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Encephalopathy of combined origin. Encephalopathy, unspecified - symptoms (signs), treatment, medications

Encephalopathy of combined genesis is a collective concept that combines a number of pathological conditions which lead to brain damage. The word encephalopathy in the diagnosis indicates suffering of the brain (encephalon - brain, pathos suffering, disease). The words of combined genesis in the formulation of the diagnosis indicate the presence of a combination of factors that can lead to brain suffering. Most often, such factors include a combination of a vascular component (a history of stroke) and a dysmetabolic process ( diabetes, decompensated conditions from the side thyroid gland), also such pathological conditions as traumatic brain injury, the consequences of toxic brain damage (including long-term chemotherapy for cancer), the consequences of brain surgery, chronic and acute hyposkic conditions (bronchial asthma, poisoning carbon monoxide, COPD, etc.). Sometimes (although, in the author’s opinion, this is not the best approach) the terminology used is encephalopathy of mixed origin, or, which is clearly incorrect terminology, mixed encephalopathy or encephalopathy of complex origin.

Information for doctors. According to ICD 10, the diagnosis is encrypted with code G93.4 - encephalopathy, unspecified. Although the term encephalopathy of combined genesis and as such a diagnosis are not used in foreign practice. In our country, there are no clear standards for the management and approach to diagnosing patients with this condition. The diagnosis must indicate all the factors that led to the development of the pathological condition; after these factors are indicated, there is a list of syndromes, for example, vestibulo-coordinator syndrome, indicating the degree of its severity.

A little about encephalopathy of combined genesis

Encephalopathy of combined genesis, as mentioned above, develops due to various factors. One of the main ones is the chronic discirculatory process, leading to chronic failure cerebral circulation. The cause of these conditions are conditions such as cerebral atherosclerosis, as well as hypertonic disease, which leads to micro and macrovascular angiopathy.

Often, some other process is no less important and has a predominant nature, including repeated brain injuries, and sometimes there is a combination of 3 or more factors leading to brain suffering. That is why it is important to identify all risk factors and pathological conditions of a systemic nature (for example, diabetes mellitus).

Symptoms and diagnosis of encephalopathy of combined origin

The symptoms of encephalopathy are varied. With the disease, syndromes such as cephalgic (that is, headache), asthenic ( general weakness), cognitive impairment (memory loss), sleep disorders, symptomatic epilepsy, hemiparesis and many other disorders may occur. Dizziness to one degree or another occurs in more than half of patients with this diagnosis, ranks first in importance among all manifestations and will be considered separately.

Clear diagnostic criteria there is no diagnosis. The diagnosis is initially made mainly on the basis of complaints, medical history (identifying risk factors, the presence chronic diseases, traumatic brain injuries, etc.), neurological examination data. The neurological status may include reflexes of oral automatism, anisoreflexia, the presence of pathological reflexes, and coordination disorders.

For differential diagnosis It is important to conduct a neuroimaging study (MRI, MSCT of the brain) to exclude oncological lesions of the brain, determine the size of the defect after injury, etc., duplex scanning of the vessels of the neck and head, and electroencephalographic studies.

Dizziness with encephalopathy of combined origin

Dizziness with encephalopathy can usually be non-systemic in nature and is expressed more in the form of feelings of instability and weakness. The time of occurrence and provoking factors can be very diverse. There are no clear diagnostic criteria of this syndrome, often dizziness with this disease is completely psychogenic in nature.

Objectification of the presence of dizziness due to pathological processes is complex process. The most important symptoms The procedures tested for dizziness are fairly routine (but no less important) procedures: conducting cordinatory tests, identifying instability, and gait disturbances.

Treatment of encephalopathy of combined origin

Therapy for encephalopathy of combined origin should be directed, first of all. To eliminate factors leading to brain damage, if possible. It is necessary to correct blood sugar levels, normalize cholesterol metabolism, correct changes blood pressure. This part represents basic therapy and is also often equally important symptomatic therapy, which is selected taking into account the existing manifestations, as well as individual characteristics each person.

For cognitive deficits, nootropic drugs are used (Pronoran, Gingko preparations and others). In the presence of symptomatic epilepsy, adequate anticonvulsant therapy is used. For headaches, it makes sense to use courses of “vascular” or neuroprotective drugs. It is important to conduct rational psychotherapeutic conversations in which it is necessary to explain the causes of the disease, as well as available methods correction of disorders with the elimination of modifiable risk factors.

