What are the signs of encephalopathy?

From the Guidelines

Encephalopathy is characterized by a wide range of nonspecific neurological and psychiatric manifestations, including altered mental status, personality changes, and motor function abnormalities, as noted in the 2014 practice guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver 1. The clinical presentation of encephalopathy can vary from mild confusion to coma, with common signs including:

• Disorientation
• Personality changes, such as apathy, irritability, and disinhibition
• Difficulty concentrating and memory problems
• Abnormal behavior, including sleep-wake cycle disruption, hallucinations, or delusions
• Physical manifestations, such as asterixis (flapping tremor of the hands), myoclonus (sudden muscle jerks), hyperreflexia, and in severe cases, seizures or posturing These signs and symptoms can be observed in various conditions, including liver or kidney failure, infections, toxins, metabolic disorders, or hypoxia, as discussed in the context of encephalitis and encephalopathy in the Clinical Infectious Diseases journal 1. It is essential to consider the differential diagnosis of encephalopathy, including metabolic, toxic, autoimmune causes, or sepsis outside the CNS, as recommended by the Association of British Neurologists and British Paediatric Allergy, Immunology and Infection Group national guidelines 1. The priority of investigations should be determined by the patient's clinical history and presentation, and prompt recognition of encephalopathy is crucial to identify and address the underlying cause, as it represents brain dysfunction that requires urgent medical attention.

From the Research

Signs of Encephalopathy

The signs of encephalopathy can vary depending on the underlying cause, but generally, it refers to dysfunction of the level or contents of consciousness due to brain dysfunction 2. Some common signs include:

• Altered mental status, which can range from mild confusion to coma 3, 4, 5
• Changes in level of consciousness, such as lethargy or stupor 2
• Difficulty with attention and concentration 6
• Disorientation to time, place, or person 5
• Memory impairment or loss 6
• Language disturbances, such as aphasia or dysarthria 5
• Motor dysfunction, such as weakness or tremors 2

Diagnostic Approach

The diagnostic approach to encephalopathy involves a thorough history and physical examination, as well as laboratory tests and imaging studies to identify the underlying cause 3, 4, 5. The evaluation of patients with encephalopathy can be challenging due to the broad differential diagnosis and the limited history and examination due to the patient's mental status 3. A practical schema for organizing the differential diagnosis is to group etiologies by their pace of onset and evolution (eg, sudden, acute, subacute, chronic) 2.

Underlying Causes

The underlying causes of encephalopathy can be primary neurologic or systemic conditions 2. Some common causes include:

• Infections, such as meningitis or encephalitis 5
• Metabolic disorders, such as hepatic or renal failure 5
• Trauma, such as head injury or stroke 2
• Toxins, such as drugs or poisons 5
• Autoimmune disorders, such as paraneoplastic or nonparaneoplastic autoimmune encephalitis 5