Features of the diagnosis
ICD-10 defines unspecified encephalopathy as G93. Synonym: acquired unspecified encephalopathy.
The diagnosis has specific features:
- put when it is not possible to clarify with additional research;
- Pediatricians often find symptoms of unspecified encephalopathy in newborns;
- in 80% of cases the diagnosis is not confirmed after 2-3 years;
- men get sick more often than women by 21%;
- The accuracy of the diagnosis is higher if it is made at 5 or 65 years of age (peak identification of the disease).
The unspecified form of the disease requires additional examinations and is not confirmed in all cases. Most often, true encephalopathy is found in middle-aged and elderly people.
Classification of forms
When making a diagnosis, the signs of the disease are taken into account. At the first stage, unspecified encephalopathy is confirmed less frequently, since pathologies are not detected during examinations, while cerebral changes are already present.
The second degree of severity allows for a faster diagnosis, as patients show mild to moderate signs of the disease. At the third stage, severe neuralgic disorders are noticeable and the diagnosis is confirmed even without additional examinations.
The specificity of unspecified encephalopathy is such that depending on the type of disease (intoxication, infectious), the type of stages also changes. In the acute course of an infectious pathology, the first degree almost immediately passes into the second or third.
Prevention
It is almost impossible to prevent pathology in children, since they suffer from congenital forms. However, the mother's compliance with simple rules will reduce the risk of developing the disorder. It is necessary to eat properly and nutritiously. Avoid taking medications without prescription, as well as alcoholic beverages.
Smoking during pregnancy and lactation, as well as performing heavy physical work that could affect the child, are not allowed. It is important to avoid injury as well as contact with toxic substances.
Adults should also lead a healthy lifestyle, eat right and exercise. However, you should not overload the body; it is important to monitor your condition and get proper and timely rest. Similar principles will help avoid the development of atherosclerosis, hypertension, kidney and liver pathologies, and diabetes.
If an adult has any chronic disease, it is important to visit a doctor in a timely manner, undergo a course of therapy and strictly follow all recommendations. Simple rules can significantly reduce the risk of developing pathology.
Causes of the disease
Any encephalopathy - unspecified or confirmed - can be either congenital or acquired. Congenital pathology is associated with several factors. The first is prenatal, it is characterized by fetal injuries and other negative factors affecting the embryo. The second is perinatal, caused by childbirth, as well as adverse effects after birth.
Most often, these forms of encephalopathy develop as a result of:
- trauma to the skull received during the passage of the fetus through the birth canal;
- metabolic diseases inherited from parents;
- abnormalities in the development of the nervous system and brain;
- alcoholism, drug addiction, infectious diseases of the mother during pregnancy.
Acquired unspecified encephalopathy is divided into several more complex types. There are no average statistics on the frequency of their occurrence, since much depends on a person’s lifestyle and his environment:
- post-traumatic – appears as a result of dystrophy, scars, atrophy of brain tissue after traumatic brain injury;
- vascular – develops when there is poor blood supply to the brain against the background of hypertension, atherosclerosis, vascular pathologies, thrombosis;
- toxic – systemic effect of harmful substances: alcohol, metals, metabolites of bacteria and parasites, chemicals, shock doses of vitamins or minerals;
- radiation – appears as a result of radiation;
- metabolic – develops against the background of diseases of internal organs;
- hypoglycemic – occurs due to a decrease in blood glucose levels.
There is a more precise classification of encephalopathies, the types of which may occur in an unspecified form. This form, known as metabolic, is divided into several subtypes. They may be associated with other disorders, for example, vascular ones: cholesterol plaques narrow the lumen and cause metabolic disorders.
Medical researchers believe that the main cause of any encephalopathy is brain hypoxia.
Diagnosis of a disease is a multi-stage, complex process that requires a lot of time. You cannot rely on the results of one analysis, since any type of encephalopathy may hide other disorders. And pathology can never arise as an independent disease.
Diagnostics
In the case of unspecified encephalopathy, correct and timely diagnosis becomes of enormous importance, as it makes it possible to identify the cause of the pathology and influence it by prescribing adequate treatment.
Physical examination
During the examination, the specialist will pay special attention to collecting complaints, life history and illness in order to clarify risk factors for the development of one or another form of encephalopathy. No less informative is the study of the neurological status, during which paresis, sensitivity disorders, instability in the Romberg position, nystagmus, etc. may be detected. Consultation with related specialists (infectious disease specialist, ophthalmologist, endocrinologist) may also be necessary.
Laboratory research
Laboratory diagnostics are aimed at identifying metabolic or hormonal imbalances that can lead to diffuse multifocal damage to brain tissue. It includes:
- Clinical analysis of blood and urine.
