Encephalopathy of the brain - what is it? Symptoms and how to treat

Toxoplasmosis on MRI of the brain Magnetic resonance imaging is a painless and informative way to study the brain. Layer-by-layer MR scanning allows you to examine in detail all parts of the organ and evaluate their structure. Using certain sequences, it is possible to study in detail the white and gray matter, blood vessels, and ventricular system.

MRI is considered an effective method for identifying focal brain lesions. These include limited areas with a disturbed structure inside the substance of the organ. Such changes are often accompanied by mass effect, swelling, and deformation of the surrounding areas. Lesions in the brain on MRI appear as areas of change in the MR signal. Based on specific features, location, size and degree of influence on surrounding structures, the radiologist can make assumptions about the nature of the pathology. Using the information listed, the doctor makes a diagnosis, makes a prognosis for the patient and selects treatment.

Who's at risk

The following categories of people are at risk:

• with atherosclerosis of cerebral vessels;
• with unstable blood pressure;
• with diabetes mellitus (treatment prescribed by an endocrinologist);
• alcohol abusers;
• after a brain injury;
• with liver disease (consult a hepatologist);
• working in hazardous industries (fumes of caustic chemicals);
• over 60 years old;
• with a sedentary lifestyle;
• with obesity (consulting a nutritionist will help to cope with the problem).
• smokers;
• suffering from vasculitis, arteritis.

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Types of encephalopathy

Hypertensive

With increased pressure, damage to the vascular bed of the brain occurs. It has been proven that with long-term hypertension, a change in the walls of the arteries occurs: the replacement of muscle cells with connective tissue (sclerosis), which leads to a decrease in vascular permeability.

In addition, small arteries lengthen and acquire pathological tortuosity, which also disrupts the metabolic processes of the brain.

For the vessels of the brain, pressure changes are much more dangerous than simply increased pressure. Often, degenerative processes develop in the first and second degrees of hypertension, when there are no “prohibitively high” blood pressure values.

Diabetic

In diabetes mellitus, pathological processes occur in the inner lining of blood vessels (endothelium), which leads to disruption of the nutrition of brain tissue.

An increased level of glucose in the blood leads to the glycosylation reaction of protein molecules. This is a “springboard” for the development of vascular pathology. Diabetes mellitus is characterized by damage to small blood vessels (arterioles, capillaries).

Discirculatory

It includes both pathological changes in blood vessels due to atherosclerosis and the presence of lesions in the brain tissue. Atherosclerotic plaques cause vascular obstruction, which leads to a decrease in blood flow to the brain tissue.

In this case, the following changes occur in the nervous tissue: cell atrophy, as well as the breakdown of the myelin (outer) sheath of nerve fibers, which is responsible for conducting nerve impulses.

Alcoholic

It is damage to blood vessels and brain tissue as a result of abuse of alcoholic beverages or their surrogates.

Toxic

Severe poisoning from poisons and chemicals leads to brain damage.

Post-traumatic

It is usually a consequence of trauma and cerebral edema.

Encephalopathy in children

It occurs as a result of a viral infection or against the background of oncological processes.

Hepatic encephalopathy

Develops in severe liver diseases (hepatitis, hepatosis, cirrhosis), when the detoxification function of the liver is impaired. In this case, brain damage occurs precisely as a result of the presence of toxic metabolites in the human blood.

Diagnostic criteria

First of all, a symptomatic diagnosis is carried out, in which the doctor must collect a complete medical history and determine the development of the main symptoms and the presence of somatic pathologies. It is also necessary to conduct a physical examination, which consists of measuring blood pressure, counting the pulse, and listening to heart sounds. Neurological tests are necessary.

To identify cerebral circulatory deficiency, a screening examination is performed. This diagnostic method should include activities such as:

• listening to the carotid arteries;
• neuropsychological testing;
• neuroimaging;
• Ultrasound examination of the central arteries of the head.

According to doctors, it is believed that cerebral circulatory deficiency is diagnosed in 80% of patients with stenotic lesions of the main cephalic arteries.

To establish the reason why vascular encephalopathy develops, laboratory tests are carried out. Patients must undergo a clinical blood test, blood biochemistry, coagulation test and blood glucose level.

