Alcoholic encephalopathy is a severe lesion of the central nervous system caused by alcohol abuse. By this concept is meant not one disease, but a whole complex of brain pathologies. Encephalopathy usually occurs in people with alcohol dependence of the second or third stage. The development of pathology is preceded by several years of regular drinking and the formation of physical dependence on alcohol.
Causes and pathogenesis of pathology
The cause of alcoholic brain encephalopathy is the long-term abuse of ethanol. The disease develops in alcoholics with experience. The appearance of the first signs of damage to the central nervous system is preceded by 5-15 years of systematic drunkenness. However, in some cases, the disease occurs much earlier. The following adverse factors may contribute to this:
- the use of low quality drinks;
- drunkenness with diseases of internal organs;
- poor ethanol tolerance.
These circumstances lead to the rapid formation of alcoholic brain encephalopathy. What it is? Ethanol dramatically reduces the absorption of B vitamins. These substances are responsible for the state of the nervous system. As a result, vitamin deficiency forms in the body. Brain cells become vulnerable to negative influences.
If large doses of alcohol constantly enter the body, then ethanol is converted to acetaldehyde. This substance acts on neurons as a poison, and it is it that becomes the cause of poor health in a hangover syndrome. Acetaldehyde poisons nerve cells. Therefore, the disease is completely called so: toxic alcoholic encephalopathy.
In addition, a severe metabolic disorder occurs in the body. The liver function is impaired, which is involved in the processing of B vitamins. The vessels of the brain become more fragile, which leads to organ edema and small hemorrhages.
Forms of the disease
This disease can occur in acute and chronic form. In the first case, severe and life-threatening disorders occur. Acute encephalopathy is manifested in the form of Gaillot-Wernicke syndrome. This condition requires immediate treatment. It is accompanied by mental disorders and severe deterioration of the general condition.
In the chronic form, alcoholic encephalopathy proceeds in the form of Korsakovsky psychosis or alcoholic pseudo-paralysis. These diseases often occur in patients with long-term dependence who have experienced episodes of delirious conditions in the past (delirium tremens or hallucinosis).
Disease code
According to the international classification of diseases of the ninth revision, the code for alcoholic encephalopathy is 291.1. This disease belonged to mental pathologies. Currently, the classification of diseases of the tenth revision (ICD-10) is in force.
Alcoholic encephalopathy in ICD-10 refers to code 9. The disease refers to damage to the nervous system. Such diseases in the international classification of diseases are indicated by the number 9.
Previously, alcoholic encephalopathy in the ICD-10 took place under the code 93.4. This meant "Encephalopathy of unspecified origin." This code is now excluded from the classification.
Currently, the ICD-10 code for alcohol encephalopathy refers to section G31. This section includes degenerative lesions of the nervous system. The ICD code for alcoholic encephalopathy is 10 - G31.2, which means "Alcohol-induced degeneration of the nervous system."
Prodromal period
Often before the first signs of alcoholic encephalopathy appear, the patient is in a long binge, after which severe withdrawal syndrome occurs. But it also happens that the manifestations of the disease occur with the daily systematic use of alcohol. At the same time, the patient remains able to work and active.
Before the appearance of vivid manifestations of pathology, the precursors of the disease are noted. If encephalopathy proceeds in a chronic form, then the prodromal period is delayed to 1 year. In the acute form of pathology, the initial symptoms of the disease last 2 to 3 weeks.
The prodromal period is characterized by the following manifestations:
- The patient becomes drowsy and lethargic, often feeling weak.
- Sleep worsens, the patient often wakes up in the middle of the night.
- Dyspeptic symptoms occur: nausea and diarrhea.
- There is a hostility to fatty and protein foods.
- The patient is disturbed by nightmares and unpleasant dreams - these are the first signs of mental disorders.
- The patient becomes short-tempered and irritable.
- Dramatically deteriorating memory.
- Symptoms from the autonomic nervous system: chills, tachycardia, increased sweating.
In some patients, the extension of the lips with a tube is noted when touching them. This symptom is called oral automatism, it is usually observed in young children. In adults, this is a sign of serious neurological and mental disorders.
Edema of the face, strabismus and trembling of the eyeballs may also appear. If you do not start therapy at this stage, then in the future the disease is difficult to treat.
Symptoms of acute form
Acute alcoholic encephalopathy occurs in the form of Gaye-Wernicke syndrome. This pathology is caused by a deficiency in the body of vitamin B1. This syndrome is noted with other types of such vitamin deficiency, not necessarily associated with alcoholism. But in this case, the lack of nutrients is caused precisely by alcohol abuse.
Gaye-Wernicke syndrome is an extremely dangerous condition. The clinical picture unfolds in just a few days, then the patient falls into a coma, which can lead to death.
The following symptoms are noted:
- The patient develops delirium with hallucinations.
