Encephalopathy

What is encephalopathy?

Encephalopathy is a group of conditions that cause brain dysfunction. Brain dysfunction can appear as confusion, memory loss, personality changes and/or coma in the most severe form. There are different types, each with different causes that range from infection, exposure to toxins, an underlying condition and more.

Encephalopathy can be life-threatening if left untreated or lead to permanent brain damage. If you notice any symptoms of encephalopathy, especially if you or a loved one aren’t feeling like yourself, contact a healthcare provider immediately.

What are the types of encephalopathy?

The most common types of encephalopathy and their causes are:

• Anoxic encephalopathy: Cardiac arrest or other cause of loss of oxygen/circulation to the brain, typically in adults.
• Chronic traumatic encephalopathy: Repeated impacts to your head.
• Hashimoto’s encephalopathy: An abnormally functioning immune system.
• Hepatic encephalopathy: Severe liver disease.
• Hypertensive encephalopathy: High blood pressure.
• Hypoxic ischemic encephalopathy: A lack of oxygen to a baby’s brain shortly after birth.
• Metabolic encephalopathy: An underlying condition that affects your metabolism.
• Toxic encephalopathy: Medications (such as painkillers, sedatives psychological medications or antibiotics), street drugs or poisons.
• Uremic encephalopathy: Nonprescription drugs, toxins in your blood, dehydration, infection, blood loss or chronic kidney disease.
• Wernicke encephalopathy: A lack of vitamin B1.

How common is encephalopathy?

Some causes of encephalopathy are common. About half a million people need hospitalization with cardiac arrest each year in the United States, but less than half survive. Amongst survivors, the majority may have some brain injury (anoxic encephalopathy). Among people in a hospital, toxic and metabolic encephalopathies are common. More than half of all people diagnosed with cirrhosis (liver scarring) experience hepatic encephalopathy. People diagnosed with alcohol use disorder are at risk of Wernicke encephalopathy. Some are distinctly rare, such as Hashimoto’s encephalopathy.

What are the symptoms of encephalopathy?

Encephalopathy changes the way you think and feel. If someone within your care experiences encephalopathy, they may not seem like themselves and their behavior may be “off.” The signs and symptoms of encephalopathy vary, but may include:

• Confusion, disorientation, poor attention span.
• Memory loss.
• Sleepiness
• Behavior changes (agitation or irritability), loss of motivation (apathy) or depression.

Additional symptoms may include:

• Hallucinations.
• Involuntary muscle movements such as jerks, tremors or eye movements.
• Seizures.
• Difficulty breathing.
• Loss of consciousness.
• Severe encephalopathy can result in coma.

If you notice any of these symptoms, contact a healthcare provider or emergency services right away.

What causes encephalopathy?

The causes of encephalopathy vary. Typically, the causes aren’t associated with major structural changes in your brain. Other conditions can also cause symptoms of encephalopathy, like:

• An infection, either in your brain or coverings (encephalitis or meningitis), or in your body.
• A brain tumor.
• Pressure within your skull against your brain (intracranial pressure).
• A head injury.
• A stroke.
• Seizures, especially if untreated.
• A vitamin deficiency or malnutrition.
• Rarely, autoimmune or mitochondrial conditions.

Sometimes, the cause isn’t clear in all cases of encephalopathy.

What are the risk factors for encephalopathy?

Encephalopathy can affect anyone at any age, from newborns to adults. It’s most common among people:

• Above age 65.
• Who experienced a difficult birth.
• Who experienced head trauma.
• Diagnosed with a medical condition that affects more than one body system like kidney and liver disease.
• Who take several medications.
• Who experience substance use disorder or have chemical exposure.

What are the complications of encephalopathy?

Complications of encephalopathy may include:

• Permanent brain damage with lasting effects on cognition and independent functioning.
• Developmental delays or problems with cognitive development or function in babies and children.
• Coma that may require placement of a breathing tube and ventilator (breathing support).

Some cases of encephalopathy are fatal.

How is encephalopathy diagnosed?

A healthcare provider will diagnose encephalopathy after:

• A detailed history including a medical history and medications.
• A physical exam.
• A neurological exam.
• Testing.

Your healthcare provider will ask you about your symptoms and health history during your exam. Since encephalopathy affects how your brain works, you might not be able to answer these questions to the best of your ability. In many cases, they’ll rely on information provided by your caregivers, including your friends and family, who may have been the ones to call for help. If you’re at a high risk of recurring encephalopathy, it helps to wear a medical ID bracelet.

What tests diagnose encephalopathy?

A healthcare provider may offer several tests to rule out conditions with similar symptoms and determine the cause of your diagnosis. Tests may include:

• Blood tests.
• Imaging tests like a CT scan or an MRI.
• Electroencephalogram.
• Lumbar puncture (spinal tap).

How is encephalopathy treated?

Each type of encephalopathy involves a different type of treatment to address the cause. A healthcare provider will recommend a treatment plan based on your specific symptoms and why they affect you. Treatment may include:

• Taking medications or supplements (like antibiotics, antiseizure medications or vitamin B1).
• Managing any underlying health conditions.
• Life support measures, including placement of a breathing tube and ventilator (breathing support).
• Surgery or organ transplant.

If the condition damaged your brain, you may need to participate in certain types of rehabilitation or therapy to help you get back to your daily routine. This may include:

• Physical therapy.
• Occupational therapy.
• Speech therapy.
• Cognitive behavioral therapy.

Are there side effects of the treatment?

Talk to your healthcare provider about the side effects of treatment. Each type of treatment comes with possible side effects that vary widely. Your healthcare provider will monitor you during a hospital stay and give you and/or your caretakers/loved ones more information about what side effects to look out for during your treatment.

How soon after treatment will I feel better?

Each person’s experience with encephalopathy varies. You may feel better within a couple of days after receiving treatment. Others may need more time and it could take weeks to months before they’re able to get back to their daily routine. While less common, some people may not make a full recovery.

Can encephalopathy be prevented?

There’s no known way to prevent all types of encephalopathy. Taking care of your overall health by eating well, exercising and protecting yourself from injury (like wearing a helmet) can reduce your risk. Your healthcare provider can help you manage any underlying health conditions that can cause encephalopathy.

What’s the outlook for encephalopathy?

There isn’t a cure for encephalopathy, but treatment can manage the underlying cause to help you feel better. Your outlook is more positive if diagnosed and treated quickly. You may feel more like yourself after only a few days of treatment.

Some cases of encephalopathy are severe and life-threatening. The condition can permanently affect how your brain functions. You may need to participate in rehabilitation to re-learn how to complete your daily activities. Sometimes after encephalopathy, you might need to make adjustments or receive help from others to do the things you were once able to do on your own, like preparing meals or organizing your medications.

If you have a chronic condition, encephalopathy can happen again in the future. Following your healthcare provider’s treatment plan can help prevent this. Encephalopathy may be life-threatening, so contact a healthcare provider right away if you notice any symptoms.

When should I see a healthcare provider?

Talk to a healthcare provider or contact emergency services immediately if you notice (or your carers/loved ones notice) symptoms of encephalopathy. Go to the emergency room if you have symptoms of encephalopathy and an underlying condition like diabetes or liver disease. Encephalopathy can be life-threatening and addressing your symptoms fast leads to the best outcome.

What questions should I ask my healthcare provider?

• What type of encephalopathy caused my symptoms?
• What type of treatment do you recommend?
• Are there side effects of the treatment?
• How do I manage other medical conditions to prevent encephalopathy?
• Do I need to participate in therapy or rehabilitation programs?