic encephalopathies are often accompanied by deep and irreversible brain damage.

Prevention of perinatal encephalopathy is a matter of the correct choice of the method of delivery, adequate management of pregnancy, and compliance with the rules for caring for a newborn. Prevention of secondary encephalopathy consists in timely detection and adequate treatment of vascular, urological, gastroenterological diseases, pulmonary pathology, endocrine and metabolic disorders. As preventive measures, one can consider proper nutrition, an active lifestyle, quitting smoking, drugs and alcohol.