To determine areas of pathology in the brain, examinations such as electroencephalography, MRI, etc. are performed. It is also possible to conduct auxiliary examination methods: ultrasound and electrocardiography, which determine the presence of diseases of the cardiovascular system.

Stages of the disease

The first , in which initial symptoms appear: absent-mindedness, forgetfulness, decreased performance, headache, tinnitus. Patients usually associate this condition with fatigue and rarely consult a doctor at this stage.

Doctor's advice

It has been noted that encephalopathy develops less frequently and much later in people who are engaged in mental work or who like to read frequently and have a need to obtain new information. There are 90-year-old professors and teachers who continue to engage in scientific work, and at the same time have excellent memory and intelligence. For those who lead an associative lifestyle and have an initial level of education, the diagnosis of “Encephalopathy” may be relevant at 30 years of age. To prevent the disease, you should solve crossword puzzles every day, read classical literature, periodically memorize poetry, retell the contents of books you read, movies you watched.

Victoria Druzhikina Neurologist, Therapist

Therapeutic effects at this stage are the most effective and can almost completely eliminate the symptoms of the disease.

Secondly , the patient’s performance is significantly reduced, he becomes slow, his speech is “sticky”. Minor speech impediments may occur. A characteristic feature of this stage is a change in the patient’s personality; he becomes irritable, angry, and touchy.

The third is characterized by gross disturbances and manifests itself with significant brain damage. Characterized by changes in speech (gross defects), a shaky, shuffling gait, trembling hands, extreme slowness, and serious memory impairment. The patient's personality may change beyond recognition.

Chronic vascular diseases of the brain

Chronic vascular diseases of the brain (dementia, dizziness, gait disturbance, weakness in the limbs, headaches, consequences of stroke)

Chronic circulatory failure - DEP

Chronic cerebrovascular insufficiency is a common type of cerebrovascular disease (with primary brain damage and secondary damage to the vascular system).

Discirculatory encephalopathy is the first stage of chronic failure, characterized by small-focal brain damage due to a smaller volume of blood supply (by 15 ml/100 g per minute) and can cause micro-strokes, hypoxia, and brain atrophy.

As a rule, the development of dyscirculatory encephalopathy occurs as a result of vascular disorders in the brain. There are venous, mixed and atherosclerotic forms of pathology.

Based on an assessment of the degree of neurological disorders, dyscirculatory encephalopathy is divided into the following degrees:

1. First stage.

Stage 1 DEP is characterized by decreased memory and attention (with impaired memorization of new information), decreased performance, rapid fatigue, and difficulty switching attention from one event to another. Prolonged mental stress can cause dull headaches and sleep disturbances with periodic dizziness.

2. Second stage.

At the second stage of DEP, personal changes are revealed (viscosity of thinking, increasing memory impairment, resentment, selfishness, irritability, narrowing of interests, decreased ability of associative thinking, generalization and abstraction). There is intermittent, short sleep, dull headaches, instability and dizziness. In addition to anisoreflexia and pseudobulbar factors, vestibulo-cerebellar disorders, decreased social adaptation and work ability are determined.

3. Third stage.

Symptoms of stage three DEP worsen, manifesting weakness, impaired control of the sphincters of the pelvic organs, a combination of headaches with memory disorders and dizziness.

Diagnosis and treatment

Diagnosis of DEP is based on clinical information and additional analyzes of the brain and vascular system. In the fundus, pallor of the optic nerve head, vascular atherosclerosis are determined, palpating of compacted and twisted temporal arteries, rheoencephalography, Doppler ultrasound, MRI, and ultrasound angiography are performed.

When initial signs of pathology appear, periodic therapeutic courses should be carried out. In accordance with the somatic status and manifestations of the pathologist, drug treatment is prescribed:

• vasoactive agents;
• antiplatelet agents;
• anti-sclerotic drugs;
• neuroprotectors and nootropics;
• tranquilizers;
• antihypoxants;
• vitamins E and B.

Blood pressure is monitored, ACE inhibitors are prescribed, nicotinic acid drugs are recommended to improve blood circulation, and statins are recommended to correct the lipid spectrum.

