Alcoholic toxic encephalopathy: symptoms and treatment

Alcoholic toxic encephalopathy is a brain injury accompanied by mental and behavioural disordersassociated with the abuse of alcohol, caused by heavy, prolonged intoxication and prolonged mineral and vitamin imbalance.

In addition to the Central nervous system, chronic alcoholism is accompanied by severe somatic disorders (damaged kidney, pancreas, liver, stomach, heart, and vessels), as well as moral and social degradation of the person.

Clinical classification of alcoholism

Neurotic phase (initial appearance) manifests itself in uncontrollable, obsessive craving for alcohol, reduce the sensitivity to the fortress of alcoholic beverages, episodic drinking.

Narcotic stage is characterized by the following features:

• withdrawal syndrome;
• the high demand for alcohol;
• prolonged binges;
• mental disorders;
• somatic disorders;
• alcoholic psychoses.

Encefalopatia stage – alcoholic toxic encephalopathy of the 1st degree is characterized by symptoms Podnimalas period (vascular disorders, severe fatigue, decrease sexual desire, the initial symptoms of memory impairment, emotional disorder). Alcoholic toxic encephalopathy 2nd degree of manifestation depends on the form of brain lesions.

Classification of brain lesions

There are acute and chronic. Acute encephalopathy is the result of severe alcohol intoxication, results in the violation of speech and coordination of movements, clouded consciousness, characterized by the following features:

• crazy form, expressed in lethargy, look "into the void", the sudden outbursts of aggression;
• form is accompanied by hallucinatory visions, illusions, vivid visual, auditory, and tactile hallucinations. Fear, panic attacks alternating with manifestations of aggression;
• degenerative forms are expressed depression, talkativeness, compulsive self-pity, anger;
• manifestations of automatism: a cyclic repetition of habitual actions, compulsively walking in familiar places.

Another stage of acute brain damage in alcoholics – delirium, the characteristics of which are:

• the lack of orientation in time and space;
• motion discoordination;
• tachycardia, sweating;
• impairment of consciousness up to coma;
• senestopatii (without reason discomfort);
• delusions;
• true hallucinations;
• partial amnesia after an attack.

The most pronounced disease in the acute form of amentia. Her symptoms are such factors as:

• disturbance of consciousness and all kinds of orientation;
• feverish, unnatural excitement;
• broken, steep, slurred speech;
• chaotic emotional disorders. Tearfulness is sharply replaced by fits of laughter, aggression is replaced by stupor and depression;
• twitchy, broken movements;
• subsequent total amnesia;
• long asthenic syndrome (exhaustion, fatigue, moodiness, intolerance to sounds and bright light).

Chronic toxic encephalopathy in alcoholics is a consequence of the severe deficiencies of minerals and vitamins, associated with prolonged intoxication. Clinical symptoms associated with irreversible, degenerative disease of the Central nervous system.

The main forms of acute alcoholic encephalopathy

There are the following forms of acute alcoholic encephalopathy:

• By Gayet-Wernicke.
• Metilirovanne acute encephalopathy.
• Super acute encephalopathy with lightning current.

Bright clinical picture of overt period alcoholic encephalopathy preceded by a period of initial manifestations (prodromally). Its duration depends on the degree of intoxication. When lightning forms it is reduced to a few weeks, it is extremely unfavorable diagnostic sign, which increases the risk of death. The main manifestation Podnimalas period is expressed asthenic syndrome with a predominance of dinamicheskih disorders.

Alcohol is accompanied by an intoxication condition, lack of attraction to alcohol, occurring after a significant excess individually of high doses, the phenomena of fatigue and morning sickness (vomiting, nausea, drowsiness, psychosis). The use of alcohol intensifies the effect of intoxication and clinical symptoms.

A withdrawal syndrome characteristic of early stages Podnimalas period. This is manifested in the uncontrolled attraction to alcohol. The appearance of the withdrawal syndrome does not depend on the dose. Develops after cessation of alcohol intake, manifested psychopathological, somatic, and neurological manifestations that take place after drinking alcohol.

Asthenic condition is manifested by aversion to food, exhaustion, up to severe anorexia, severe diarrhoeal disorders (vomiting, constant nausea), heartburn, belching with a rotten smell, disorders of the chair. Possible migrenepodobna States: unilateral,throbbing headache, intolerance of bright light, smells and sounds.

