Encephalopathy

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Medical Author:

Benjamin Wedro, MD, FACEP, FAAEM

Benjamin Wedro, MD, FACEP, FAAEM

Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

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Medical Editor:

Charles Patrick Davis, MD, PhD

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.

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Encephalopathy is a broad term used to describe abnormal brain function or brain structure. (Encephalo= brain + pathy= disorder). The abnormality may be transient, recurrent, or permanent. The loss of brain function may be reversible, static and stable, or progressive with increasing loss of brain activity over time.

Brain cells are linked together with neurons, called axons and dendrites, covered in myelin sheaths. The electrical impulses work together with chemical receptors to allow brain activity to translate into thought and action. Different locations in the brain are associated with specialized function, for example, vision function is located in the occipital lobes, speech production in Broca's area in the lower part of the frontal lobe, speech recognition is located in Wernicke's area of the temporal lobe, and the motor strip in the parietal lobes of each hemisphere.

The brain also requires blood flow to provide oxygen and glucose to function. Other chemicals, nutrients, and vitamins are needed for normal function both immediately and in the long term.

• The brain develops quickly in the fetus as it grows in a mother's uterus; and any disruption in this growth and development may lead to encephalopathy.
• Abnormalities in anatomic structure, electrical, and chemical function may lead to altered mental function and encephalopathy.
• Poisoning of brain tissue and cells may also affect function. This poison may be produced within the body, for example from liver or kidney failure, or it may be ingested intentionally or unintentionally. Examples of intentional ingestion include alcohol intoxication or drug abuse. Examples of unintentional ingestion include carbon monoxide poisoning, medications, or toxic substances such as lead paint.
• Encephalopathy may be due to a birth defect (a genetic abnormality causing abnormal brain structure or chemical activity with symptoms being found at birth), or it may be evident towards the end of life due to disease, such as dementia or Alzheimer's disease.

Depending upon the cause, encephalopathy may occur at any age. Symptoms may present as a form of altered mental status including confusion and loss of memory because the impairment affects the thought process locations in the brain, or symptoms may present with a physical impairment like weakness or numbness of a body part, or uncoordinated movements because it affects the motor or sensory parts of the brain. Global involvement may present as seizure, or any combination of thought, motor, or sensory symptoms. The symptoms depend on what part of the brain is being affected and how much or how little it continues to function.

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