What is encephalopathy?

encephalopathy_clock_80female
80-year old right handed woman with sepsis and hypoxemia

WESTBOROUGH, MA October 7, 2016 The clock of the week brings up an interesting question.  What is encephalopathy? I hear that all the time from patients and more likely, family members who are confused as to the definition of encephalopathy.  I will make an effort in this blog to provide some explanation for this.  Look at the clock and see that is quite confused.  Remember prior published clocks and the fact that the directions are exactly the same for every person.  “Draw the face of a clock, put all the numbers on it and set the hands for 11:10”.  Essentially it is a three step command that requires both attention and problem solving.  In prior published blogs and You Tube videos I have made an effort to illustrate the range of clocks given by patients of various diagnostic classifications.

Encephalopathy is a common manifestation in patients with sepsis (infectious illness) such as pneumonia and urinary track infection, delayed hemodialysis, and many others. In refers to brain dysfunction often due to multifactorial issues including metabolic and infectious causes.  According to the Health Line encephalopathy may be temporary or permanent.  The patient who created the illustrated drawing was very cooperative but subject to altered mental status when getting sick, fatigued or on dialysis days.  The treatment for encephalopathy depends on the underlying reason for the AMS but largely is treating the symptom picture to manage the patient comfortably.

make-up-a-sentencescan
“I want you to make up a sentence…”

Symptoms of encephalopathy often begin rapidly and may be seen as confused behavior, decreased attention, and poor problem solving.  Neuropsychology services across the country are referred these patients in earnest in hope of tracking changes in their cognitive status and behavior.  The assessment process is lengthy.  At some point, patients are asked to make up a sentence containing a noun and a verb as part of the basic cognitive screening.  As you can see from the illustration below, this patient had difficulty with this task.  Almost any sentence will suffice but in this case the woman added the heart to represent the word ‘love’ and placed a smiley face at the bottom of her page to indicate her completion of the task.  Persons with encephalopathy often exhibit unusual limitations in their awareness of their condition and exhibit varying levels of confusion throughout the day.  Slowly these symptoms resolve – sometimes quite rapidly.  Just as rapidly, some patients are vulnerable to altered mental status at the first sign of infection.

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