Vascular disorders are manifested by tachycardia, irregular blood pressure, sweating, tingling in limbs, feeling of "pins and needles", sleep disorders (alternating insomnia and severe sleepiness, until lethargy), pain in the heart, shortness of breath, dizziness, noise in the ears.

Often with sensory disorders by type of hyperesthesia (increase in sensitivity). In severe cases, join the manic-depressive state. The phase of depression manifested severe depression, retardation of thought processes, stiffness, apathetic, indifferent attitude toward themselves and others.

Further, sad mood can rapidly change to severe agitation, feverish activity, unnatural gaiety. Patients sing, joke, laugh, rush to perform varied work that they immediately get bored. The manic phase is quickly replaced by depression.

Second degree acute toxic encephalopathy in alcoholism occurs after the cyclic alternation of an intoxication and withdrawal syndromes. For the final step Podnimalas period is characterized by pronounced aversion to alcohol, the prevalence of a symptoms, lethargy, confusion, depression.

Alcoholic encephalopathy at gayet-Wernicke

Develops as a result of severe deficiency of vitamin B1, accompanied by the defeat of the midbrain and hypothalamus, disorders of neural connections, demyelination of gray matter, hemodynamic disorders and hemorrhage in cerebral tissue. This encephalopathy often affects men.

Manifest disease is manifested by monotonous delirium with hallucinations, then join:

• paralysis of the eyeball;
• motor disorders (impaired balance, coordination of movements);
• severe confusion;
• severe tachycardia, sweating, fever.
• stereotype, the cyclical repetition of movements;
• the impossibility of verbal contact, patients do not respond to treatment. Vague, abrupt phrases are replaced by cries, in a low whisper, laugh, cry.
• severe anxiety, fear, panic attacks;
• diarrhea.

Schizophreniform symptomatology (acute, obsessive, delusions, colorful hallucinations, severe depression) in combination with a high fever is unfavorable diagnostic sign.

The characteristic appearance of patients:

• pronounced fatigue, haggard, puffy, pale, greasy face;
• sclera jaundiced;
• crimson, twitching tongue;
• the natural topography of the papillae of the tongue smooth;
• sharply-painful, enlarged liver.
• meningeal symptoms.

Informative ocular symptoms: ptosis (drooping of the eyelid), nystagmus (rhythmic, rapid movement of the eyeball), double vision, impaired vision, fog before the eyes, flickering flies.

Metilirovanne form. The disease develops without striking clinical symptoms. Accompanied by sleepiness, lethargy, lethargy, tearfulness, hypochondriacal symptoms.

Super acute encephalopathy manifested by severe neurological symptoms, coma and a lethal outcome within 4-5 days.

Chronic alcoholic encephalopathy

Korsakoff's psychosis (alcohol paralysis)

More often develops in women. The classic triad of symptoms: retrograde amnesia (an inadequate estimate of the time patients forget events before the illness), confabulation (the replacement of true memories about, until the unreal, fantastic), disorientation in space and time.

Also characteristic symptoms, such as lethargy, apathy, confusion, drowsiness, limecrete, vestibular disorders, hypochondriacal syndrome, irritability. Join neuritis, muscular atrophy, gait disturbance. Rare euphoric mental disorders. Significant is the awareness of patients of their own condition, many patients try to hide from others severe memory impairment.

Alcoholic pseudospiralis

Mainly occurs in men. Characterized by euphoria, delusions of grandeur, hallucinatory-delusional syndrome. Severe speech disorders, memory disorders, confusion. Possible seizures, tremor (shaking) language, hand, twitching of facial muscles. Rare schizophrenic disorder.

Hepatic encephalopathy is a complex prisoneroflies disorders resulting from liver damage. People suffering from chronic alcoholism, hepatic encephalopathy develops on the background of liver cirrhosis.

Neurological symptoms and mental disorders are considered to be potentially reversible in the early stages.

Common symptoms:

• flapping tremor spasmodic flexor and extensor movements of the wrist;
• hepatic smell (sweet, rotten, pungent smell);
• severe lethargy, monotony of movements;
• slow speech, devoid of emotional colouring;
• behavior change, the patient will close, aggressive;
• progressivejaundice;
• violations of intellect, the patient can not place the numbers in the correct order to answer simple questions.

