Encephalopathy

  • Medical Author:
    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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What are the symptoms of encephalopathy?

Despite the numerous and varied causes of encephalopathy, at least one symptom present in all cases is an altered mental state. The altered mental state may be subtle and develop slowly over years (for example, in hepatitis the decreased ability to draw simple designs, termed apraxia) or be profoundly obvious and develop rapidly (for example, brain anoxia leading to coma or death in a few minutes). Often, symptoms of altered mental status can present as inattentiveness, poor judgment, or poor coordination of movements.

Other serious symptoms that may occur include:

  • lethargy,
  • dementia,
  • seizures,
  • tremors,
  • muscle twitching and myalgia,
  • Cheyne-Stokes respirations (an altered breathing pattern seen with brain damage and coma), and
  • coma.

Often the severity and type of symptoms are related to the severity and cause of the brain disease or damage. For example, alcohol-induced liver damage (alcoholic cirrhosis) can result in involuntary hand tremors (asterixis), while severe anoxia (lack of oxygen) may result in coma with no movement. Other symptoms may not be as severe and be more localized such as cranial nerve palsies (damage to one of the 12 cranial nerves that exit the brain). Some symptoms may be very subtle and result from repeated injury to the brain tissue. For example, chronic traumatic encephalopathy (CTE), due to injury like concussions repeatedly sustained by football players and others who play contact sports, may cause slow changes over time that are not easily diagnosed. Such injury may lead to chronic depression or other personality changes that can result in life-changing consequences.

Even infants and children can suffer encephalopathy. Similar symptoms can occur in the perinatal period if, the neonate had any compromise to brain blood flow during its development. Rasmussen's encephalitis is a rare disease that is seen in children that progresses to intractable seizures if untreated. It may be due to autoantibody development. Another rare form of encephalopathy that usually develops in younger people (about ages 4 to 20 years) is the MELAS syndrome ("Mitochondrial Encephalopathy, Lactic Acidosis, Stroke-like episodes") due to faulty DNA in the patient's mitochondria (a tiny part within the cell that is responsible for energy conversion).

Medically Reviewed by a Doctor on 10/29/2015
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