- Biochemical blood test (coagulogram, lipid profile, sugar, kidney and liver tests).
- Test for thyroid hormones (free T4 and TSH).
Instrumental diagnostics
Instrumental diagnostic methods that allow you to verify the etiology of encephalopathy or confirm its unspecified form are:
- Electrocardiography.
- Ultrasound Dopplerography (Doppler ultrasound) of extracranial vessels.
- Duplex or triplex ultrasound examination of extra- and intracranial arteries and veins.
- Electroencephalography.
- CT or MRI of the brain.
To more clearly see lesions in the brain parenchyma using computed tomography, it is necessary to use intravenous contrast with iodine-containing water-soluble substances.
Development mechanism
For a more precise understanding of what unspecified encephalopathy is, you need to consider the mechanism of development:
- occurs . It is caused by vascular spasms and other disturbances in the functioning of organs and the circulatory system.
- Metabolic disorder . Cells do not receive enough nutrients, atrophy and degeneration begin.
- Proliferation of lesions . Demyelinated lesions, dying tissue, form in the white matter of the brain.
- They arise . At first they become small and isolated, then they grow.
- Swelling and congestion . The formation of these signs leads to the death of large areas of the brain.
Gradually, a person loses cognitive functions, and the nervous system suffers. Advanced encephalopathy cannot be treated; dead areas of the brain are not restored.
The brain reacts very quickly to any changes, since this organ contains a minimal supply of oxygen. As soon as it is no longer enough, pathological processes immediately develop.
Treatment
The fight against the disease is aimed at eliminating the symptoms and causes that gave impetus to the development of encephalopathy. Medicinal and conservative methods are used for therapy.
In the acute form, doctors reduce cranial pressure, eliminate convulsions, and use methods that support life processes: artificial ventilation, hemodialysis, and the administration of nutrients through a dropper bypassing the stomach.
Then the patient is prescribed medications that he takes for 1-3 months:
- lipotropic drugs - normalize the metabolism of fats and cholesterol (Lipostabil, dietary supplements with carnitine, methionine, choline, lecithin);
- angioprotectors - prescribed for heart disease, normalize the walls of blood vessels, improve the movement and outflow of venous blood (Detralex, Troxerutin, Indovazin, Cavinton);
- medications against blood clots (Aspirin, Ginkgo Biloba, Cardiomagnyl);
- neuroprotectors – nourish nervous tissue (Piracetam, B vitamins);
- sedatives and tranquilizers - reduce rapid nerve impulses in affected neurons (Sibazon);
- amino acids, vitamins;
- performance stimulants.
For speedy rehabilitation, the patient is prescribed physiotherapeutic procedures, gymnastics, acupuncture, massage, walks, and a certain daily and rest regimen.
Epileptic encephalopathy, which occurs in young children with an EEG pattern characteristic of epilepsy, stands apart. This only indicates a predisposition to epilepsy, which does not exclude its development in the future. The cause is a violation of brain formation.
Symptoms of pathology
Encephalopathy occurs slowly, and at least 3-6 months must pass from the onset of the disease to achieve the first symptoms. However, acute types are characterized by an accelerated course . At an early stage, regardless of the type of disease, certain signs are detected:
- difficulties in performing mental activities that previously did not cause problems;
- problems with step-by-step activities;
- memory loss;
- severe sleep disturbances, which lead to daytime drowsiness and nighttime insomnia, the patient experiences nightmares;
- severe fatigue even when doing familiar things that used to be enjoyable;
- extraneous noise in the ears, dizziness, headaches that constantly bother the patient;
- after stress, the patient feels an incredible loss of strength and emptiness;
- the character becomes hot-tempered, the mood often changes, irritability and tearfulness appear;
- the patient suffers from visual and hearing impairments.
In the initial stages of the disease, the patient remains in normal health, and changes begin mainly when weather conditions change. Symptoms are influenced by stress, anxiety and mental overload.
Dysfunctions of the nervous system develop slowly, beginning with a lack of coordination and mild seizures. The mental state is constantly deteriorating: apathy develops, the range of interests narrows, memory, speech, and attention suffer. Dementia is the final stage of encephalopathy.
Each type of encephalopathy, which may initially have been unspecified, develops its own symptoms.
Vascular form
Develops in older people due to problems with blood vessels, less common in adults 30-50 years old. The vessels of the neck, head, and upper half of the body suffer. At stage 2, it manifests itself with pronounced neurological symptoms: shuffling, instability, tremors, urination problems, disorientation.
Post-traumatic encephalopathy
Appears at different ages due to injuries, accompanied by severe nausea and headaches, as well as severe fatigue. Medicines only provide temporary relief. Attacks of falling, convulsions, asthenia, as well as problems with mental activity are possible.
