Alcohol encephalopathy of the brain: what is it, signs, principles of treatment

There are target organs in the human body that are most vulnerable to the adverse effects of ethanol. In the first place is the nervous system, ahead of the liver and pancreas for the frequency of complications.

What is it?

Alcohol has a toxic effect on nerve cells, which leads to disruption of their functioning and death of

. Before proceeding with the description of alcoholic encephalopathy, it is necessary to explain a number of syndromes that occur when alcohol-containing substances are misused.

Alcoholic disease of the brain is a pathological process in the brain, which manifests itself in a variety of psychopathological and neurological symptoms against the background of alcohol abuse.

Alcoholic brain disease is most often diagnosed as withdrawal syndrome, alcoholic psychosis, alcoholic encephalopathy and dementia, convulsive seizures. Some of these conditions are treated by an expert in narcology and / or psychiatry. In his practice, a neurologist often has to deal with encephalopathies and convulsive syndrome.

Alcohol encephalopathy is a syndrome of brain substance damage that develops as a result of oxygen starvation and impairment of blood supply to nerve cells on the background of alcohol intake.

Damage to the brain with alcohol abuse occurs as a result of the toxic effect of alcohol on nerve cells and / or as a result of the harmful effects of substances that are formed during alcoholic liver damage.

Ethanol in the body breaks down to a toxic metabolite - acetaldehyde, which freely penetrates the blood-encephalic barrier and affects all structures of the central nervous system. The defeat of the liver leads to the accumulation of toxic decay products, which also affect the nervous system. At the same time, alcoholism develops a deficiency of B vitamins, leading to a disruption of the excitation of the nerve fiber.

According to Shumsky classification, alcoholic encephalopathy occurs in the following nosological variants:

• Acute alcoholic encephalopathy Wernicke. Korsakov's psychosis.
• Mitigated encephalopathy.
• Lightning encephalopathy.
• Alcoholic pseudo-paralysis.
• Rare forms of alcoholic encephalopathy( alcoholic pellagra, alcoholic amblyopia, central myelinosis of the bridge, alcoholic cerebellar atrophy, etc.).

Signs of

An indispensable condition for the development of any alcoholic encephalopathy is chronic alcoholism in humans. As a rule, the disease develops at the end of the second and in the third stage of alcoholism. In women with a constant abuse of ethanol, encephalopathy can be diagnosed 3-4 years after the start of alcohol intake. The lifespan of patients with alcoholic encephalopathy averages from 6 to 20 years.

Prodromal period

The prodromal period is typical for acute and chronic encephalopathies, it can last from several weeks to several months. During this period, the person is diagnosed with nonspecific symptoms: malaise, decreased appetite, general weakness, decreased mood, and others. Asthenic phenomena predominate and can lead to the appearance of aversion to food, a sharp decrease in physical activity. The person is troubled by heartburn, nausea, stool disorders, blood pressure changes. Changes in the sleep are found in almost all patients. There is drowsiness in the daytime and insomnia at night, nightmarish dreams, sleep becomes intermittent and shallow.

A person complains of a heartbeat, body aches, chills, which is replaced by a feeling of heat. There is trembling in the hands, headaches, dizziness. In the prodromal period, a person continues to abuse alcohol-containing drinks, which aggravates the general condition.

Acute encephalopathies

People with long-term use of alcohol develop a vitamin B deficiency that leads to the development of encephalopathy

. According to the severity of the course and the duration of the disease, acute encephalopathies are divided into three types:

1. Acute alcoholic encephalopathy Wernicke.

The reason for the development of Wernicke's encephalopathy is the deficiency of thiamine( vitamin B1), which is formed in people with prolonged use of alcohol, starvation or disturbances in the absorption of food in the digestive tract in other diseases. The exact mechanism of damage to the structures of the central nervous system with a deficiency of vitamin B5 is not known, but it is established that primarily affects the gray matter of the brain, mamillary bodies, thalamus and cerebellum. There are degenerative processes in nerve cells( neurons), microcirculation.

The clinical picture is dominated by a triad of symptoms:

• Ophthalmoplegia is the complete absence of voluntary movements of the oculomotor muscles that are responsible for eyeball movements. In the clinic, this is manifested by the development of strabismus or the immobility of the eyes. Strabismus can be one-sided or bilateral, converging or divergent. Often, a horizontal or vertical, large-scale nystagmus is identified. Nystagmus is an oscillatory movement of eyeballs with a certain amplitude.
• Ataxia - a violation of coordination of movements, which occurs when the cerebellum and the nuclei of the vestibular nerves are affected. The gait of a person is violated. It becomes shaky, leads to falls and is accompanied by dizziness.
• Impaired consciousness. The concentration of attention decreases, the memory worsens, there is a retardation in thinking and difficulties in learning new information. In severe cases, there is confusion, stunning, which can be replaced by a coma.