It makes sense to carry out a course of treatment of encephalopathy of combined genesis in an outpatient setting, because need for injectable drugs usually absent and requires long-term correction of risk factors and patient education the right image life.

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Therapy of dizziness in encephalopathy of combined origin

Treatment of dizziness in encephalopathies of combined origin is sometimes a difficult task. Classically used drugs (,), vinpocetine (), gingko biloba (,). The effectiveness of each of them is a matter of long-term analysis, because there is no drug that is ideal in any case of dizziness. Non-drug methods are also very important, in particular.

Dizziness associated with encephalopathy is usually quite well corrected, although regular repeat courses treatment.

Encephalopathy in children is a group of non-inflammatory diseases of the nervous system. In fact, any encephalopathy is a diffuse disorder of the brain, as a result of which its blood supply is disrupted, the number of nerve cells and their destruction is observed. These disorders may have different signs and symptoms, so it is worth considering the most well-known groups of diseases that carry common name"encephalopathy".

The causes of the disease can be both congenital and acquired: a minor injury can cause child's body and serious disorders in the nervous system. But most often we're talking about exactly about congenital diseases nervous system.

Perinatal

The diagnosis of perinatal encephalopathy is usually made if there is an unspecified form of the disease. This term only means that the brain damage occurred in perinatal period, that is, from approximately 28 weeks of pregnancy until the first eight days of the baby’s life.

The disease can occur in children for a variety of reasons:

the birth of a child at too young or, on the contrary, an adult age;
long-term treatment for infertility, abortions and miscarriages;
mother's illness during pregnancy (hypertension, heart disease, diabetes, unspecified or known form flu, surgery, kidney disease);
risk of miscarriage;
bad habits;
taking medications;
toxicosis;
exposure to radiation;
work in hazardous industries and much more.

Dysfunctions can also occur in the first days of a baby’s life: due to purulent infections, or major surgery. In all these cases it is possible oxygen starvation, which means hypoxic encephalopathy.

Residual

“Residual” is translated from Latin as “residual.” If such a diagnosis was made, there was or is a previous neurological deficit. Often it's simple residual effects previously suffered pathological processes in the central nervous system and different areas brain. It can be acquired, congenital, or hereditary, but we are talking about the death of central nervous system cells and neurons.

The classification of this disease is quite extensive.

Symptoms

Symptoms depend on which part of the brain is damaged and how much, what the damaging factor was and how long its effect lasted. All symptoms cannot be present at once, but there will definitely be a combination of some of them or even one, but pronounced one.

The disease is divided into 4 periods:

acute (first month of life);
recovery (about 4 months);
late recovery period (one or two years);
Exodus.

IN acute period disease, hypoxic coma of varying depth is possible (possible with cerebral edema), movement disorders, depression of the central nervous system (infant lethargy), convulsions, increased neuro-reflex excitability.
During recovery period Symptoms such as cerebrovascular disease, convulsions, vegetative-visceral disorders, movement disorders, developmental delay, and regurgitation occur.
If a child has posthypoxic encephalopathy, sucking reflexes may be absent, arrhythmias and constant agitation, combined with weakness, may be observed.

It is worth noting that in cases of minor perinatal encephalopathy, the diagnosis of “unspecified form” is often made, and this may mean that the brain damage is not too serious. In this case, it is enough just not to miss visits to the neurologist and neuropathologist and monitor the further development of the child’s condition, and treatment is prescribed as needed.

Children with residual encephalopathy often experience symptoms ranging from the most harmless (migraines, lethargy, fainting, VSD, paresis, reflex pyramidal deficiency, sleep disturbances, increased excitability) to, epilepsy, myelopathy, cerebral palsy and neuropathy.

motor dysfunction;
nausea and vomiting;
frequent changes of emotions;
uncharacteristically weak memory for a child.

Treatment

If a diagnosis of “posthypoxic encephalopathy” is made, then a variety of antihypoxants are prescribed: cytoflavin, reamberin, mildronate, neoton, Mexicor, etc. Treatment also includes massage and exercise therapy (for children over one month old), physiotherapy, proper nutrition and vitamin therapy, orthopedic correction and work with a speech therapist, as well as with a psychologist (for older children).

