Update: December 2018
Seeing in the conclusion of the doctor the word “encephalopathy”, patients
start looking for answers to questions, what is it, is it necessary
treat and what the consequences may be. Particularly concerned
parents of newborn babies, as most of them know
that this disease is somehow related to the brain, but how
namely, not many have an idea.
What is encephalopathy and what is it like?
Энцефалопатия – это поражение клеток brain,
caused by the action of damaging factors, and leading to
dysfunction of brain structures. It is not independent
disease, and a syndrome that can be caused by many
reasons. Most forms of encephalopathy progress quite
slow and easy to treat with the elimination of provoking
factor a. Some forms, such as toxic, hepatic,
diabetic encephalopathy without treatment can lead to development
coma and death.
The basis of the development of brain damage is its low resistance
to prolonged lack of oxygen (brain death occurs already
6 minutes after cessation of blood flow) and high
sensitivity to toxic agents. As a result of acute or
chronic hypoxia (lack of oxygen) the cells die, which
leads to dysfunction of the brain.
Hypoxia can develop as a result of:
- cardiac arrest
- impaired lung ventilation
- long-term violation of cerebral circulation.
Brain toxicity may be due to:
- the influence of poisonous substances from outside (alcohol,
- toxins formed inside the body at different
diseases (liver and kidney diseases, diabetic ketoacidosis,
severe infectious diseases).
Virtually any violation of the internal constancy of the body
may have a damaging effect on brain cells. In connection with
the nature of the causal mechanism are the following forms
- Hypoxic encephalopathy develops as a result of
stopping the delivery of oxygen to the brain. This group includes
perinatal, postresuscitation, asphyxia
- Vascular (dyscirculatory) encephalopathy occurs when
нарушении кровотока по сосудам brain. It includes
venous, atherosclerotic, hypertensive forms.
- Toxic – due to poisoning with various poisons and
chemicals (lead, carbon monoxide – carbon monoxide, chloroform, etc.),
alcohol, narcotic substances.
- Toxico – metabolic – due to brain poisoning
metabolic products that are not removed from the body. Allot
bilirubin encephalopathy with hemolytic disease
newborns, hepatic with hepatitis, liver cirrhosis,
uremic in acute or severe chronic renal
insufficiency, hyper – and hypoglycemic in patients with sugar
- Posttraumatic develops immediately or after some time
after a skull injury.
- Radiation – due to exposure to ionizing radiation.
Encephalopathy in children – perinatal encephalopathy (PEP)
This form is also called hypoxic – ischemic
encephalopathy. This is a dysfunction of the brain that developed under
the influence of adverse factors acting on the fetus from week 28
pregnancy, childbirth and up to 8 – 10 days of life of the newborn.
In severity can be mild, moderate and severe.
The course of the process is acute (up to 1 month), early
recovery (3 – 4 months) and late recovery
periods (12 – 24 months).
According to some authors, the diagnosis of perinatal encephalopathy
30 – 70% of newborns are exposed.
The reasons энцефалопатии у детей:
- factors leading to brain hypoxia during pregnancy –
chronic maternal diseases (diabetes, heart defects, pyelonephritis
and others), infectious diseases (influenza, rubella, tuberculosis),
bad habits, stress, toxicosis, preeclampsia, chronic
placental insufficiency, threatened abortion,
- risk factors in childbirth – asphyxia of the newborn, prolonged
anhydrous period with the risk of infection of amniotic fluid,
swallowing and inhalation of water by a child, swift or prolonged
childbirth, premature detachment of the placenta.
- risk factors in the first days after birth – infectious
diseases of the newborn, surgical interventions,
Signs of perinatal encephalopathy
- Encephalopathy in mild children. Manifesting syndrome
general excitability – the baby is restless, often crying for a long time, badly
breastfeeds, sleeps little, often wakes up, often spits up
(Regurgitations of not more than 2 tbsp. are considered normal.
spoons, after each feeding, allowed to regurgitate fountain not
more than once a day). Muscle tone can be as high as
and lowered. There may be convergent squint.