Hypertensive form
Appears during a hypertensive crisis or from constant exposure to high blood pressure. Characterized by unclear speech, muscle weakness, and marked slowness in movement. Patients may experience headaches and deteriorating swallowing functions.
Venous form
The predominant symptoms are those affecting memory and intelligence, as well as thought processes. In the hot season, chills may occur with venous encephalopathy. The patient is bothered by a cough and heaviness in the head. Facial puffiness and pallor may appear.
Toxic form
Unspecified toxic encephalopathy is characterized by convulsions, a feeling of stupor, problems with breathing and circulation. Nausea, weakness and pressure changes, combined with difficulty controlling urination or bowel movements, can be chronic.
Severe poisoning in almost all cases is accompanied by loss of consciousness, hallucinations, and delirium. In advanced forms of the disease, death often occurs.
Alcohol form
Included in the group of intoxication encephalopathy, accompanied by delirium tremens (delusions and hallucinations). If the disease is chronic, then after a few months of constant alcohol consumption, tremors, weakness, anxiety, depression and personality disintegration appear.
Leukoencephalopathy
A form of the disease in which nausea, severe pain in the head occurs, and a person suffers from hallucinations, phobias and obsessive fears. All brain functions are inhibited.
Metabolic encephalopathy
Occurs with attacks of confused consciousness. The person becomes sluggish and has difficulty with processes such as speaking and performing everyday activities. Over time, drowsiness and hallucinations develop, and the patient falls into a coma.
Acute encephalopathy
Rarely occurs in an unspecified form. Severe and extensive brain damage appears, which means its rapid death after a stroke or edema. Symptoms of the acute form overlap with other diseases and do not allow an accurate diagnosis to be made without additional research.
general description
Hypertensive encephalopathy (acute hypertensive encephalopathy) (I67.4) is an acute or subacutely developing syndrome of cerebrovascular accident with neurological symptoms, which is a complication of severe arterial hypertension. Modern antihypertensive therapy has led to a rare prevalence of this condition. More often occurs over the age of 55–60 years. Etiological factors: malignant course of arterial hypertension, withdrawal of antihypertensive drugs, taking sympathomimetic drugs, kidney disease, pheochromocytoma, Cushing's syndrome, toxicosis of pregnancy, aortic dissection, periarteritis nodosa.
Features of encephalopathy in children
The diagnosis of unspecified encephalopathy is most often made in infants under 6 months of age. However, it can only be confirmed after tests.
In a child, the disease occurs in 3 degrees:
Easy . Crying, excitability and constant anxiety appear. Sleep deteriorates, stress levels increase, appetite decreases, and vomiting attacks become more frequent. Muscle tone changes significantly, and sometimes strabismus develops.
Average . The functioning of the nervous system worsens: blood pressure rises, convulsions and hydrocephalus appear. The child’s skin becomes marbled, the eyes become slightly closed, as in “setting sun” syndrome. The child almost always presses his arms and legs to his body. Constant crying and insomnia develop.
Heavy . There is a complete suppression of brain functions, consciousness is impaired. The baby falls into a coma. In most cases, death occurs.
Childhood encephalopathy often leads to complications. In adults they also develop in 80% of cases.
Forecast
If a person has survived encephalopathy, and therapy was provided on time, then the risk of complications is minimal. Here are the most common consequences of the disease: paralysis and paresis, convulsions, strabismus, metabolic disorders, excess weight, -epilepsy-.
In severe forms, problems with movements almost always develop, epilepsy and mental disorders occur. The patient is given a disability.
Toxic encephalopathy has the worst consequences; it is almost never unspecified. Treatment of the disease is complicated by the fact that the symptoms in all its forms are almost the same, and even modern diagnostic methods do not allow us to accurately determine the cause of the pathology.
Unspecified encephalopathy is not a disease, but a diagnosis that precedes a detailed study of the patient to make a more accurate verdict. In order to notice the disease in time and prevent its development, you need to undergo a full medical examination at the first sign and get an opinion from several doctors.
Possible complications
If left untreated, the pathology will certainly provoke deterioration, as well as serious complications.
The most common consequences:
- Stroke.
- Hypertensive crisis.
- Amyotrophy.
- Development of dementia.
- Complete loss of ability to move.
- Trophic changes in tissues, infection.
- Frequent seizures.
- Coma.
The most dangerous complication is death. If treatment is started in a timely manner, the prognosis for the patient is favorable, but if the symptoms are ignored, irreversible complications will certainly develop.
An unspecified form of encephalopathy is considered a fairly common disease. This condition is accompanied by multiple symptoms from internal organs and systems, and therefore requires comprehensive and timely treatment.
