home Audience 1 Encephalopathy, unspecified - causes, treatment, prognosis. Encephalopathy of combined origin

Encephalopathy, unspecified - causes, treatment, prognosis. Encephalopathy of combined origin

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 specifically about congenital diseases of the 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 transferred 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), motor disturbances, 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 have 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.

Encephalopathy, unspecified, is a class VI disease (diseases of the nervous system), which is included in block G90-G99 (other disorders of the nervous system) and has disease code G93.4.

Description of the disease

Encephalopathy is a non-localized disease of the brain. It is expressed by the death of nerve cells due to cessation of blood circulation, oxygen starvation and disease.

To diagnose diseases, specialists need to find out the pronounced location of the lesion, the localization of the disease in the gray or white matter of the brain, as well as the degree of impaired blood flow. If the cause of the disease cannot be established, then encephalopathy is called unspecified (idiopathic, i.e., occurring independently). The most common is vascular.

Causes of the disease

Encephalopathy, unspecified (ICD-10 diagnosis code G93.4) is classified into two types: congenital and acquired. Congenital is divided into prenatal (when damage occurs in the womb) and perinatal (in the event that the damaging factor acted on last weeks before or immediately after the baby is born). This type of pathology is caused by:

defects consisting in abnormal processes of brain development;
metabolic disorders in the body caused by genetic factors;
if during pregnancy the baby was affected by a damaging factor;
traumatic brain injury that occurs in a baby during childbirth.

Mitochondrial encephalopathy

Mitochondrial encephalopathy, unspecified in infants, is classified as separate group congenital diseases. It is formed as a result of disturbances in the functions and structures of mitochondria.

Acquired encephalopathy

Acquired encephalopathy is classified into several types due to various damaging factors:

Post-traumatic is the result of moderate and severe(for example, falling from a height, head injuries in athletes, road accidents, etc.). With this type of disease there are various lesions frontal nervous tissue and atrophic changes (shrinkage and shrinkage of the brain), hydrocephalus.
Toxic encephalopathy unspecified in adults occurs due to poisoning by various toxins: alcohol, high doses pesticides, heavy metals, gasoline, etc. It is mainly manifested by various kinds of nervous and mental disorders (insomnia, anxiety, irritability, hallucinations, prolonged headaches, etc.).
Radiation is the result of ionizing irradiation of the body during radiation sickness. With this pathology, various neurological disorders are observed.
Metabolic occurs due to metabolic disorders against the background of illnesses internal organs: liver, kidneys, pancreas. Manifests itself depending on the properties of the underlying pathology.
Vascular encephalopathy. The cause may be an addiction to bad habits, old injuries, atherosclerosis, diabetes, radiation exposure and other factors that cause cerebral hypertension. Signs of this type of disease are: loss of structure and integrity of consciousness, frequent headaches, depressive states, partial loss of own memory.
Hypoxic is the result of prolonged oxygen starvation. Leads to serious neuralgic complications.

And these are not all varieties.

In children

There is unspecified encephalopathy in children. Thus, as a result of traumatic exposures in the womb, infections or other causes, residual encephalopathy is diagnosed in older children. The venous form is a particular variety of the vascular form, which manifests itself as stagnation venous blood in the brain due to disruption of its outflow.

Metabolic encephalopathy is divided into several other types:

Bilirubin is found only in newborn babies. Develops against the background of incompatibility between the blood of mother and fetus, as well as due to infectious toxoplasmosis, jaundice, diabetes mellitus at the mother's. Manifests general weakness, decreased muscle tone, poor appetite, belching, vomiting.
Gaye-Wernicke encephalopathy occurs due to vitamin B1 deficiency. Side effects may develop due to alcohol addiction, severe vitamin deficiencies, HIV, malignant neoplasms. Mainly manifested by hallucinogenic syndrome and anxiety states.
Leukoencephalopathy manifests itself as a disorder of the white matter of the brain. The disease is progressive. Appears after an infection due to decreased protective functions body.
Atherosclerotic disease develops mainly due to disorders of lipid metabolism in the body. Manifests increased fatigue, weakness, dizziness, headaches, sleep disorders, isolation.

Scientists say that the cause of any type of unspecified encephalopathy is primarily brain hypoxia (lack of oxygen). This happens due to the fact that the organ begins to be less well washed with blood, excessive venous accumulations, swelling, and hemorrhages appear. Anoxic encephalopathy may occur due to low intake nutrients into neurons and eventually become a separate disease. Metabolic encephalopathy is a special case of toxic encephalopathy, when toxins are not eliminated and, as a result, penetrate into the blood.