If you have cerebrovascular insufficiency, you should avoid overheating, climbing mountains, smoking and drinking alcohol, watching TV and using a PC for long periods of time.

Classification and types of vascular diseases of the brain

Vascular diseases of the brain are classified as follows:

• initial signs of circulatory failure;
• transient disorders (ischemic attacks, cerebral hypertensive crises, acute hypertensive encephalopathy);
• persistent circulatory disorders (hemorrhagic, ischemic strokes, consequences of a previous illness);
• progressive cerebral circulatory disorders (non-traumatic chronic subdural hematoma, dyscirculatory encephalopathy).

Acute circulatory disorders are classified as secondary diseases. The main causes of their manifestations are atherosclerosis and hypertension. Sometimes strokes can occur as a result of vasculitis (allergic, infectious, syphilitic), systemic lesions of connective tissues, congenital pathologies of cerebral vessels, systemic blood disorders (coagulopathy, erythmias, leukemia).

The course of many diseases is complicated by transient ischemic attacks, which often develop acutely or prolonged.

Stroke treatment is carried out in an inpatient setting at the RSC Yaroslavl Regional Clinical Hospital. Diagnosis is carried out using computed tomography of the brain. In this case, MRI better reveals brain swelling, recognizing the appearance of small infarcts. Echoencephaloscopy and angiography can be performed.

The basis for the treatment of strokes is a combination of thrombolytic treatment with TRAs and neuroprotectors; at later stages, therapy with antioxidants and antiplatelet agents is carried out.

Diagnosis of vascular diseases

Popular diagnostic methods include ultrasound examination of arteries, magnetic resonance imaging, and neurological studies.

It is possible to determine the subtleties of the development of neurological diseases using modern methods (tomography with radionuclides, spectroscopy, positron tomography, duplex scan, thermal imaging, etc.).

General treatment concept

Treatment of vascular diseases of the brain and cerebrovascular disorders can be carried out by a therapist, neurologist and cardiologist. Complex therapy is often carried out, consisting of nutritional correction, the use of drugs and traditional methods. Sometimes surgery is prescribed.

Drug treatment

In each case, individual treatment is prescribed with certain drugs and their dosages are selected.

Popular means include:

• fibrates (Lipanor, Fenofibrate);
• statins (Simvastatin, Zocor);
• antioxidants;
• vasodilators (Eufillin, Papaverine);
• drugs to improve metabolic processes and blood circulation (Vasobral, Cavinton);
• Antiplatelet, decongestant, anti-inflammatory drugs, and glucocorticoids can also be prescribed.

For the treatment of atherosclerosis, angioprotectors (Anginin, Prodectin, Stugeron), anticoagulants (Pelentan, Sincumar, Heparin), antioxidants, vitamin-mineral complexes, cholesterol-lowering drugs (Thiamin, Pyridoxine, Diosponin) are prescribed.

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Symptoms

The disease is characterized by the following symptoms:

• forgetfulness;
• attention disorders;
• memory impairment;
• slowness;
• "viscosity of speech";
• speech defects (omission of letters, replacement of words, difficulty finding a synonym, lack of long sentences);
• gait disturbances (unsteadiness, difficulty maintaining balance, tendency to fall, clumsiness when turning);
• headache, dizziness;
• noise in ears;
• drowsiness, fatigue, weakness;
• sleep disorders (difficulty falling asleep, shallow sleep, frequent awakenings at night);
• decreased performance, inability to do more than one thing at a time;
• dysfunction of the pelvic organs: urinary incontinence, up to complete loss of control over urination, in advanced cases - fecal incontinence;
• “poverty” of emotions (loss of interest in others, apathy, withdrawal into oneself, a feeling of detachment, uselessness, lack of expression of emotions);
• decreased intellectual potential (in the severe stage, the patient sometimes cannot count to 10).

Symptoms of the disorder from stage to stage

Angioencephalopathy is manifested by a general clinical picture:

• decreased concentration;
• memory impairment;
• confusion and headache;
• rapid fatigue;
• poor sleep;
• depressed mood;
• decreased performance;
• instability of mood.

