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Types of Encephalopathy | Knowledge Brush-Up

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I frequently care for patients with a metabolic encephalopathy diagnosis, but I had a “fuzzy” understanding of the different encephalopathy types and causes.  With a little research, I brushed up on my clinical knowledge and would like to share the information with you. 

Specializes in Clinical Leadership, Staff Development, Education. Has 28 years experience.

Do you have a good clinical understanding of the different types of encephalopathy?

Types of Encephalopathy | Knowledge Brush-Up

I have always enjoyed pulling together the clinical puzzle pieces for my assigned patients. Recently, I needed a “brush up” on my knowledge to understand the different types and causes of encephalopathy. I’m all about sharing information, so here is a summary of what I learned.

Traumatic Encephalopathy

Chronic traumatic encephalopathy (CTE) is a brain disease usually caused by repeated head traumas. A diagnosis can only be made after an autopsy to study sections of the brain is done. Therefore, CTE is rare and not well understood at this time. Here are a few key points:

  • Majority of CTE cases occur in athletes that play contact sports, such as football, hockey, and boxing. It may also occur in military personnel that have been exposed to explosive blasts.
  • CTE is the result of multiple head traumas over a period of time. However, symptoms usually appear until years, sometimes decades, after the head injury. A 2017 study looked at 111 brains of former deceased NFL players and found 110 of the 111 showed clear signs of CTE post-mortem. It is not known just how many people are living with CTE.

Toxic Encephalopathy

Underlying conditions, such as infection or exposure to toxic substances can cause toxins to build up in the blood and eventually damage the brain. There are three types of toxic encephalopathy: hepatic, uremic and infectious.

Hepatic Encephalopathy

This type of encephalopathy occurs when the liver is unable to remove toxins, such as ammonia, from our blood. Toxins can build up to the point of entering into the brain, causing confusion, mood changes and other symptoms. Here are a few of the conditions that can contribute to hepatic encephalopathy:

  • Dehydration
  • Alcoholic binges
  • Overdose of certain drugs

Uremic Encephalopathy

This type of encephalopathy occurs when our kidneys are unable to remove toxins and waste products, like uremia, from our blood. In kidney failure and acute kidney injury, toxins build in the blood and affect the brain. This build up usually occurs when the estimated glomerular filtration rate (eGFR) falls and remains below 15mL/min.

Infectious Encephalopathy

This type of encephalopathy occurs when infection causes inflammation of the brain tissue or the tissues that line the brain or spinal cord. The source of infection may be a bacteria, virus or fungus. Jakob-Creutzfeldt disease is a rare form of infectious encephalopathy caused by prions, which are a type of protein. Infections in other parts of the body, such as urinary tract infections or sepsis can also lead to infectious encephalopathy.

About Metabolic Encephalopathy

This is the diagnosis that sparked my quest for information. Metabolic encephalopathy is an umbrella term for all of the above types of toxic encephalopathy. I most often care for patients with a metabolic encephalopathy diagnosis linked to:

  • Sepsis
  • Urinary tract infections
  • Pneumonia
  • Bacteremia
  • Malignant hypertension
  • Dehydration and acute kidney injury
  • Drug overdose
  • Diabetic ketoacidosis

Wernicke's Encephalopathy

This condition, also known as Wernicke’s disease, is caused by vitamin B deficiency from alcoholism, poor nutritional intake, or poor food absorption.

Hashimoto Encephalopathy

This rare type of encephalopathy occurs in people with Hashimoto’s disease. Hashimoto’s disease is a rare autoimmune condition that causes your immune system to attack your thyroid. How the condition is linked to infectious encephalitis is not well understood.

Glycine Encephalopathy

Glycine encephalopathy occurs when high levels of glycine, an amino acid, builds in the brain. The condition is genetic and usually appears soon after birth.

Hypoxic-ischemic Encephalopathy

This type occurs when your brain does not get enough oxygen, which results in brain damage. Hypoxia may be because of carbon monoxide poisoning, cardiac arrest or near-drowning.

Let’s Hear from You

What types of encephalopathy do you encounter in your own practice?

References

Cruetzfeldt-Jakob Fact Sheet (CDC)

Study aims to track mild traumatic brain injuries over decades

National Institute of Health’s Encephalopathy Information Page

What Is Encephalopathy?