Identify mental disorders, which are manifested by visual, tactile, verbal hallucinations. A person sees instead of a crack on the wall a snake or hears someone else's speech, tries to twist an imaginary tap, talks to himself. In severe cases, hallucinations cease to be combined with the environment, the person is in an imaginary space, but there remains orientation in his own personality. As the disease progresses, drowsiness and apathy occur during the day, and hallucinations are resumed at night.

In severe cases, the hypothalamus is affected, which leads to a drop in blood pressure and development of coma. Lethal outcome occurs in the absence of treatment as a result of a disturbance in the regulation of the hypothalamus vegetative reactions of the body( blood pressure, heart rate, vascular tone, etc.).

An early sign of recovery is the normalization of sleep. Acute Mitigated Alcohol Encephalopathy.

The disease begins with a prodromal period, which is characterized by the appearance of nonspecific symptoms. There is rapid fatigue, decreased appetite, general weakness, sleep disturbance. A person's mood is reduced, there is emotional depression, concern with his condition with the search for non-existent diseases in himself. From the side of the peripheral nervous system, neuritis is diagnosed - the damage to nerve fibers that innervate a certain area. Neuritis is accompanied by painful sensations, a feeling of tingling or numbness. The prodromal period lasts an average of 1-2 months and is replaced by the appearance of delirium. Delirium is a hallucination of auditory and visual, which are accompanied by delirium. The patient expresses himself, talks to imaginary subjects, does not come into contact with others. After the mitigation of mitigated encephalopathy, residual events are revealed in the form of memory disorders that are difficult to treat. Neurological disorders on the background of the development of delirium are minor.

1. Lightning encephalopathy( supra-acute form).

It is characterized by a rapid onset and a high incidence of deaths on days 2-5 from the onset of the disease. The prodromal period lasts about 2-3 weeks and is replaced by the development of psychosis, which is represented by a professional delirium( the patient believes that he is in the workplace).

The person rises body temperature to 40-41 C, it is difficult to get rid of antipyretic agents. The consciousness is broken down to the coma.

Chronic encephalopathies

In the clinical picture of Korsakov's psychosis, memory disorders predominate

1. Korsakovsky psychosis.

It is believed that the disease is based on the defeat of the nuclei of the thalamus against a background of prolonged alcoholism. It develops more often after suffering alcoholic psychoses, which were accompanied by severe hallucinations. In the clinical picture, memory disorders predominate in the form of loss of episodes from life of different duration that preceded the disease( retrograde amnesia), and the inability to memorize new information( fixative amnesia).Such patients can not remember the room number, the address of the hospital, what they ate for breakfast and other moments, but long-past events remember well. The violation of the memory of the patients does not upset and they are not worried about their condition. Another symptom of Korsakov's psychosis is false memories. They arise in response to questions that ask a sick person, and he "dumps in memory" replaces fictitious events. Patients may be disoriented in place, time and in surrounding people. There is a rapid fatigue, a lack of interest in the world around him.

1. Alcoholic pseudo-paralysis.

The disease is manifested by psychopathological and neurological symptoms.

Psychopathological symptomatology is represented by ideas of one's own greatness in the patient, lack of criticism to his behavior and behavior of surrounding people, euphoria. From the nervous system reveal trembling in the hands, in the tongue and mimic muscles. Speech becomes vague, memory is broken, there may be convulsive seizures. Alcoholic pseudo-paralysis on the background of treatment can completely stop, or, conversely, progress. It depends on the accompanying and transferred diseases in the patient.

Principles of treatment

1. The medical measures are complex and take a long time( up to several months).
2. Appoints drugs that make up the deficiency of B vitamins in high doses( thiamine, pyridoxine, etc.)
3. Replenishment of micro and macroelements deficiency( potassium, sodium, calcium, magnesium).
4. Memantine( akatinol).It is the drug of choice for correction of cognitive disorders. Improves memory and concentration. Protects nerve cells from the toxic effects of ethanol. He proved himself well in the treatment of Wernicke's encephalopathy and acute forms of Korsakov's syndrome.
5. With prevalence of psychopathological symptoms, drug therapy is performed in a hospital. Prescribed by indications tranquilizers, antidepressants, antipsychotics. Correction of cardiac activity is carried out simultaneously. Diuretics are introduced to prevent cerebral edema.

The prognosis of alcoholic encephalopathies depends on the clinical picture and the course of the disease. In recent years, treatment methods have made it possible to significantly reduce mortality from acute and chronic encephalopathies, but they are not a guarantee of restoration of work capacity.