Encephalopathy

Carl Wernicke was the first to describe Wernicke's encephalopathy, named after him, in 1881 (Singer 2010).

The term "metabolic encephalopathy" was coined by Kinnier Wilson in 1912 (Engel 2011).

Encephalopathy is a clinical condition that describes global cerebral dysfunction (Engel 2011). The term itself is used for multiple brain diseases of different genesis (Laux 2011).

Encephalopathy can be acute (and thus reversible) or chronic (Link 2006).

Encephalopathy can be caused by numerous diseases such as:

• Forms of vascular dementia such as:
  • subcortical arteriosclerotic encephalopathy
  • leukoencephalopathy (in this case there is a patho-anatomical vacuolar demyelination of the hemispheric medulla [Berlit 2006])
  • vascular encephalopathy due to, for example, an ischemic insult (Herold 2018)
• metabolic encephalopathy (Kasper 2015) such as:
  • Wernicke's encephalopathy due to vitamin B1 deficiency in the context of chronic alcohol abuse, e.g.
  • hepatic encephalopathy
  • uremic encephalopathy (Herold 2018)
  • Dysequilibrium encephalopathy (when renal replacement therapy is too rapid and intensive [Ketteler 2015]).
  • Dialysis encephalopathy
  • heavy metal encephalopathy
  • hypercalcemic encephalopathy
  • hypoglycemic encephalopathy (Berlit 2006)
  • human spongiform encephalopathy (so-called Creutzfeldt Jakob disease)
• subcortical vascular encephalopathy (caused by e.g. arterial hypertension or diabetes mellitus )
• Encephalopathy caused by viruses:
  • progressive multifocal leukoencephalopathy (reactivation of a JC virus infection = John Cunningham virus)
  • HIV-associated encephalopathy
  • human herpesvirus 6 encephalopathy
  • Influenza-associated encephalopathy (Herold 2018)
  • Covid 19- encephalopathy (Hellwig 2022).
• Encephalopathy due to aluminum-containing phosphate binders (Herold 2018).
• Encephalopathy caused by cytostatic drugs:
  • acute encephalopathy caused by e.g.
    • 5- Fluorouracil
    • Procarbazine
    • Methotrexate
    • Interferon alpha
    • Interleukin- 2
    • Etoposide
    • Cortisone
    • High-dose polychemotherapy with stem cell transplantation
    • Tamoxifen (at maximum dose) etc. (Link 2006)
  • Chronic encephalopathy caused by e.g.:
    • BCNU (at maximum dose)
    • Cytosine anabinoside
    • Fludarabine > 40 mg / m² KOF / day
    • High-dose polychemotherapy
    • Methotrexate etc. (Link 2006)
• (Genetic) epileptic encephalopathy (Appendino 2019).
• hypoxic-ischemic encephalopathy (HIE) due to cardiovascular arrest (Bender 2017)
• encephalopathy triggered by craniocerebral trauma (e.g., boxer's encephalopathy)
• Hashimoto's encephalopathy (Laux 2011)
• SLE encephalopathy in the context of systemic lupus erythematosus
• encephalopathy triggered by neuro- tuberculosis (Berlit 2006)

etc.

Encephalopathy is manifested by:

- confusion

- clouding of consciousness

- Coma (Soon 2012)

- gait and stance unsteadiness

- nystagmus

- memory impairment (Singer 2010)

- possibly epileptic seizures (Berlit 2006)

- Non-specific symptoms such as:

- vomiting

- respiratory disturbance

- hypothermia (Bald 2012)

Therapy depends on the disease causing the encephalopathy.

The prognosis depends on the disease causing the encephalopathy.

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