J. Adderton MSN has over 20 years experience in clinical leadership, staff development, project management and nursing education.

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7 Comment(s)

Inpatient stroke codes! Majority of them are toxic/metabolic encephalopathy. Any change in mental status triggers the staff to call for us.

OldEMTNurse, LPN, EMT-I

Specializes in LTC. Has 24 years experience.

I have never cared for nor treated anyone that I know of, but I was treated for viral encephalomengitis when I was 19 years old. It began after I had a surgical removal of my appendix. I was recuperating well, until one day, as I was walking down the local hospital hall, my legs began to hurt terribly. The pain eventually got so bad, my mother called her family physician. By that time I was in bed writhing in pain radiating from my back through my legs.

When my mother's Phyaician injected me with a strong narcotic of which to this day I have no knowledge about what type it was, I soon sunk into a coma. I was then transferred to a private room and placed on IV meds, sinking in and out of consciousness, and suffering from seizures.

My Physician then decided to transfer me to the Columbia Presbyterian Medical Center's Neurological Institute where I as administered several neurological tests including Lumbar punctures. The spinal fluid was cloudy, so I was subjected to other lumbar punctures as well including after I was discharged. I spent 7 1/2 weeks in the hospital with that ailment.

When I was discharged, I was placed on medication and had to travel to the the Neurological Institute several times before I was declared completely well.

If you have any information about what I suffered from, I would like to receive your input.

J.Adderton, BSN, MSN

Specializes in Clinical Leadership, Staff Development, Education. Has 28 years experience.

2 hours ago, OldEMTNurse said:

My Physician then decided to transfer me to the Columbia Presbyterian Medical Center's Neurological Institute where I as administered several neurological tests including Lumbar punctures. The spinal fluid was cloudy, so I was subjected to other lumbar punctures as well including after I was discharged. I spent 7 1/2 weeks in the hospital with that ailment.

When I was discharged, I was placed on medication and had to travel to the the Neurological Institute several times before I was declared completely well.

WOW!, you and your family went through a lot. Thanks for sharing your story and I imagine someone reading this may have had a similar situation and can shed some light.

adventure_rn, BSN

Specializes in NICU, PICU.

Kernicterus, aka bilirubin encephalopathy. It occurs in newborns, and results from high unconjugated bilirubin levels (20+). It's technically considered a "never event," like wrong site surgery, since all babies should be routinely screened for jaundice and hyperbilirubinemia. If untreated, it can cause cerebral palsy, hearing loss, seizures, and death.

The biggest risk factor is an ABO or Rh blood type incompatibility between mom and baby, where the mom's ABO/Rh antibodies attack the baby's blood cells and cause profound hemolytic anemia. We usually treat hyperbili by laying the babies under bright blue phototherapy lights, which look just like baby tanning beds. If the baby's bilirubin levels are still high despite phototheraphy, we'll perform an exchange transfusion where we remove all of the baby's blood and replace it with new, transfused whole blood. On autopsy, the brains of babies with kernicterus are stained a jaundicey-yellow color.

OldEMTNurse, LPN, EMT-I

Specializes in LTC. Has 24 years experience.

I wonder then since I was born the smallest of a set of twins, at a weight of 3 pounds 11 ounces in 1943, and thinking I was not going to survive, I wasn't given a name at first, and my parents didn't take me home with them, but did take my twin sister.

However, my grandparents decided to be responsible for me, so my grandmother named me and cared for me, keeping me alive, if my tiny weight at birth had any bearing on why I became afflicted with the Viral encephalomylitis. I had always thought it was the result of my appendix being removed by a surgeon who made some sort of mistake during surgery, because my neurological affliction happened during the time I was recovering I was recovering from that.

J.Adderton, BSN, MSN

Specializes in Clinical Leadership, Staff Development, Education. Has 28 years experience.

3 hours ago, adventure_rn said:

If untreated, it can cause cerebral palsy, hearing loss, seizures, and death.

WOW!, did not know the complications were this serious.

J.Adderton, BSN, MSN

Specializes in Clinical Leadership, Staff Development, Education. Has 28 years experience.

@OldEMTNurse

Thanks for sharing your story. It's hard to imagine the limitations of medicine decades ago from where we are now.