Acute encephalopathy syndrome

Acute encephalopathy syndrome is what we often call delirium. This condition is not only caused by pathological factors. Sometimes it occurs due to excessive drinking addiction. Any addictive substance may cause this symptom when one is addicted. In addition, brain infections can also cause delirium. This article introduces the symptoms and detailed causes of delirium. If you don’t know, take a look.

symptom

The diagnosis of delirium syndrome is generally not difficult based on the characteristics of sudden onset, impaired consciousness, and other cognitive impairment symptoms that are lighter during the day and heavier at night. Patients with physical illness, craniocerebral trauma, and a history of alcohol and drug dependence may be helpful in diagnosis. Once the delirium syndrome is identified, its underlying cause should be clarified immediately. Acute schizophrenia and mania accompanied by confusion can be differentiated through medical history and psychiatric examination. If in doubt, an EEG can be performed. The delirious state is often accompanied by diffuse slow waves, which parallels the severity of cognitive impairment and can be used for identification.

Causes

Delirium is a generalized brain dysfunction caused by many qualitative factors. Organic causes can be divided into four groups: ① Diseases originating in the brain, such as infection, tumor, trauma, epilepsy and stroke; ② Systemic diseases acting on the brain, especially metabolic and endocrine diseases, systemic infection, cardiovascular disease and collagen disease; ③ Poisoning by exogenous substances, i.e. poisoning from drugs, industry, plants or animals; ④ Withdrawal caused by abuse of addictive substances, which often occurs in alcohol and sedative-hypnotic drug dependence. Elderly patients are particularly susceptible to delirium, which seems to be related to the following factors: advanced age and concomitant organic brain diseases, visual and auditory impairment, reduced synthesis of neurotransmitters (especially acetylcholine), age-related changes in pharmacokinetics and pharmacodynamics, a high prevalence of chronic physical diseases and susceptibility to acute illnesses, weakening of the homeostatic regulatory mechanism formed by the hypothalamus-pituitary-adrenal axis, sleep or sensory deprivation, lack of flexibility in limb movements, and psychosocial stress (such as the death of a loved one or moving to a new environment). Since the elderly have reduced tolerance to drugs, drug poisoning is a common cause of delirium in the elderly, and can even occur at therapeutic doses of commonly used drugs, such as diuretics, digoxin, anti-Parkinson's disease drugs, antipsychotics, antidepressants, and sedatives and hypnotics. Any drug with anticholesterol activity can easily cause delirium in the elderly. Common causes of delirium in the elderly include congestive heart failure, pneumonia, urinary tract infection, cancer, hypokalemia, dehydration, sodium depletion, cerebral infarction, etc. Certain physical disorders that do not directly affect the brain, such as a hip fracture, minor surgery under local anesthesia, mild respiratory infections, and severe constipation, can also cause delirium.

Causes of delirium Intracranial causes Infection: meningitis, encephalitis Brain trauma: especially concussion Subarachnoid hemorrhage Epilepsy and post-epileptic status Extracranial causes Alcohol, drugs (intake or withdrawal) Alcohol and sedative-hypnotic drug dependence Antipsychotic drugs Other drugs: anticholinesterases, antiepileptic drugs, antihypertensive drugs, anti-Parkinson's disease drugs, cardiac glycosides, cimetidine, insulin, opium, salicylates, steroids Toxins: carbon monoxide, heavy metals and other industrial poisons Endocrine dysfunction (hypo or hyper) Pituitary Pancreas Adrenal gland Parathyroid gland Thyroid Non-endocrine organ diseases Liver: hepatic encephalopathy Kidneys: uremic encephalopathy Lungs: pulmonary encephalopathy, hypoxemia Cardiovascular system: heart failure, arrhythmia, hypotension Nutritional deficiency: thiamine deficiency with fever and sepsis Systemic infection Electrolyte imbalance caused by various reasons

Postoperative State The pathogenesis of delirium is poorly understood. The cognitive impairment and concurrent slow EEG activity in patients with delirium are due to a general decrease in brain oxidative metabolism. Any disease or toxic substance that can reduce the supply, intake and utilization of substances related to brain metabolic activities can cause delirium. A decrease in the brain's oxidative metabolic rate can lead to a decrease in the synthesis of acetylcholine. Choline deficiency constitutes one of the characteristic manifestations of metabolic-toxic encephalopathy, namely delirium.