The diagnosis of “residual encephalopathy” is made after examining the child and communicating with the mother. Further, they may come in handy additional methods examinations. The diagnosis can be clarified using x-rays, rheovasography and electroencephalography.

Treatment is also prescribed by a neurologist. There is no diagnosis of “residual encephalopathy” in the International Classification of Diseases, 10th revision, but no one has canceled treatment, because this disease can be the beginning of the formation of serious pathologies of the psyche and nervous system in adulthood.

The disease is treated medicinally with anticonvulsants and diuretics that improve blood supply to the brain. Additionally, massage and reflexology for children, exercise therapy, herbal medicine and correction by a psychologist are prescribed.

Forecast

Most often, the disease ends in recovery, but there are also sad consequences. Thus, delays in mental, speech, physical or motor development are possible.

Also possible minimal dysfunction brain, which is characterized by some signs and, as well as neurosis-like conditions. However, with age, this may also pass or simply smooth out.

If treatment is prescribed incorrectly or the disease is not detected in time, serious damage to the brain and central nervous system is possible:

epileptic syndrome (can also be a consequence of epileptic encephalopathy in children);
hydrocephalus (including progressive);

Interesting read:

Consequence perinatal encephalopathy There may also be a residual form in older children, but if you start fighting the disease in childhood, there may be no complications.

Hello, This diagnosis is G93. 4 encephalopathy, unspecified. Her symptoms? Signs? Consequences.

Nikolay, Moscow

ANSWERED: 08/22/2016

Hello, you did not indicate your complaints. Clinical signs You can find diseases by asking a question in a search engine. If there is a problem, report it in detail, post the results of previous research

Clarification question

ANSWERED: 08/22/2016 Kravtsov Alexander Vasilievich Khabarovsk 0.0 psychiatrist-narcologist

Hello, Nikolay! More precisely: G93.4 “Encephalopathy, unspecified” - this is when others are excluded: alcoholic encephalopathy (G31.2) and toxic (G92). Encephalopathy, also called “organic brain damage”, is a general name for non-inflammatory (as opposed to encephalitis - inflammation) diseases of the brain. Encephalopathy can be congenital or acquired (for example, organic lesions brain associated with poisoning, infections, alcoholism, injuries, hypovitaminosis, vascular diseases of the brain, lack of vitamin B1). Encephalopathy is a disease in which brain tissue undergoes dystrophic changes, leading to disruption of its function. Symptoms of encephalopathy are very diverse. The most common are: Disorders of memory and consciousness; Lack of initiative; Headache; Desire to die; Dizziness; Noise in the head; Depression. Patients with similar symptoms often complain of fatigue, irritability, absent-mindedness, tearfulness, bad dream, general weakness. In this case, apathy, viscosity of thought, verbosity, narrowing of the circle of interests and criticism, daytime drowsiness, and difficulty pronouncing certain words are noted. Consequences and prognosis: The progressive course of encephalopathy leads to depression brain functions and disability. However, with adequate and timely treatment provided that the patient follows the recommendations of specialists serious consequences can be avoided.

Clarification question

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Reasons for the development of the disease

There are many reasons for the development of mixed encephalopathy. It should be highlighted various groups and briefly describe each of them:

Discirculatory processes. Described in detail in. They are almost always one of the factors leading to the disease.
Dysmetabolic processes. Include any endocrine and other metabolic disorders, which pathologically affect brain tissue. Diabetes mellitus is the most common endemic goiter. The word toxicodismetabolic can also refer to alcohol abuse.
Consequences of traumatic brain injuries. Most often, the consequences remain after a brain contusion, however, multiple concussions can also be included when making a diagnosis.
Residual encephalopathy, meaning any birth defects development of the central nervous system.
Hypoxic, this factor indicated in the presence of severe obstructive pulmonary disease, uncontrolled bronchial asthma, lung tumors, including those operated on with existing insufficiency of external respiration.
Consequences of ischemic and hemorrhagic strokes, especially in the presence of severe pyramidal insufficiency.
Consequences surgical interventions on the brain, carried out for any indication (cancer process, etc.).
Toxic factors. Any poisoning, including alcohol substitutes, metals, carbon monoxide.

Symptoms

Symptoms can be combined into several syndromes that are similar for any pathological process brain. This is cephalgic syndrome (headaches), vestibular disorders(dizziness, throwing to the sides when walking), mood disorders, including neurasthenic syndrome, memory impairment, speech impairment, memory loss. In each case, the symptoms are unique; a lot depends on the specific factors that led to the pathological condition.