- Encephalopathy of moderate severity. Manifested by one or
multiple neurological syndromes – depression syndromes
nervous system, motor hypertension disorders,
convulsive, hydrocephalic. Observed cerebral depression
activity, a general decrease in muscle tone. Further –
increased flexor tone (baby’s arms and legs are constantly
bent and pressed to the body), squint, bulging large spring,
marbling of the skin, the symptom of the “setting sun” – visible strip
protein between the iris and the upper eyelid (can also occur
in healthy children). Sucking and swallowing a child is broken, he
sleeps poorly, screams in a dream, often monotonously and shrill
- Severe encephalopathy manifests complete depression
brain function and consciousness, the child is in pre-comatose
condition or coma.
In the maternity hospital, the child is examined by a neurologist, an oculist, while
of necessity – by a neurosurgeon. Appointed by the study of gas
composition of blood, acid – base state (CBS), analysis
cerebrospinal fluid (lumbar puncture), neurosonography,
duplex scanning of the vessels of the head, radiography of the skull,
электроэнцефалография, КТ или МРТ brain.
After discharge from the hospital, the child is observed by a neurologist once in
two to three months. With the development of speech, manifestations of personal
features of the baby, you may need to observe a speech therapist,
child psychologist and psychiatrist.
Therapy of hypoxic brain damage begins in the hospital in
acute period, then in the recovery period is held in
clinic or in hospital by children’s neurologists.
- Detoxification, anticonvulsant therapy,
drugs that improve metabolic processes in the brain
(cinnarizine, cortexin, actovegin, solcoseryl, pantogam, phenibut,
piracetam and others).
- Drugs that reduce intracranial hypertension (mannitol,
- During the recovery period, massage courses are held,
physiotherapy (electrophoresis on the neck area), therapeutic
physical culture, swimming, acupuncture, manual therapy.
Consequences of perinatal encephalopathy in children
Mild encephalopathy can pass without a trace or cause
to the development of minimal brain dysfunction, which manifests itself
hyperactivity, absent-mindedness, restlessness, disturbance
attention of the child. This is sometimes called hyperactivity syndrome and
deficiency of shooting (SGDV).
Moderate and severe forms can lead to motor impairment,
speech and psychomotor development, neurotic reactions, asteno
– autonomic disorders (malfunctions of the internal organs and
weakness of the body). More dangerous and severe complications –
hydrocephalus (cerebral edema), epilepsy and cerebral
Can there be consequences of perinatal encephalopathy during
Neurologists believe that not cured in infancy
encephalopathy can lead to development in adolescence
vegetative – vascular dystonia, migraine, epilepsy, and in adults – to
increased risk of stroke.
Prevention of perinatal encephalopathy
Disease prevention begins at the planning stage and
conducting pregnancy. This is a rejection of bad habits, good
food, walks in the fresh air, treatment of chronic and
infectious diseases, correction of placental insufficiency
blood flow, the right attitude and readiness for childbirth, competent
birth management by an obstetrician.
Vascular (dyscirculatory) encephalopathy
Dyscirculatory encephalopathy (DEP) is a chronic disorder.
кровоснабжения brain, вызванное поражением сосудов шеи и
heads. It develops mainly in adults and the elderly, after 70
years the risk of cerebral circulatory insufficiency increases by three
times. Every fifth patient at the reception at the therapist about
diseases of the heart and blood vessels makes characteristic complaints.
- The cause of atherosclerotic encephalopathy is atherosclerosis.
