Encephalopathy

Encephalopathy occurs when your brain function is temporarily or permanently altered by brain disease or damage. There are several types of encephalopathy that result from an infection, tumor, inherited condition or head injury.

If you have a type of encephalopathy, you may experience an altered mental state including memory loss or personality changes. Our multidisciplinary team – including our experienced Neurocritical Care Unit (NCCU) – is here for you and will guide you through your diagnosis and treatment process.

What is encephalopathy?

Encephalopathy is an umbrella term for any type of disorder, disease or damage that affects your brain’s function or structure. Damage occurs when the flow of oxygen or blood to your brain decreases. Encephalopathy can affect anyone, especially those with head trauma, birth complications and certain medical conditions.

The type of encephalopathy is determined by the cause. Regardless of the type, encephalopathy is a serious condition that needs immediate medical care to improve recovery and avoid serious complications. The condition may result in either temporary or permanent brain damage, and it can also lead to long-term and life-altering complications including a coma.

Types of encephalopathy

Common causes of hepatic encephalopathy.

Each type of encephalopathy has its own set of causes and risk factors. Common risk factors include infections of the brain such as meningitis, brain tumors, diet, alcohol use and long-term exposure to toxins such as drugs, radiation and industrial chemicals.

Types of encephalopathy are categorized by if the damage is reversible or irreversible. The most common types are anoxic encephalopathy and chronic traumatic encephalopathy, which are irreversible.

Types of reversible encephalopathy

• Hepatic encephalopathy: Occurs when your liver function decreases, allowing toxins to build up in your blood. This impacts your brain function. Liver dysfunction, including chronic liver disease, can cause this type of brain damage. Alcohol use disorder, overdosing on acetaminophen and a high level of proteins in your diet can lead to liver conditions.
• Hashimoto’s encephalopathy: This type occurs when your immune system isn't functioning normally due to thyroid problems. When this happens, your immune system may attack your brain function. It’s linked to an autoimmune disease called Hashimoto’s disease that impacts your thyroid function.
• Metabolic encephalopathy: If you have an underlying condition that affects your metabolism, such as diabetes, liver disease or kidney failure, your brain function may be impacted. A common example of metabolic encephalopathy is if you have diabetes and your blood sugar gets too high, leading to confusion or even a coma.
• Toxic encephalopathy: Occurs when there’s long-term exposure to drugs and medications such as painkillers or antibiotics. This type is also caused by exposure to poisons.
• Uremic encephalopathy: Similar to toxic encephalopathy, this type is caused by an accumulation of toxins from acute or chronic kidney failure. It can also happen due to blood loss, dehydration and infection.
• Wernicke encephalopathy: Also known as Wernicke-Korsakoff syndrome, this memory disorder is caused by a lack of thiamin or vitamin B1. This can occur with alcohol use disorder and malnutrition.

Irreversible encephalopathy types

• Anoxic encephalopathy: Also known as a hypoxic-ischemic brain injury, this type of brain damage is caused by the loss of oxygen and circulation to your brain. Many factors can lead to this, including cardiac arrest, a serious asthma attack, seizure, choking, near drowning or a blunt force injury to your head.
• Chronic traumatic encephalopathy (CTE): Common among professional athletes, this type of brain damage occurs from repeated impacts and injuries to your head.

What’s the difference between encephalitis and encephalopathy?

It’s common to confuse these two acute neurological conditions, but they differ. With encephalitis, the brain itself is inflamed, causing an altered mental state. Encephalopathy can have many causes. Encephalitis can eventually cause encephalopathy.

Encephalopathy symptoms

Recognizing symptoms of encephalopathy is vital to getting proper treatment and minimizing long-term complications. The most common symptom of encephalopathy is a change in your personality. Other symptoms depend on the type of brain damage and if you have an acute (severe) case of encephalopathy.

Common symptoms include:

• Behavior changes
• Confusion
• Hallucinations
• Loss of consciousness
• Memory loss

Acute symptoms include:

• Coma
• Dementia
• Involuntary muscle movements
• Seizures
• Tremors

Diagnosing encephalopathy

Our dedicated team of specialists will complete a series of exams to diagnose your type of encephalopathy. They’ll start with a physical exam and discuss your medical history and medications. A neurological exam will follow to check your brain and nervous system function.

Depending on your type, labs and imaging may be ordered to provide insight and rule out any other possible related conditions.

Potential tests include:

• Blood tests: A blood sample and test measures abnormal levels that may indicate the source of the brain damage.
• CT scan: This is a noninvasive test that uses special X-ray equipment that captures many cross-sectional views of an organ or area being examined. A computer then combines the many slices to create a two-dimensional view of the organ, tissue or blood vessel for examination.
• Electroencephalogram (EEG): This test monitors brain wave activity during seizure and non-seizure periods.
• Lumbar puncture: Also known as a spinal tap, a lumbar puncture can diagnose diseases of the central nervous system, including the brain.
• MRI: This imaging test combines a powerful magnetic field, radio waves and a computer to create highly detailed images of the brain and other organs or body structures and their functions.

Encephalopathy treatment options

It may take time to fully heal from these types of brain injuries. Your individualized treatment plan depends on your type of encephalopathy, if it’s reversible or not, and your symptoms. It will also be important to manage any underlying conditions that caused the brain damage.

Treatment may include:

• Surgery
• Medications
• Occupational therapy
• Physical therapy
• Speech therapy

In some acute cases, emergency surgery, organ transplant or life support will be needed.