Encephalopathy history and symptoms

Encephalopathy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]

Overview

The hallmark of encephalopathy is an altered mental state.

History

History is the most important part of a evaluation. It provides insight into cause, precipitating factors and associated co morbid conditions. Complete history helps in deciding the right therapy for the person and helps in determining the prognosis. Certain key issues of a history in patients of encephalopathy include that the person may be disoriented and may be tough to interview. In such cases history from the care givers or the family members is taken into consideration. Specific histories about the symptoms (duration, onset, progression), associated symptoms, drug usage have to be obtained.

• Onset, duration and progression of symptoms
• Associated symptoms(lethargy, fever, confusion)
• Medications
• Trauma
• Symptoms of other organ failure (Renal failure, Liver failure, Adrenal failure)
• Poisons or chemicals ingested
• Co-morbid conditions like diabetes, immunodeficiency
• Severe infections
• Any dehydration history for severe loss of fluids
• Exposure to toxic substances
• Trauma

Symptoms

There is a frequent overlap between complications and symptoms. It is due to the fact that encephalopathy may present in any manner. Associated symptoms gives us clue about the cause of the disease.

• Confusion or agitation
• Changes in behavior and personality
• Progressive cognitive ability
• Forgetfulness
• Disorientation
• Insomnia
• Muscle stiffness or rigidity
• Tremor (particularly a flapping tremor of the hands)
• Difficulty speaking
• Asterixis (rapid momentary loss of tone in the muscles)
• Uncontrollable movements or seizures
• Stupor or coma

Associated symptoms

• Cheyne-Stokes respirations - an altered breathing pattern seen with brain damage and coma
• Hematemesis
• Nausea and vomiting
• Severe headache
• Dyspnea
• Visual disturbances
• Palpitations, angina
• Hematuria

References

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