Encephalopathy (from the Greek. enkephalos - the brain and pathos - suffering, illness; a synonym for pseudoanatolica) - non-inflammatory lesions of the brain, which is clinically can often be confused with the true encephalitis (see). Encephalopathy may be due to a variety of intoxication, hypoxia, injuries, radiation injuries, avitaminosis, General severe infections, etc. Typical example of one of these polietiologic diseases of the Central nervous system is, for example, Wernicke's encephalopathy, which is developing on the ground of chronic alcoholism and the associated heavy weight. This disease is reproduced in the experiment and stopped energetic (mainly parenteral) vitamin therapy. It encephalopathy include cerebral complications developing after poisoning S, among which of special importance lysergic acid, and various drug intoxication (in particular, the administration of barbiturates).
Encephalopathy may be caused by severe acute and chronic infections. There are encephalopathy influenza, measles (A. P. Awzen), encephalopathy in patients with malaria in a coma.
Inflammation can occur when encephalopathy only as a so-called secondary inflammation in response to the circulatory and necrotic changes in the Central nervous system a Typical example of the latter are the so-called malaria granuloma of Duroc, who represent only one of the stages of organization of the circle of perivascular hemorrhage and necrosis.
At the acute cerebrovascular diseases petrogeokhimicheskie differential diagnosis between BSE and true encephalitis is not extremely difficult. It is much harder for persistent forms of neuroinfections, when the exudative phase of the process and particularly perivascular infiltrates can be reverse development. It encephalopathy include acute and chronic forms of brain edema, as well as the so-called brain purple, accompanied by the formation of multiple minor bleeding in the white matter of the hemispheres and corpus callosum.
These pathological processes sometimes can be combined. In such cases, the question of primary or secondary encephalopathy should be solved on the basis of the aggregate patologicheskih, clinical, virological, serological and epidemiological data.
Forms of encephalopathy. Encephalopathy may be seen in the picture are of varying etiology of diseases of nervous system, caused by exogenous and endogenous intoxications, disorders of blood circulation and metabolism, injury to the skull and brain. Accordingly, the clinical picture encephalopathy diverse. Below is described the clinic some encephalopathies.
Hemorrhagic encephalopathy first described Wernicke (K. Wernicke, 1881), entitled "hemorrhagic top polyencephalic" in individuals suffering from chronic alcoholism. Later research has shown that the disease occurs not due to intoxication by alcohol, and due to the deficiency of the complex, mainly by the lack of vitamin B1, often observed in alcoholism. She also described in cancer of the esophagus and stomach, resection of the stomach, vomiting pregnant, stenoses privratnika, which developed after administration of sulfuric acid with the purpose of suicide.
The disease begins with mild expressed delirious state, which can last several weeks, sometimes there comes sharply. Appear headaches, sharp anorexia, nausea, vomiting. Anxiety and insomnia later replaced by sleepiness. Characteristic are eye disorders: diplopia, ptosis, anisocoria, no reaction of pupils on light and accommodation. Often detected also eye, ataxy, muscle stiffness of the neck. Less common choreiform jerking of the limbs. Sometimes, this picture is combined with the Korsakov syndrome and polyneuritis. The disease progresses rapidly, soon joined by tachycardia, respiratory failure, a drop of cardiac activity. Without treatment, the disease results in death within 10 to 20 days. Recovery is slow, often incomplete. Treatment - vitamin B1 50 mg intramuscularly 2 times a day. At the same time inside appoint other vitamins b and C.
Lead encephalopathy is one of the most frequent forms of intoxication by heavy metals. The disease develops gradually and begins with the intellectual and emotional disorders. There is a heightened excitability, irritability, loss of memory and ability to concentrate, sometimes mild euphoria. Soon there are severe headache, dizziness, trembling of the limbs or a General shake. Sometimes there seizures and changes at the bottom of the eyes in the form of congestive nipple or atrophy. In some patients, along with encephalopathy appears polyneuritis.
Especially hard lead encephalopathy occurs in children: quickly come cramps, stiffness of the neck, long nipples optic nerves. Often there are signs of focal lesions of the brain in the form of paralysis or cerebellar ataxia. This clinical picture can simulate a brain tumor. Differential diagnosis is carried out on the basis of establishing contact with lead, detection of lead in the urine and feces, increased content in the blood when spectrographic investigation. Children are seeing changes in the epiphyses of the long bones.
Treatment is primarily aimed at the removal of lead from the body. Recommended for intravenous infusion 10-30% solution of sodium hyposulphite 20 ml daily for a period of 15-20 days. Children to reduce intracranial pressure, intravenous infusion of 40% glucose solution in 20 ml, lumbar puncture, severe congestive nipple optic nerves - operation decompression.