aorta and carotid arteries (in 60% of cases)
- The cause of hypertonic form – arterial hypertension
- The cause of the venous form is a violation of the venous outflow from the cavity
skull in venous thrombosis, blood stasis in the jugular veins due to
pulmonary diseases and cardio – pulmonary insufficiency
(bronchial asthma, severe obstructive bronchitis)
- To encephalopathy of mixed origin, except for the above,
may result in:
- chronic heart failure
- heart rhythm disorders
- osteochondrosis of the cervical spine
- changes in the vascular wall in diabetes mellitus
Symptoms of Vascular Encephalopathy
- In the initial stage
encephalopathy is manifested by common symptoms that the patient has
takes for overwork. He is worried about general weakness,
fatigue, irritability, mood swings, disturbances
sleep, daytime sleepiness and sleeplessness at night, flickering
flies before eyes, hearing impairment. Possible memory impairment
especially household, the patient does not remember why he went into the room, that
wanted to take etc He becomes absent-minded, cannot concentrate
attention to the work performed. Dizziness and
- In the second stage
DEP begin more pronounced neurological and mental
disturbances – unsteady gait, instability when walking, “shuffling”
legs, trembling of the limbs, increased muscle tone,
neurological disorders of urination, tearfulness,
touchiness, elements of aggression. Memory deteriorates significantly
the patient is unable to perform the same amount of mental
- Third stage
characterized by the inability to navigate the place and
time, gross mental disorders, disorders
mental functions. A person is not able to lead labor
activity and loses self-care skills.
The doctor prescribed laboratory (complete blood and urine,
blood glucose testing, cholesterol levels) and
instrumental diagnostic methods. From the last shown:
- ECG, 24-hour blood pressure monitoring and ECG
- electroencephalography – recording of electrical activity
- rheoencephalography – recording the movement of blood through the vessels of the brain
- echocardiography – ultrasound of the heart
- Ultrasonography with duplex scanning of the carotid arteries, intracranial
arteries and veins
- radiography and MRI of the cervical spine
- МРТ brain
Treatment of dyscirculatory encephalopathy
In order to suspend the progression of dysfunction
brain, важно выявить и лечить причину. For this
antihypertensive drugs are prescribed (charter, prestarium,
concor et al) cholesterol-lowering drugs
(rosuvastasin, atorvastatin, etc.), diuretics (indapamide, lasix,
diacarb), drugs for the treatment of diabetes.
Apply to improve cerebral blood flow
drugs – cinnarizine, cavinton, antioxidants – actovegin,
solcoseryl, mexidol, vitamin E and ascorbic acid, nootropic
drugs that improve metabolism in brain cells – piracetam,
Nootropil, Vinpotropil, Pantogam, Neurox, Cerepro, etc. These
drugs can be used in tablet form for a long time
(several months) and courses in the form of injections.
Represents the effects of brain injury,
that can develop in children and adults in a few weeks,
months and years after injury. Develops in 70 – 80% received
damage to the skull.
Легкое сотрясение brain к энцефалопатии, как правило,
does not lead. Causes may be shaking 2 or more degrees
контузия, ушиб brain, переломы костей черепа с
crushing of the brain substance. Such injuries occur when
car accidents, falls from a height, beatings,
Signs of Post-Traumatic Encephalopathy
Symptoms can appear within a few days after injury.
- severe headaches, accompanied by nausea, drowsiness,
feeling of weakness. Painkillers are ineffective or with
short-term effect. Pains can disappear with change
- short-term loss of consciousness
- dizziness, imbalance, unsteadiness of gait,
falls, “reel” from side to side
- memory impairment, reduced reaction rate and concentration
attention, impaired mental functions, inability
analyze and draw conclusions
- psychomotor retardation, depression, asthenia (exhaustion
Для оценки степени органического повреждения brain
MRI is a must. Other studies are assigned
according to the observation plan drawn up by the doctor (blood tests,
Treatment of post-traumatic encephalopathy
Treatment in the acute period of injury is carried out in the department.
neurosurgery, neurology or traumatology, depending on
character trauma. After discharge, the patient should be monitored.
neurologist in the clinic, and with pronounced symptoms every year
hospitalized in the hospital.
Therapy is carried out by the same groups of drugs – vascular,
antioxidants and nootropic drugs.
This form arises as a result of action on brain cells.
toxic substances from outside, and toxins formed in
some diseases (toxic – metabolic
- In newborns – bilirubin EP with hemolytic
neonatal diseases, fetal alcohol syndrome with damage
brain, ЭП при приеме беременной наркотиков,
anticonvulsants, antidepressants, antipsychotics.