Diagnostics

Diagnosis is made by identifying factors that can lead to encephalopathy, the presence of complaints, objective and neurological examination. In some cases, neuroimaging studies and other instrumental methods are required.

MR signs include identified consequences of severe pathological conditions of the brain (stroke, head injury, etc.), identification of hydrocephalus. MRI may also reveal focal glial changes, including leukoaraiosis.

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Treatment

Treatment of encephalopathy of mixed origin should, first of all, be aimed at eliminating all pathological influences. It is necessary to control the level of blood pressure, sugar, and monitor the lipid profile. At toxic damage brain, the effect of the substance should be eliminated, and if possible, detoxification of the body should be carried out.

Also, neuroprotective and metabolic drugs are indicated for all patients in the treatment of encephalopathy of mixed origin. Also, depending on the severity of the syndromes, medications are prescribed that affect dizziness, metabolic processes, nootropic drugs with a decrease in cognitive functions.

Disease is a complex problem. All patients should be under the supervision of neurologists or therapists at their place of residence. It is also recommended that all patients undergo inpatient treatment at least once a year, after all complete cure is impossible, and a long period without treatment can lead to a significant increase in all manifestations.

Encephalopathy is a non-inflammatory diffuse brain lesion, expressed in the death of nerve cells under the influence of various factors: cessation of blood flow, lack of oxygen, disease.

The disease is diagnosed by the location and severity of the lesion, its location in the white or gray matter, degree of blood flow disturbance.

In cases where the cause cannot be established, they speak of unspecified (idiopathic) encephalopathy.

The most common is vascular encephalopathy.

Encephalopathy can be congenital or acquired. The first is divided into prenatal (when a damaging factor acts on the fetus before it is born) and perinatal (the cause of the baby’s illness lies in last weeks before or after birth) and may be caused by:

abnormal brain development;
metabolic diseases caused by genetics;
damaging effects during pregnancy;
birth trauma of the skull.

A type of congenital encephalopathy is mitochondrial - the result of pathology of the cellular organelles of mitochondria.

Acquired occurs due to various injuries and is divided into several types.

Table. Classification of acquired encephalopathy

Type of disease	Cause
post-traumatic	dystrophic, cicatricial, atrophic changes in nervous tissue due to traumatic brain injury
toxic	systematic ingestion of toxins: alcohol, heavy metals, solvents, bacterial waste products, hypovitaminosis
radial	ionizing radiation for radiation sickness
metabolic	metabolic disorders in diseases internal organs– liver, pancreas, kidneys
vascular	poor blood supply to the brain due to hypertension, atherosclerosis, disorders venous outflow, vascular diseases brain, etc.
hypoglycemic	a strong decrease in blood glucose levels, the main nutrient component of the brain, which leads to the destruction of cellular proteins and fats

This is far from full list encephalopathies.

Thus, as a result of traumatic exposure in the womb, infection or other reasons, older children are diagnosed with residual encephalopathy. A special case of vascular encephalopathy is venous (dyscirculatory), in which venous blood stagnates in the brain due to a violation of its outflow.

Metabolic encephalopathy is divided into several separate diseases:

bilirubin encephalopathy develops against the background of jaundice and poisons the body with the liver pigment bilirubin;
Wernicke encephalopathy is a consequence of vitamin B deficiency;
small focal progressive leukoencephalopathy appears after an infection due to weakened immunity;
atherosclerotic is caused by oxygen starvation of blood vessels due to the deposition of cholesterol plaques on them.

Scientists tend to believe that the cause of any encephalopathy is brain hypoxia (oxygen starvation). This occurs due to deterioration in blood flow to the organ, excessive venous filling, edema, hemorrhage, and the action of external and internal toxic substances.

Hypoxic (anoxic) encephalopathy occurs with low intake into neurons nutrients(for example due to low pressure) and is classified as a separate disease.

Metabolic encephalopathy – special case toxic: with it, toxins are not eliminated and enter the blood.

Symptoms

Clinical manifestations of the disease are varied and depend on the type, severity, treatment used, and age.

On early stages there is sleep disturbance, daytime sleepiness, lethargy, tearfulness, absent-mindedness, fatigue, lack of interest and initiative, decreased memory (usually for recent events), mental abilities, verbosity.