In general, the expression of symptoms depends on the extent of the disease.

1. At the initial stages (microangioencephalopathy), a change in the patient’s pathetic sphere is observed. There is a loss of strength and a change in mood. Most patients begin to suffer from depression. Mental disorder is very weakly manifested.
2. Angioencephalopathy of the second degree is characterized by a rapid decrease in memory, thinking and attention. There are disturbances in the motor system.
3. The 3rd degree of the disease is manifested by the most severe symptoms. At this stage, dementia may appear. Due to abnormal brain activity, somatic symptoms (miotic pain) begin to appear. The manifestation of all signs depends, in particular, on the zone of constant ischemia. When nerve cells in subcortical structures die, tinnitus, general malaise, sleep disturbance and unstable mood appear. Disturbed thinking suggests that the cerebral cortex, in which the centers of higher nervous activity are located, takes part in this process. With cortical ischemia, a sharp decrease in memory is observed. When such a symptom appears, patients cannot clearly draw up a plan for their actions and focus on anything specifically.

Treatment

Considering the variety of factors causing encephalopathy, treatment should be carried out in the following areas:

1. Eliminating the cause of the disease.
2. Improving blood supply to the brain.
3. Prescription of drugs that protect nerve cells from damage.

For encephalopathy, the following groups of drugs are prescribed:

1. Neuroprotective drugs. These drugs are highly effective in treating encephalopathy disorders. They improve trophic processes in nerve cells, provide protection and restoration of cell membranes from damage. The most commonly prescribed drugs are: Cerebrolysin, Nootropil, Encephabol, Cortexin.
2. Improving blood microcirculation in the vessels of the brain is achieved by prescribing drugs such as Actovegin and Kurantil.
3. Hypotensive (blowing blood pressure). Preference is given to drugs with a long action (about 24 hours) in order to avoid hypertensive crises. If one drug is insufficient, a combination of drugs is prescribed. The most commonly used are ACE inhibitors (Enalapril, Lisinopril, Fosinopril), beta blockers (Nebilet, Metoprolol, Bisoprolol), diuretics (Hypothiazide), Indapamide, Spironolactone. .
4. Statins are drugs that lower blood lipid levels. Typically prescribed are Atorvastatin (Atoris), Simvastatin (Simvacard), and Rosuvastatin (Rozart). In addition, to correct lipid levels, you must adhere to a low-calorie diet.
5. Antioxidants - these drugs protect the cell from pathological oxidation processes and the effects of toxic free radicals. The use of the drug Mexicor for encephalopathy is effective.
6. Antiplatelet agents - by reducing platelet aggregation, blood circulation in small vessels improves. Usually medications such as Aspirin and Clopidogrel are prescribed.
7. Monitoring glucose levels is mandatory for diabetes mellitus.
8. Detoxification - promotes the removal of toxic metabolites from the body; this therapy is especially effective for alcoholic and hepatic encephalopathy. In cases of severe intoxication, plasmapheresis (hardware purification of blood plasma from toxins) may be required.

After drug treatment, special attention should be paid to the patient’s rehabilitation:

1. Compliance with the work and rest regime.
2. Normalization of sleep.
3. Maintaining a diet if necessary (for obesity, diabetes).
4. Dosed physical activity.
5. Spa treatment.

Encephalopathy is very insidious, since the initial manifestations of the disease are very nonspecific and can be regarded by a person as chronic fatigue. In addition, it is sometimes very difficult to determine which factor leads to brain damage.

Encephalopathy often develops as a result of several causes affecting the body at once. This means that the boundaries of each type of encephalopathy are very blurred. That is why in the treatment of this condition it is justified to prescribe several groups of drugs with different mechanisms of action.

This article has been verified by a current qualified physician, Victoria Druzhikina, and can be considered a reliable source of information for site users.

Bibliography

1. https://mir.ismu.baikal.ru/src/downloads/2581419b_uchebnoe_posobie_distsirkulyatornaya_entsefalopatiya.pdf 2. https://dep_ninh.pnzgu.ru/files/dep_ninh.pnzgu.ru/hronicheskaya_nedostatochnost_mozgovogo_krovoobrascheniya.pdf
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