There are five degrees of Central nervous system in hepatic encephalopathy:

1. At zero degree the consciousness is not changed, a decrease in memory, impaired concentration, behavior is not changed.
2. The first degree accompanied by light disorientation in space, impaired sleep (insomnia). A decrease in the ability to think logically, account.
3. The second: increase of the degree of retardation and speech disorders, developing complete disorientation in space and time. Appears liver smell and flapping tremor.
4. The third degree is accompanied with stupor, amnesia, lack of reflex reactions.
5. The fourth stage is coma.

At the time of development produce fulminant (up to 1 week), acute (up to months) and subacute (up to three months). Characteristic changes in the biochemical analysis of blood (decrease in total protein, increased ALT, AST).

Symptoms of alcoholic encephalopathy should be differentiated from schizophrenia, manic-depressive syndrome, brain tumors, toxic encephalopathy in cases of poisoning with toxic substances. Behavior changes in programmulina period (anxiety, confusion, disorientation in space, impaired speech and coordination) are similar to hypoglycemic state in diabetes.

Further prognosis and quality of life of patients

Until recently, the vast number of patients with alcoholic encephalopathy died. Existing methods of treatment has allowed to reduce sharply the number of deaths and increase the number of complete recoveries in cases of acute forms of alcohol intoxication. However, chronic forms often end up with permanent mental disorders, severe dementia and social degradation of the individual.

Basic therapy

When encephalopathy gayet-Wernicke conducted the following procedures:

• introduced injecting high dosages of the b vitamins;
• in addition, use of ascorbic acid, Riboxin;
• correction of hypomagnesemia and other electrolyte disorders (under the control of biochemical analysis of blood);
• desensitizing therapy;
• infusion therapy for the purpose of detoxification and rheological properties of blood.

Alcohol withdrawal syndrome due to the use of symptomatic therapy:

• infusion therapy glucose-saline solutions. The duration depends on the degree of neurological impairment and levels of intoxication;
• b vitamins, ascorbic acid;
• antihistamines;
• drugs that improve cerebral blood circulation;
• diuretics;
• blockers of craving for alcohol (anticonvulsants, antipsychotics, antidepressants);
• medications;
• sedatives.

The goal of therapy in asthenic syndrome, correction of metabolic disturbances, emotional reactions and cognitive functions. Drugs used to improve metabolism and cerebral blood flow, tonic.

Sleep disorders patient are assigned:

• hypnotics and anxiolytics in minimal doses. Tranquilizers are not used;
• possible use of neuroleptics;
• antidepressants;
• physiotherapy (electrosleep, acupuncture, darsonvalization, amplipulse, magnetic therapy, etc.).

In acute alcohol intoxication the treatment involves the excretion of alcohol and its metabolites, correction of electrolyte imbalance:

• gastric lavage, saline laxative, enema;
• the use of enterosorbents (activated charcoal);
• in severe poisoning, use antidotes;
• infusion therapy;
• antihistamines;
• drugs that improve cerebral blood circulation;
• antipsychotics;
• tranquilizers;
• diuretics.

When the diagnosis of "hepatic encephalopathy" is used in infusion of concentrated solutions of glucose, fresh frozen plasma, a cleansing enema with subsequent infusion of antibiotics through the catheter, the drugs, correcting electrolyte disturbances, systemic antibiotic therapy.

The consequences of chronic alcoholism

In addition to neuropsychiatric disorders, due to damage to the nervous system and the gray matter of the brain chronic alcohol intoxication is accompanied by heavy defeats:

• pancreas (alcoholic pancreatitis with outcome in diabetes mellitus, malignant tumors of the pancreas);
• of the liver (alcoholic hepatitis, cirrhosis, acute hepatic encephalopathy, ascites, fatty liver, hepatocarcinoma):
• the development of atherosclerosis, increases the risk of heart attack and stroke;
• gastritis, ulcer of the stomach;
• damage to the kidneys.

Preventive measures

After the elimination of acute manifestations of toxic alcoholic encephalopathy help patients is to create a motivation for quitting drinking, psychological assistance and support. Further social adaptation and return to normal life. Recommended supervision at the psychiatrist's place of residence to prevent recurrence. Treatment by a physician forelimination of concomitant somatic pathology.