There are several stages of development of this disease. Experts highlight the following:

In the case of the initial or first stage, the patient’s memory decreases, he is irritable, has trouble falling asleep and sleeps anxiously, and also suffers from headaches.
In the second case, the nature of the disease is more pronounced, all symptoms worsen. In addition to headaches and sleep disturbances, the patient may complain of apathy and lethargy.
At the third stage, serious changes in the brain are diagnosed, there are paresis, speech is impaired, and vascular parkinsonism develops.

Symptoms

The manifestations of unspecified encephalopathy vary widely depending on the severity, type, age and treatment used. As a rule, in the first stages of the disease, sleep disturbances, lethargy, daytime sleepiness, absent-mindedness, tearfulness, lack of interest, increased fatigue, decreased memory and thinking abilities are observed. May also begin to appear painful sensations, noises and ringing in the head, decreased hearing and visual functions, mood swings, lack of coordination, irritability.

What symptoms occur as the disease progresses?

IN advanced cases symptoms may progress, resulting in parkinsonism (slow movements combined with trembling of the limbs) and falsebulbar palsy (manifested by impaired speech, chewing and swallowing functions). Also, do not forget that mental disorders (depression, suicidal thoughts, phobias) may develop. Let's look at how unspecified encephalopathy G 93.4 is diagnosed in infants and adults.

Diagnosis of encephalopathy, unspecified

In order to correctly determine the form of the disease, the doctor must carefully analyze the patient’s medical history for traumatic brain injury, intoxication, atherosclerosis, kidney disease, liver disease, lung disease, pancreas disease, hypertension, exposure to radiation, as well as acquired or genetic metabolic disorders.

To make a diagnosis of encephalopathy, unspecified G 93.4, the following procedures are performed:

General blood analysis.
General urine analysis.
Various metabolic tests (liver enzyme levels, glucose, electrolytes, ammonia, lactic acid, blood oxygen).
Measuring blood pressure levels.
CT and MRI (to detect brain tumors, various anatomical anomalies, infections).
Creatinine.
Drug and toxin levels (cocaine, alcohol, amphetamines).
Doppler ultrasound.
EEG or encephalogram (to detect brain dysfunction).
Autoantibody test.

These are not all the tests necessary to make a diagnosis. Only the attending physician can order certain tests based on the patient's symptoms and medical history.

Treatment of encephalopathy

Treatment of unspecified encephalopathy is aimed at eliminating the underlying causes and symptoms that gave rise to development of this disease. Conservative and medicinal methods are mainly used for treatment.

If the disease is acute, treatment is primarily aimed at reducing intracranial pressure and elimination of seizures. For this purpose they use artificial ventilation lungs, extrarenal blood purification, and nutrients are administered through an IV.

Medicines

Subsequently, the patient is prescribed medications which he must take for several months:

various lipotropic medicines that help normalize cholesterol and fat metabolism (dietary supplements with choline, methionine, carnitine, lecithin, “Lipostabil”);
drugs that prevent blood clots (Ginkgo Biloba, Aspirin, Cardiomagnyl);
angioprotectors prescribed for various heart diseases to normalize the walls of blood vessels, the movement and outflow of venous blood (Troxerutin, Detralex, Indovazin);
neuroprotectors for nourishing nerve tissue (B vitamins, Piracetam;
tranquilizers and sedatives to dilute rapid nerve impulses in affected neurons (“Sibazon”);
vitamins and amino acids;
various performance stimulants.

Also for get well soon Physiotherapeutic procedures, acupuncture, walks, gymnastics, massage, and a certain rest regimen are prescribed. What is the prognosis for a diagnosis of encephalopathy, unspecified?

Disease prognosis

Any type of encephalopathy is characterized by vomiting, nausea, dizziness and headaches. If severe brain damage (or swelling) occurs, the disease develops very acutely, dizziness appears, very severe headache, anxiety, visual impairment and much more.

Typical complications of encephalopathy unspecified origin are:

coma;
paralysis;
convulsions.

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

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 of 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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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 in 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, hemodialysis, and the 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 the movement and outflow of 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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information about the disease and treatment

Encephalopathy, unspecified - a disease of class VI (Diseases of the nervous system), included in block G90-G99 Other disorders of the nervous system, has a disease code: G93.4.