- It is impossible to establish contact with the patient, his speech is inarticulate.
- The patient's tongue acquires a raspberry color, the liver is enlarged, and the face is swollen.
- The patient makes random erratic movements.
- Body temperature rises to +40 - +41 degrees.
- The patient has tachycardia and rapid breathing, while blood pressure drops.
- Convulsions appear.
- There is strabismus and hemorrhage in the sclera.
After about 2 weeks, a coma occurs, ending in death. Medical care for an acute form of the disease should be provided immediately. However, the outcome of the disease depends on the form of its course.
The consequences of acute encephalopathy
If the acute form of the disease proceeds favorably, then it is characterized by a delirious state with hallucinations and delusions, which can last up to 1.5 months. Fatal outcome does not occur. The consequence of the disease is the psycho-organic syndrome. The patient has a decrease in intelligence and memory, as well as volitional functions. Depression and irritability are observed. The patient forever loses working capacity, since such a violation of the brain is irreversible.
Acute encephalopathy can occur in a mitigated form. Within 1-2 months, the patient has depression, increased anxiety and a hypochondriacal state, then hallucinations and delusions occur.
The most unfavorable course is characterized by a fulminant form. The prodromal period lasts 3 weeks, followed by severe delirium with symptoms of damage to the central nervous system. This form of the disease usually lasts several days, then a fatal outcome occurs. If the patient manages to survive, then pseudo-paralysis occurs, accompanied by severe mental disorders.
Symptoms of Korsakovsky psychosis
The chronic form of encephalopathy can occur in the form of Korsakovsky psychosis. This form of the disease is more common in women.
Serious memory impairment occurs. Patients poorly remember even recent events. The assimilation of new information becomes impossible. False memories arise, patients talk about events that never happened. Patients do not navigate in space and their personality, can not answer simple questions. Patients do not move much, their vocabulary is significantly reduced. Inflammation of the nerves in the arms and legs.
The clinical picture of pseudoparalysis
This form of chronic encephalopathy is characteristic of the male sex. It is characterized by mental disorders and gross personality changes. Dramatically reduced intelligence. The patient loses all previous skills.
Self-criticism disappears in a person. Patients become rude, cynical, they experience mood swings from severe irritability to complete indifference to everything that happens. This is accompanied by trembling limbs, speech disorders. There is a feeling of numbness in the legs and arms, as well as muscle weakness, because of this the disease is called pseudo-paralysis.
Diagnostics
Diagnosis of the disease begins with a history. It is necessary to establish the fact of abuse of alcohol. To clarify the diagnosis, the following examinations are prescribed:
- electroencephalography;
- MRI and CT of the brain.
In addition, the doctor probes the liver area, with this pathology, the organ is usually enlarged. A blood test for liver enzymes is also prescribed: with encephalopathy, their level exceeds the norm.
Drug therapy
Treatment of alcoholic encephalopathy is carried out in a hospital. Prescribe a diet rich in proteins and vitamins. The following medications are used for therapy:
- vitamins PP, C and group B in injections;
- medications to improve cerebral circulation: Actovegin, Cinnarizine, Piracetam, Encephabol;
- metabolic aids: Antioxipax, Mildronate;
- anticonvulsants: Finlepsin, Relanium.
Vitamins and drugs to improve metabolism must be taken not only during illness, but also after recovery, during rehabilitation. Concomitant symptomatic treatment is also performed. If the patient has signs of liver damage, then hepatoprotectors are prescribed. With pancreatitis, enzymatic drugs are indicated, and with infectious complications, antibiotics are indicated.
If the patient is diagnosed with signs of cerebral edema, then diuretics are prescribed: Veroshpiron, Furosemide, Diacarb.
During the treatment period, it is necessary to completely abstain from alcohol. After improvement, it is recommended to undergo a course of treatment for alcoholism. Consultation with a narcologist is necessary regarding the choice of a treatment method: coding, hypnosis or the introduction of drugs based on teturam.
Disease prognosis
The prognosis of alcoholic encephalopathy depends on the form of the disease and on the timeliness of going to the doctor. The acute form of pathology is accompanied by high mortality. Even if the patient was able to survive, then he still has serious impairments of intelligence, memory and other mental shifts.
Chronic forms of the disease have a more favorable prognosis. Korsakovsky psychosis and pseudo-paralysis with timely treatment end in recovery. In humans, the level of B vitamins gradually normalizes and neurological and mental disorders disappear. However, this is possible only with the complete rejection of alcohol.
Prevention
Prevention of the disease is primarily to stop drinking alcohol. If the patient cannot stop drinking on his own, then it is necessary to seek help from a narcologist.
In addition, you need a proper diet with a sufficient amount of B vitamins. It is also important to monitor blood sugar levels and regularly measure blood pressure. This will help reduce the risk of the disease.