Inpatient Management of Encephalopathy

Abstract

Unexplained encephalopathy is a common occurrence in tertiary care centers and neurologic disorders should be considered after ruling out the infectious, toxic and metabolic etiologies. Neuroimaging combined with a thorough history and examination is often helpful in ruling out stroke and fulminant demyelinating encephalopathies. Autoimmune encephalopathy should be suspected in any patient with unexplained acute or subacute onset encephalopathy or rapidly progressing dementia. Anti-N-methyl-D-aspartate receptor (NMDA-R) encephalitis is the most studied form and Hashimoto encephalitis is the most controversial form of autoimmune encephalopathies. Obtaining a combined serum and Cerebrospinal fluid (CSF) autoantibody testing will increase the diagnostic yield of autoimmune and paraneoplastic encephalitis. When diagnosing NMDA receptor antibodies CSF is always more sensitive than serum and in contrast, voltage-gated potassium channel (VGKC) complex antibodies are more readily detectable in serum than in CSF. Neuralspecific antibody tests frequently result after several weeks and treatment should be administered without a significant delay to prevent brain damage. Autoimmune encephalitis is often treatment responsive when immunotherapy (glucocorticoids, intravenous immune globulin, plasma exchange) is used in various combinations. The absence of inflammatory markers and autoantibodies in the serum or CSF may not rule out the possibility of paraneoplastic encephalopathies.

Changes in cerebral hemodynamic parameters for patients with encephalopathies of different genesis

“…Вступ. У структурі неврологічної патології найбільш актуальними та соціально значущими залишаються енцефалопатії різного генезу внаслідок неухильного зростання захворюваності, розвитку виражених нервовопсихічних порушень, негативного впливу на якість життя, ранньої інвалідизації пацієнтів, що визначає медико-соціальну значимість їх ранньої діагностики, адекватного лікування та профілактики [1,2]. Серед енцефалопатій різного генезу вагому частку займає дисциркуляторна енцефалопатія, яка за даними Т.С.…”

Acute retroviral syndrome presenting as encephalitis and cerebellar ataxia: case report and literature review

“…El plan diagnóstico en la encefalitis aguda debe incluir pruebas en sangre para buscar signos de infección (hemograma, marcadores inflamatorios), pruebas básicas metabólicas, pruebas toxicológicas, pruebas de VIH, neuroimágenes, y, conforme corresponda, prueba de punción lumbar (11). En el caso presentado, los resultados del plan diagnóstico permitieron excluir trastornos metabólicos y tóxicos, así como meningitis (bacterial, criptocócica y tuberculosa), y encefalitis autoinmune.…”

Two PerPLEXing Cases of Hashimoto’s Encephalopathy Unresponsive to Steroid and Intravenous Immunoglobulin Therapy

“…This echoes our own patients, who underwent a similar extensive workup which was largely unrevealing. The relationship between thyroid function and symptoms of encephalopathy is also essential to elucidate, with systematic reviews of a limited number of cases suggesting that 45%-55% of patients present with a hypothyroid profile, 7% with a hyperthyroid profile, and the remaining in a euthyroid state [ 6 ].…”