TRAUMATIC ENCEPHALOPATHY is a complex of neurological and mental disorders that occurs in late or long term traumatic brain injury. Caused by degenerative, dystrophic, atrophic and cicatricial changes in brain tissue due to injury. Timing of appearance, nature and severity neuropsychiatric disorders however, they depend on the severity and location of the injury, the age of the victim, the effectiveness of treatment and other factors. Neurological disorders are expressed by vegetative and vasopathy, chronic hypertensive syndrome, disorders of cerebrolinal fluid dynamics, traumatic arachnoiditis and arachnoencephalitis, epileptiform seizures and focal neurological disorders. Neurological disorders accompanied by mental disorders characteristic of psychoorganic syndrome.

Traumatic asthenia is manifested by weakness, increased fatigue, decreased performance, combined with irritability, weakness (crying with slight excitement), emotional lability, hyperesthesia (painful reaction to relatively mild stimuli - light, sounds, etc.). Patients are characterized by violent short outbursts of irritation for minor reasons, followed by tears and repentance. Autonomic and vestibular disorders (headache, dizziness), sleep disorders complement clinical picture. External adverse influences - heat, travel in transport, somatic diseases and mental trauma - worsen the condition of patients.

Traumatic apathy is, as it were, extreme degree asthenia with passivity, lethargy, slowness of movements, low sensitivity to external impressions. The motivation for activity is sharply reduced. Patients lie down a lot. Interests are limited to the basic needs of life.

Psychopathic-like states ( pathological changes nature) arise gradually, against the background of gradual attenuation of symptoms of acute and late periods of injury. Often there is only an intensification of the psychopathic character traits that existed before the injury. The most typical are ex-plosivity (explosiveness), a tendency to litigiousness, and unmotivated mood swings. "Explosiveness" is manifested by attacks of irritation with a hysterical overtones or with anger, aggression and other dangerous actions. Incorrect behavior is aggravated by a tendency to drunkenness and chronic alcoholism.

Affective disorders most often they are shallow, angry-irritable depressions (dysphoria) that arise in a conflict situation, with overwork, intercurrent illnesses, and also for no apparent reason. Also noted opposite states complacent and elated mood (euphoria) with lightness of judgment, uncriticality, low productivity, disinhibition of drives, drunkenness. The duration of the state of altered mood ranges from several hours to several months, but, as a rule, is calculated in days. The states of euphoria last longer.

Paroxysmal (epileptiform) conditions (traumatic epilepsy) appear both soon after injury and several months and even years later. Along with the typical large, abortive, Jacksonian seizures There are a variety of non-convulsive paroxysms - small seizures. Epileptiform states also include states of confusion ( twilight states), during which patients can perform consistent, outwardly appropriate actions, of which no memories are retained (outpatient automatisms). The structure of the twilight state may include delusions, hallucinations, and fear. These experiences determine the behavior of patients and can determine dangerous actions. Hysterical twilight states are possible that arise in response to a conflict-traumatic situation.

Traumatic dementia occurs as a long-term consequence of severe traumatic brain injury. Additional harms are important for its development - alcoholism, vascular disorders, infections and intoxications. A decrease in the level of judgment and memory disorders in some cases are combined with indifference, lethargy, and decreased motivation; in others, with a carefree euphoric mood, lack of criticism, and disinhibition of drives.

Long-term consequences of trauma in the form of affective and hallucinatory-delusional psychoses (traumatic psychoses) are relatively rare.

People with traumatic encephalopathy need a gentle lifestyle. Dehydration and restorative therapy, nootropics (piracetam, pyriditol, pantogam, aminalon) are periodically prescribed. At increased excitability they give tranquilizers and neuroleptics [chlozepid (Elenium), sibazon (Seduxen), nozepam (tazepam), phenazepam, sonapax, tizercin], and for lethargy and apathy - stimulants (centedrine, sydnocarb, tincture of lemongrass, eleutherococcus). Patients with paroxysmal disorders are treated in the same way as patients with epilepsy.

Class number:

Class VI

Class name:

Nervous system diseases

Block number:

G90-G99

Disease code:

G93.4

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Good afternoon. Please tell me, my daughter is 2 months old, we went to the first appointment with a neurologist as planned, and after a 5-minute examination, she wrote a diagnosis: perinatal encephalopathy, s-motor violations, G93.4. I started reading on the Internet and was shocked. How can such diagnoses be made to a child at 2 months without more serious examinations? I'm really looking forward to your answer - is this possible? The recommendations include massage, exercise therapy, fitball, baths with sedative herbs and electrophoresis. Thank you in advance.

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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 of 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