Possible pain, noise or ringing in the head, mood swings, decreased vision and hearing, irritability, and loss of coordination.

These symptoms progress and advanced cases appear neurological syndromes: parkinsonism (trembling of the limbs combined with slow movements) and falsebulbar palsy (impaired speech, chewing and swallowing).

Possible violation mental functions(depression, death wish, phobias). Trauma typically causes compression of the brain cranial pressure.

TO senile dementia leads to leukoencephalopathy of vascular origin - a disease in which the interaction between neurons is disrupted due to the destruction of their membranes due to poor nutrition brain

Epidemiology

The disease is more often diagnosed in middle-aged and elderly people. It occurs at any time of the year, individual species encephalopathies (toxic, infectious) are observed during the cold season.

Infectious encephalopathy occurs under the influence of various pathogens (rubella, tetanus, HIV, mad cow disease). In the latter case, the disease is most severe and is called spongiform encephalopathy.

Diagnostics

To establish the form of the disease, the doctor carefully analyzes the medical history: whether the patient has had concussions, intoxication, any pathologies (atherosclerosis, hypertension, liver, kidney, pancreas, lung diseases), genetic or acquired metabolic disorders, whether he has been exposed to radiation.

Diagnostics includes the following procedures:

biochemical urine analysis;
blood chemistry;
biochemical analysis of cerebral fluid;
nuclear magnetic tomography;
echography in newborns and children.

Encephalopathy in pregnant women is not a pathology. The condition is associated with hormonal changes.

Treatment

The fight against the disease is aimed at eliminating the symptoms and causes that gave impetus to the development of encephalopathy. Medicinal and conservative methods are used for therapy.

At acute form Doctors reduce cranial pressure, eliminate convulsions, and use methods that support life processes: artificial ventilation lungs, hemodialysis, administration of nutrients through an IV, bypassing the stomach.

Then the patient is prescribed medications that he takes for 1-3 months:

lipotropic drugs - normalize the metabolism of fats and cholesterol (Lipostabil, dietary supplements with carnitine, methionine, choline, lecithin);
angioprotectors - prescribed for heart disease, normalize the walls of blood vessels, improve movement and outflow venous blood(Detralex, Troxerutin, Indovazin, Cavinton);
medications against blood clots (Aspirin, Ginkgo Biloba, Cardiomagnyl);
neuroprotectors - nourish nerve tissue(Piracetam, B vitamins);
sedatives and tranquilizers - reduce rapid nerve impulses in affected neurons (Sibazon);
amino acids, vitamins;
performance stimulants.

For speedy rehabilitation, the patient is prescribed physiotherapeutic procedures, gymnastics, acupuncture, massage, walks, and a certain daily and rest regimen.

Epileptic encephalopathy, which occurs in young children with an EEG pattern characteristic of epilepsy, stands apart. This only indicates a predisposition to epilepsy, which does not exclude its development in the future. The cause is a violation of brain formation.

Prognosis and complications

Any encephalopathy is characterized by headache, nausea, vomiting, and dizziness.

When severe defeat or cerebral edema, a serious violation of microcirculation, encephalopathy develops acutely, severe headache appears, especially in the back of the head, dizziness, restlessness, anxiety, blurred vision, staggering, possible numbness of the ends of the fingers, nose, lips, tongue. Subsequently, anxiety replaces lethargy and clouding of consciousness.

In acute forms of hepatic, pancreatic and renal encephalopathy, disturbances of consciousness and convulsive seizures are common.

For encephalopathy caused by pneumonia (including exacerbation chronic form), heart attack, thromboembolism pulmonary artery, eye movements not controlled by consciousness, decreased muscle strength, and mental disorders are observed.

Among the typical complications of all encephalopathies are:

convulsions;
paralysis;
to whom.

If you follow the doctor's recommendations, the prognosis is favorable.

Advanced cases of the disease threaten:

epilepsy;
paralysis, movement disorders;
loss of brain functions, intelligence, memory;
emotional instability, mood swings, depression;
disability.

Toxic encephalopathy is the most severe and has the worst consequences.

Due to the fact that one type of disease contains many special cases that are classified as a separate type, the symptoms of different encephalopathies are similar and it is often impossible to establish the cause of the disease. The insidious enemy is fraught with life-threatening complications and requires constant monitoring by a specialist and long rehabilitation.

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