- In young children and adolescents – household poisoning
drugs, alcohol, gasoline and mercury vapor. In children up to three years
toxic encephalopathy often develops on the background of acute respiratory viral infection, flu,
intestinal infection and is called neurotoxicosis.
- In adults, acute or chronic
occupational or household poisoning with carbon monoxide, mercury,
lead, manganese, carbon disulfide, gasoline, pesticides,
drugs. Most often in adults, toxic
encephalopathy develops with the systematic use of alcohol
and its surrogates and poisoning with methyl alcohol.
Symptoms of toxic encephalopathy
65% of newborns develop jaundice, but only in 1 –
5% bilirubin level rises significantly what can
вызвать органическое поражение brain. Signs of it
are drowsiness or lethargy of the newborn, oppression
reflexes, including sucking and swallowing, disorders
rhythm of breathing and heartbeat, spasm of the back of the neck,
shrill cry. Symptoms of severe encephalopathy – stupor
or coma. Similar symptoms in newborns manifest
opioid (narcotic) and drug encephalopathy.
Acute toxic encephalopathy in children and adults occurs
with a single exposure to a poisonous substance in a large dose.
Manifested by states of mild stupor, lethargy or
excitement to seizures, severe respiratory and circulatory disorders
Chronic intoxication is characterized by persistent headaches,
nausea, drops in blood pressure, general weakness,
irritability, limb sensitivity,
dysfunction of the pelvic organs (involuntary urination and
defecation). Severe encephalopathy is pronounced
mental disorders such as delusions, hallucinations, aggression, and
also convulsive seizures and loss of consciousness. Spicy alcoholic
encephalopathy, or Gaia-Wernicke encephalopathy, develops
almost immediately after delirium amid daily consumption
large doses of alcohol. The patient sees hallucinations, hears voices,
refuses to eat, talks to himself, does not respond to
questions, sharply something shouts out. Tremor is characteristic
limbs, falling when trying to walk, severe muscle weakness.
The disease usually lasts from 3 to 6 weeks, but with fulminant
after 3 to 5 days of symptoms, coma and death occur.
In chronic alcoholic encephalopathy, initial signs
which develop after a few months of constant
drinking, the patient notes a pronounced feeling of anxiety,
depression of mood, weakness, worsening of sleep, trembling of eyelids, tongue,
limbs. With the progression of alcoholism and brain damage
nightmares begin to dream, volitional and intellectual
characteristics, depression appears, lack of taste for life and
a feeling of complete fatigue. Depression develops, often occur
hallucinations, loss of consciousness, convulsions. At the last stage
alcoholism, when the body’s reserves are exhausted, there is a full
personality degradation and alcoholic dementia.
The hospital conducts a blood and urine test for the presence of
suspected toxic agent. Показано МРТ brain
to assess the extent of its organic damage.
When bilirubin encephalopathy is prescribed phototherapy,
intravenous administration of blood plasma, antioxidants and nootropics,
solutions of glucose, ringer and vitamins, replacement blood transfusion
(usual jaundice of newborns, without hemolytic disease and without
encephalopathy does not require transfusion).
In acute and chronic poisoning detoxification is carried out.
organism, appointed vascular and nootoropnye drugs. Treatment
should be done only in the hospital, especially in children and
teenagers. Alcoholic brain damage treated together
narcologists and toxicologists.
What is dangerous encephalopathy?
Predict in advance how encephalopathy caused by
one or another causative factor is quite difficult, since
the brain due to its plasticity has powerful mechanisms
compensation. But it’s still proven that the severe forms of this
syndrome complex cause persistent neurological and mental
violations, for example:
- vascular encephalopathy is the cause of dementia in the elderly,
or senile dementia, in 10 – 15% of cases
- post-traumatic epilepsy develops in 11 to 20% of patients,
suffered from head injury
- bilirubin encephalopathy can lead to childhood paralysis,
loss of sight and hearing, mental and mental retardation.
Symptoms of such effects a neurologist will be able to diagnose already on
second month of a child’s life.
Острые формы тяжелого поражения brain опасны тем, что
lead to swelling of the brain, the development of coma and death.