Encephalopathy metabolic encephalopathies

Suggested Alternatives for Differential Diagnosis Bartonellosis, brucellosis, other causes of encephalitis, coxsackieviruses, cryptococcosis, cysticercosis, cytomegalovirus, histoplasmosis, legionellosis, leptospirosis, listeria, lyme disease, malaria, rabies, tuberculosis, mumps, stroke, metabolic encephalopathy, Reye syndrome, Bartonella infection, Naegleria infection, Ebstein-Barr virus, prion disease, toxic ingestions, and AIDS. 

Given the high dependency of cerebral energy production and neurotransmitter synthesis on glucose and oxygen, limitations in supply of these substrates results in metabolic encephalopathy. 

The metabolic encephalopathies comprise a series of neurological disorders not caused by primary structural abnormalities rather, they result from systemic illness, such as diabetes, liver disease and renal failure. Metabolic encephalopathies usually develop acutely or subacutely and are reversible if the systemic disorder is treated. If left... 

There are two major types of metabolic encephalopathy those due to lack of glucose, oxygen or metabolic cofactors (vitamins, for example) and those due to peripheral organ dysfunction. This chapter will review the neurochemistry of the major metabolic encephalopathies, which are listed in Table 34-1. 

Miller, A. L. Carbon dioxide narcosis. In D. W. McCandless (ed.) Cerebral Energy Metabolism and Metabolic Encephalopathy. New York Plenum Press, 1985, pp. 143-162. 

Hypocalcemic encephalopathy occurred in a 35-year-old woman with hypoparathyroidism. It was believed that the administration of methylprednisolone intramuscularly had precipitated severe hypocalcemia, which had led to a metabolic encephalopathy (SEDA-20, 371 132). 

Almost all patients with acute or chronic Al encephalopathy showed EEG alterations. These were characterized by multifocal bursts of slow (delta) and spike activity. Background rhythms between bursts were relatively normal in patients with chronic Al encephalopathy, in contrast to uremia and other metabolic encephalopathies where there is general slowing of the rhythmic cycle [33, 99-102, 105, 118]. 

Delirium, toxic confusional state, metabolic encephalopathy or acute confusional state are terms that are used interchangeably and often loosely to describe a syndrome of acutely disordered cognition, sometimes associated with reduced level of consciousness and abnormal attention (see Table 32.1). The syndrome is very common, especially in the elderly and in patients with dementia, and presentations vary widely both in the speed of onset and severity (Siddiqi et al. 2006). The differential diagnosis is broad and includes almost any medical condition, but the commonest causes are sepsis, adverse drug reaction and metabolic derangement (Francis et al. 1990). 

Desferrioxamine Simultaneous administration should be avoided as transient metabolic encephalopathy, characterised by loss of consciousness for 48-72 hours, has been reported. 

Hazell AS, Todd KG, and Butterworth RE (1998) Mechanisms of neuronal cell death in Wernicke s encephalopathy. Metabolic Brain Diseases 13, 97-122. 

Langlais PJ (1995) Pathogenesis of diencephalic lesions in an experimental model of Wernicke s encephalopathy. Metabolic Brain Diseases 10, 31-44. 

Butterworth RF (2006) Metabolic Encephalopathies. In Siegel GJ, Albers RW, Brady ST, Price DL (eds) Basic neurochemistry, 7th edn. Elsevier, London, pp 593-602 Butterworth RF, Besnard AM (1990) Thiamine-dependent enzyme changes in temporal cortex of patients with Alzheimer s disease. Metab Brain Dis 5(4) 179-184 Butterworth RF, GaudreauC, Vincelette J, Bouigault AM, LamotheF, Nutini AM (1991) Thiamine deficiency and Wernicke s encephalopathy in AIDS. Metab Brain Dis 6(4) 207-212 Butterworth RF, Heroux M (1989) Effect of pyrithiamine treatment and subsequent thiamine rehabilitation on regional cerebral amino acids and thiamine-dependent enzymes. J Neurochem 52(4) 1079-1084... 

Jaundice, hypoglycaemia, bleeding, encephalopathy, metabolic acidosis and convulsions are followed by cardiovascular collapse, coma and sometimes death 48-60 h after ingestion. 

Anderson E, Zink W, Xiong H, Gendelman HE (2002) HlV-l-asso-ciated dementia A metabolic encephalopathy perpetrated by virus-infected and immune-competent mononuclear phagocytes. J Acquir Immune Defic Syndr 31(Suppl 2) S43-S54. 

Vogt H. Non-convulsive status epileptics or metabolic encephalopathy due to carbamazepine induced hyponatremia Epilepsia 1999 40(Suppl 2) 254. 

Asterixis, a jerky relaxation of tonically contracted postural muscles, was observed in some patients with structural lesions of the brain or metabolic encephalopathy who were taking levodopa, but not in patients with Parkinson s disease (10). 

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